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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Stempel DA et al; "Patterns of Asthma Control: A 3-Year Analysis of Patient Claims." Journal of Allergy and Clinical Immunology; V.115; No.5; 5/05; p935
      STUDY DESIGN: This analysis characterized changes in asthma control over a 36-month period for managed care enrollees from a number of plans distributed across the U.S. Control was assessed on a resource utilization definition of asthma exacerbations, including asthma-related emergency department visits, asthma-related hospitalizations, oral corticosteroid use, or increased dispensing of short-acting beta-2-agonists. Asthma-related utilization was analyzed over 36 months to determine the pattern of asthma control over time. All data are collected from claims submitted by providers (i.e., physicians, pharmacies, and hospitals) to payers (i.e., managed care organizations) to receive payment for services rendered. The study population was identified from the database for the period 1996 through 2002. Subjects aged 5 to 55 years with asthma were identified by using ICD-9-CM codes 493.0 through 493.9. In all, 63,324 patients were identified who had a diagnosis of asthma and met the 36-month enrollment-utilization criteria.
      UNCONTROLLED ASTHMA: During any quarter of the study, as many as 25% of study patients were considered to have uncontrolled asthma, with about 42% meeting the operational definition in any given 12-month period. Among patients with controlled asthma in year 1, 53% experienced a period of uncontrolled asthma in one or more of the subsequent 8 quarters. Although the risk of loss of control in years 2 and 3 was nearly 4-fold lower for the subjects with initially controlled asthma than the risk for the uncontrolled cohort members, the index event for loss of control in the former group was more likely a claim for an emergency department visit-hospitalization or for an oral corticosteroid dispensing. The uncontrolled cohort experienced an even higher risk of further episodes of uncontrolled asthma, with about 34% to 46% meeting criteria for uncontrolled asthma in each quarter of years 2 and 3. By the end of the 3 years of observation, a minority of the population (27%) was consistently identified as having controlled asthma. The definition of control selected for the purposes of the present research uses a moderately low threshold.
      DISCUSSION: About 50% of patients initially identified as having controlled asthma had uncontrolled asthma at some time over the subsequent 2 years, with a noteworthy proportion of these patients having an asthma-related emergency department visit, having a hospitalization, or requiring the use of oral corticosteroids. These results highlight the inability of most asthmatic subjects to continually maintain asthma control and the unpredictability of exacerbations, even in previously controlled patients. These data demonstrate the need for constant surveillance of control and the need to maximize adequate and consistent use of controller therapy to maintain control.

Search Criteria: Text - Journal of Allergy and Clinical Immunology; V.115; No.5; 5/05; p935