Publications

BACKGROUND

There are few data on the use of alternative therapies in adult asthma and their impact on health outcomes.

OBJECTIVE

The objective of this study was to study the prevalence and morbidity of asthma self-treatment with herbs, coffee or black tea, and over-the-counter (OTC) medications containing ephedrine or epinephrine.

METHODS

We carried out a cross-sectional analysis of interview data for 601 adults with asthma recruited from a random sample of pulmonary and allergy specialists. We estimated the 12-month prevalence of reported use of herbal products, coffee or black tea, or OTC products to self-treat asthma and their association with emergency department visits and hospitalization.

RESULTS

Herbal asthma self-treatment was reported by 46 (8%; 95% confidence interval [CI] 6% to 10%); coffee or black tea self-treatment by 36 (6%; 95% CI 4% to 8%), epinephrine or ephedrine OTC use by 36 (6%; 95% CI 4% to 8%), and any of the three practices by 98 subjects (16%; 95% CI 13% to 19%). Adjusting for demographic and illness covariates, herbal use (odds ratio [OR] 2.5; 95% CI 1.1 to 5.6) and coffee or black tea use (OR 3.1; 95% CI 1.2 to 7.8) were associated with asthma hospitalization; OTC use was not (OR 0.8; 95% CI 0.3 to 2.5).

CONCLUSIONS

Even among adults with access to specialty care for asthma, self-treatment with nonprescription products was common and was associated with increased risk of reported hospitalization. This association does not appear to be accounted for by illness severity or other disease covariates. It may reflect delay in utilization of more efficacious treatments.

To study the relationship between physician subspecialty practice type and health measures in patients with adult asthma, we prospectively studied 601 adults with asthma. The subjects were recruited from a random sample of board-certified pulmonary or allergy internal medicine subspecialists practicing in northern California; 539 patients (90%) were restudied after 18 months. Structured telephone interviews were used to elicit demographics, clinical variables, and measures of asthma severity, asthma-specific quality of life, and physical function status. At baseline and follow-up, 283 subjects (53%) reported their principal asthma care provider type as a pulmonary specialist throughout and 150 (28%) as an allergy specialist throughout, 53 (10%) switched provider type during follow-up, and 53 (10%) reported that their principal asthma care physician was from neither subspecialist group. Taking into account illness severity and other demographic and clinical covariates, the group whose principal asthma care came from an allergy subspecialist was more likely than the pulmonary specialist-care group to report possessing a peak expiratory flow rate meter (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8 to 4.6) and less likely to be receiving high-dose inhaled steroids (OR, 0.3; 95% CI, 0.1 to 0.6). Taking into account demographic and clinical covariates, allergists' care was related to worse subject-reported asthma-specific quality of life (P = 0.02), but not to statistically increased risk of hospitalization, decreased physical function, or an increased number of reported health-related restricted-activity days. We observed subject-reported specialist variation in management and health outcomes among adults with asthma not accounted for by differing disease severity or other clinical and demographic variables.