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In a Washington University School of Medicineand Barnes Jewish Hospital study, nearly 100adults hospitalized for asthma and a history offrequent health care use were randomized toreceive specialty care or general care for sixmonths. There was a 60 percent reduction inhospitalizations in the group receiving specialtycare, and readmissions for asthma werereduced by 54 percent. [25]Care coordinated through an asthma center bya multispecialty team of experts at the LaheyClinic Medical Center in Burlington, Mass.,resulted in an 89 percent decrease in hospitaladmissions among 125 patients with difficultto-controlasthma. [26]A study of adults with moderate-to-severeasthma documented a 77 percent decrease inhospitalization after patients completed acourse of outpatient treatment in a specialtyasthma care center, compared to their rates ofhospitalization in the six months prior to theprogram. [27]Emergency Room VisitsPatients who are cared for by asthmaspecialists require fewer emergency room visits.A study of 9,608 patients, ages 3 to 64 years,enrolled in a large health maintenanceorganization found that dispensing of seven ormore canisters of inhaled corticosteroidscombined with care by an asthma specialistwere both independently associated with alower risk of emergency asthma care. [20] In astudy of children with asthma, emergencydepartment use was significantly less amongthose who saw an allergist. [28] And, in arandomized study of more than 2,000 children,those who had routine access to allergist carewere only 54 percent as likely to requireemergency services compared with childrentreated by primary care providers. [24]In a study of individuals with severe asthma,the average annual number of emergency roomvisits was 3.45 for each patient enrolled in aspecialty allergy clinic, compared to 6.1 visitsfor patients who were not enrolled. [29]Another study found a 76 percent reduction inemergency visits after comprehensive treatmentin a specialty allergy center. [26]Sick Care Office VisitsDespite the availability of new therapies andmedications that can prevent asthma attacks,many patients are still showing up foremergency services to treat uncontrolledexacerbations of the disease. Each year, thereare 1.8 million emergency department visits forasthma. [2] Clinical studies document thatemergency visits are frequently the result ofpoor asthma management. [20, 28]Annually in America, about 14.7 millionphysician office and outpatient clinic visits arefor the treatment of asthma. [1]Supervision of care by an allergist can reducethe number of sick care office visits for asthmapatients. A study of patients with moderate-tosevereasthma in a Kaiser Permanente health8
Number of Visits35030025020015010045%reduction insick careoffice visitswith asthmaspecialistsNumber of Lost Days1,2001,00080060040077%reductionin time lostfrom workor schoolwith asthmaspecialtycare502000Non-SpecialistCareSpecialistCare0Non-SpecialistCareSpecialistCareASTHMA SICK CAREOFFICE VISITSSource: Westley, et al. Allergy Asthma Proc. 1997.LOST WORK/SCHOOLDAYS DUE TO ASTHMASource: Castro, et al. Am J Respir Critical Care Med. 2003.plan in Denver found sick care office visitswere reduced by 45 percent in patients whoreceived follow-up care from an allergist for atleast one year. [30]Missed Days from Work or SchoolAggressive management of asthma by anallergist also can reduce the estimated10 million work days and 13 million schooldays missed each year because of asthma. [1]One study reported that adult patientsaveraged an 80 percent reduction in missedwork days, and children had 65 percent fewerabsent days from school after receiving care ina multidisciplinary asthma center. [27] Anotherstudy randomly assigned nearly 100 adultswho had a history of frequent health care toreceive either specialty care or general care forsix months. The general care group had 1,040days of lost work or school, compared to 246days for those assigned to specialty care. Thespecialty care group had direct and indirectcost savings of $6,462 per patient. [25]Patient Satisfaction andQuality of LifePatients who receive asthma care from anallergist experience improved emotional andphysical well being, and are more satisfiedwith their physician and with the quality oftheir general medical care.9
Page 1: Asthma Managementand the Allergist:
Page 5 and 6: SummaryAsthma is among the most com
Page 7 and 8: Asthma in America• Affects 22 mil
Page 9 and 10: When To Refer toan AllergistAccordi
Page 11: control according to NIH Guidelines
Page 15 and 16: Emergency Room VisitsInpatient Care
Page 17 and 18: symptoms and when to seek help for
Page 19 and 20: Specialty Care of Asthmain Health P
Page 21 and 22: References1. Centers for Disease Co
Page 23 and 24: 40. Legorreta AP, Christian-Herman
Page 25 and 26: Finkelstein JA, Lozano P, Shulruff
Page 27 and 28: two subspecialty groups: allergists
Page 29 and 30: Specific findings: The Epidemiology
Page 32: When To Refer to an AllergistPatien

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