Use of asthma medication dispensing patterns to predict risk of adverse health outcomes: a study of Medicaid-insured children in managed care programs

Ann Allergy Asthma Immunol. 2004 Mar;92(3):319-28. doi: 10.1016/S1081-1206(10)61569-4.


Background: Regular use of inhaled anti-inflammatory (AI) medication improves outcomes for children with persistent asthma.

Objective: To relate 3 measures of asthma medication dispensing to physical health and hospital-based events among children with asthma who were enrolled in 1 of 5 managed care health plans.

Methods: Parents of Medicaid-insured children with asthma were interviewed at baseline and 1-year follow-up. Utilization data were collected from the health plans in which the children were enrolled. Subjects were stratified into 3 subgroups according to asthma severity: intermittent asthma; persistent asthma for which beta-agonist (BA) medication was dispensed infrequently (< or = 3 times per year); and persistent asthma for which BA medication was dispensed frequently (> or = 4 times per year).

Results: Baseline interviews were completed by 1,663 parents (63% response rate), 1,504 of whom were enrolled in their health plan for at least 11 months during the baseline year. Follow-up interviews were completed by 1,287 (86%) of the 1,504 parents. Among the subgroup of children with persistent asthma for whom BA was dispensed frequently, those who had 1 to 3 AI dispensings had a greater risk for hospital-based events than those with 6 or more AI dispensings. Baseline-year AI medication utilization patterns were not associated with follow-up-year outcomes. No clinically meaningful association was found in subgroups with less severe asthma; however, few AI medications were dispensed to these children.

Conclusions: Policymakers and clinicians who wish to use medication-based measures to evaluate quality of asthma care should consider counting the number of times AI medication is dispensed among children with more severe asthma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenergic beta-Agonists / therapeutic use
  • Anti-Asthmatic Agents / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / drug therapy*
  • Child
  • Child, Preschool
  • Drug Utilization
  • Female
  • Humans
  • Male
  • Managed Care Programs
  • Medicaid
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Risk Factors
  • United States


  • Adrenergic beta-Agonists
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents