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Visits to Emergency Department and Urgent Care Facility by Inner-City Chicago Veterans with Asthma-COPD Overlap Who Are Treated with Montelukast for 2 Years
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A1360 - Visits to Emergency Department and Urgent Care Facility by Inner-City Chicago Veterans with Asthma-COPD Overlap Who Are Treated with Montelukast for 2 Years
Author Block: I. Rubinstein1, B. Whitten2, M. Heneghan3, J. Ng3; 1Univ of Illinois At Chicago, Chicago, IL, United States, 2Jesse Brown VA Medical Center, Chicago, IL, United States, 3Pharmacy, Jesse Brown VA Medical Center, Chicago, IL, United States.
Background: Patients with asthma-COPD overlap (ACO) are characterized by frequent visits to emergency and urgent care facilities for acute exacerbations relative to patients with asthma alone. Accordingly, ACO represents an unmet medical need for which appropriate long-term control medications should be deployed. Therefore, the purpose of this study was to determine whether inner-city Chicago veterans with ACO are treated with montelukast, an oral control medication for asthma, and, if so, whether this is associated with a decrease in their visits to emergency department and urgent care facility for acute exacerbations.
Materials and Methods: Electronic medical records and prescriptions of veterans seen at Jesse Brown VA Medical Center (JBVAMC) who were prescribed montelukast between January 2004 and September 2014 were reviewed. The diagnoses of asthma and ACO were based on the 2015 GINA/GOLD Handbook. Each veteran was followed for at least 2 years before and after initiation of montelukast. The number of visits to the emergency department and/or urgent care facility of JBVAMC for acute exacerbations and the number of acute exacerbation-related hospitalizations for 2 years before and after initiation of montelukast were recorded.
Results: A total of 32 veterans (29 males) with asthma and 22 veterans (19 males) with ACO who were adherent to montelukast therapy for 2 years were recruited. Mean age (±SD) was 56.0±12.5 and 61.0.0±12.8 years, respectively (p=NS). Veterans with ACO were predominantly African-Americans (68%) whereas those with asthma were both African-Americans (47%) and Caucasians (41%). Mean BMI (±SD) was 30.8±8.6 and 32.6±5.5 in veterans with ACO and asthma, respectively. Current smoking was reported by 5 patients with ACO (23%) and 6 patients with asthma (19%). The majority of veterans in both groups were treated with ICS and LABA. Only one veteran in each group was treated with LAMA. Among veterans with ACO, the number of visits to the emergency department and urgent care decreased significantly from 34 before to 22 after montelukast (35%; p=0.03). Among veterans with asthma, the number of visits to the emergency department and urgent care decreased significantly from 25 before to 11 after montelukast (56%; p=0.02). There was no statistically significant difference in the number of acute exacerbation-related hospitalizations between both groups after montelukast.
Conclusions: Treatment of inner-city Chicago veterans with ACO and asthma with montelukast for 2 years is associated with significant decreases in visits to the emergency department and urgent care facility of JBVAMC for acute exacerbations.
Author Block: I. Rubinstein1, B. Whitten2, M. Heneghan3, J. Ng3; 1Univ of Illinois At Chicago, Chicago, IL, United States, 2Jesse Brown VA Medical Center, Chicago, IL, United States, 3Pharmacy, Jesse Brown VA Medical Center, Chicago, IL, United States.
Background: Patients with asthma-COPD overlap (ACO) are characterized by frequent visits to emergency and urgent care facilities for acute exacerbations relative to patients with asthma alone. Accordingly, ACO represents an unmet medical need for which appropriate long-term control medications should be deployed. Therefore, the purpose of this study was to determine whether inner-city Chicago veterans with ACO are treated with montelukast, an oral control medication for asthma, and, if so, whether this is associated with a decrease in their visits to emergency department and urgent care facility for acute exacerbations.
Materials and Methods: Electronic medical records and prescriptions of veterans seen at Jesse Brown VA Medical Center (JBVAMC) who were prescribed montelukast between January 2004 and September 2014 were reviewed. The diagnoses of asthma and ACO were based on the 2015 GINA/GOLD Handbook. Each veteran was followed for at least 2 years before and after initiation of montelukast. The number of visits to the emergency department and/or urgent care facility of JBVAMC for acute exacerbations and the number of acute exacerbation-related hospitalizations for 2 years before and after initiation of montelukast were recorded.
Results: A total of 32 veterans (29 males) with asthma and 22 veterans (19 males) with ACO who were adherent to montelukast therapy for 2 years were recruited. Mean age (±SD) was 56.0±12.5 and 61.0.0±12.8 years, respectively (p=NS). Veterans with ACO were predominantly African-Americans (68%) whereas those with asthma were both African-Americans (47%) and Caucasians (41%). Mean BMI (±SD) was 30.8±8.6 and 32.6±5.5 in veterans with ACO and asthma, respectively. Current smoking was reported by 5 patients with ACO (23%) and 6 patients with asthma (19%). The majority of veterans in both groups were treated with ICS and LABA. Only one veteran in each group was treated with LAMA. Among veterans with ACO, the number of visits to the emergency department and urgent care decreased significantly from 34 before to 22 after montelukast (35%; p=0.03). Among veterans with asthma, the number of visits to the emergency department and urgent care decreased significantly from 25 before to 11 after montelukast (56%; p=0.02). There was no statistically significant difference in the number of acute exacerbation-related hospitalizations between both groups after montelukast.
Conclusions: Treatment of inner-city Chicago veterans with ACO and asthma with montelukast for 2 years is associated with significant decreases in visits to the emergency department and urgent care facility of JBVAMC for acute exacerbations.
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