Repeat Emergency Department Visits Among Patients With Asthma and COPD

Not Applicable

Terminated

Conditions: Asthma
COPD

Interventions: Drug: beclamethasone dipropionate
Drug: albuterol
Drug: Prednisone

Registration Number: NCT02499887

Lead Sponsor: State University of New York at Buffalo

Brief Summary: The purpose of the proposed study is to determine whether the addition of inhaled corticosteroids to treatment with oral corticosteroids and albuterol would reduce repeat emergency department (ED) visits among patients treated for acute exacerbations of asthma and COPD discharged from the emergency department to home. The investigators hypothesize that patients treated with inhaled corticosteroids in addition to oral corticosteroids and albuterol will have lower rates of 30-day return visits to the emergency department than those patients treated with oral corticosteroids and albuterol only.

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 6

Inclusion Criteria

Treated in the ED at the Erie County Medical Center (ECMC) for acute symptoms of asthma or COPD during the study period
Patient age ≥ 18 years
Resident of the City of Buffalo or Erie County
Discharged to home
Patient expresses willingness to return to ECMC or own primary care provider for follow-up visits
Able to provide informed consent
Able to comprehend English language

Exclusion Criteria

Received oral or inhaled corticosteroids in the week before ED presentation
Presented to the ED primarily for prescription refills
Complicated comorbid conditions (e.g. renal disease, cardiovascular disease, CHF, HIV)
Admitted to ECMC or discharged to another facility
Previously enrolled during a prior visit to the ED during the study period
For female patients--pregnant or pregnancy status indeterminate
Antibiotics are prescribed to treat current asthma/COPD exacerbation.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment	beclamethasone dipropionate	Treatment: 30 day QVAR® (beclamethasone dipropionate) inhaler (80 mcg, 1 puff twice daily) plus 30 day albuterol inhaler plus non-tapering course of oral prednisone (50 mg/d) for 5 days Spacers will be dispensed with all multiple dose inhalers (MDI) to promote proper use and administration of inhaled medications.
Standard of Care	albuterol	Standard of Care: 30 day albuterol inhaler plus non-tapering course of oral prednisone (50 mg/d) for 4 days (1st dose will have been given in the ED) Spacers will be dispensed with all multiple dose inhalers (MDI) to promote proper use and administration of inhaled medications.
Standard of Care	Prednisone	Standard of Care: 30 day albuterol inhaler plus non-tapering course of oral prednisone (50 mg/d) for 4 days (1st dose will have been given in the ED) Spacers will be dispensed with all multiple dose inhalers (MDI) to promote proper use and administration of inhaled medications.
Treatment	Prednisone	Treatment: 30 day QVAR® (beclamethasone dipropionate) inhaler (80 mcg, 1 puff twice daily) plus 30 day albuterol inhaler plus non-tapering course of oral prednisone (50 mg/d) for 5 days Spacers will be dispensed with all multiple dose inhalers (MDI) to promote proper use and administration of inhaled medications.
Treatment	albuterol	Treatment: 30 day QVAR® (beclamethasone dipropionate) inhaler (80 mcg, 1 puff twice daily) plus 30 day albuterol inhaler plus non-tapering course of oral prednisone (50 mg/d) for 5 days Spacers will be dispensed with all multiple dose inhalers (MDI) to promote proper use and administration of inhaled medications.

Primary Outcome Measures

Name	Time	Method
Percentage of Subjects With a Return Visit to the ED Within 30 Days of ED Discharge	30 days	Subjects' medical records will be reviewed for the 30 day period following ED discharge to determine if they return to the treating ED or another regional ED for treatment of an acute asthma/COPD exacerbation. Regional ED records will be queried by use of data maintained by HEALTHeLINK, our regional health information organization system. This will allow for more complete capture of ED return visits that could be obtained by looking only at a single ED.

Secondary Outcome Measures