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Management Plans and Education
Perhaps one of the most fundamental questions in asthma is the extent to which control can be achieved. In a large trial of over 3,400 patients, Bateman and coworkers showed that total control, which was defined as no day or night symptoms, no exacerbations, and a PEF of more than 80% predicted for more than 7 of 8 weeks, was achieved in 41% of patients with uncontrolled asthma after 12 months' treatment with salmeterol/fluticasone; minimal symptoms, or well controlled asthma, were achieved in 71%. Exacerbation rates were reduced to a very low level, particularly with salmeterol/fluticasone. Asthma control was achieved at a lower dose of fluticasone and more quickly with salmeterol/fluticasone than with fluticasone alone, although a substantial number of patients required escalation of therapy to high-dose corticosteroid therapy and an important minority appeared to have persistent symptoms and/or airway dysfunction.
To determine whether patients with frequent use of healthcare for asthma would benefit from a limited, multifaceted intervention from an asthma nurse, Castro and coworkers
randomized 96 adult patients (82% African American), who had been hospitalized for asthma exacerbation and were frequent users of healthcare, to nurse intervention or usual care for 6 months. Readmissions to hospital were decreased by 60% (31 readmissions in the intervention group versus 71 in the usual-care group). Visits to the emergency room did not change. Days absent from work or school were 240 in the intervention group and 1,040 in the usual care group). The intervention achieved savings of $6,462 per patient in direct and indirect health care costs. The authors conclude that a brief multifaceted intervention by an asthma nurse can achieve improved control of asthma, decreased hospital use, and cost savings.
Citations 1-2 of 2 total displayed.
Can Guideline-defined Asthma Control Be Achieved?: The Gaining Optimal Asthma ControL Study
- Eric D. Bateman, Homer A. Boushey, Jean Bousquet, William W. Busse, Tim J. H. Clark, Romain A. Pauwels, and Søren E. Pedersen for the GOAL Investigators Group
Am. J. Respir. Crit. Care Med. 170: 836 -844. First published online as doi:10.1164/rccm.200401-033OC
[Abstract]
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Asthma Intervention Program Prevents Readmissions in High Healthcare Users
- Mario Castro, Nina A. Zimmermann, Sue Crocker, Joseph Bradley, Charles Leven, and Kenneth B. Schechtman
Am. J. Respir. Crit. Care Med. 168: 1095 -1099. First published online as doi:10.1164/rccm.200208-877OC
[Abstract]
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