Canadian Chronic Asthma History

Black and Hispanic patients were more likely to have a history of hospitalization and reported a greater number of ED visits. They were more likely to state that they used the ED as their primary source of asthma care and prescriptions. The three groups were equally likely to have recently used systemic corticosteroids and inhaled bronchodilators, but black and Hispanic patients were less likely to have used inhaled corticosteroids. Black patients and, especially, Hispanic patients were less likely to own a spacer and a peak flowmeter, while action plans were low across all three groups. Comorbid medical conditions were equally likely (blacks, 9%; Hispanics, 4%; whites, 8%; p = 0.03).

Black and Hispanic patients exhibited more severe objective airway obstruction (based on PEFR), but blacks reported slightly less severe subjective distress. Black and Hispanic patients received more inhaled bronchodi-lator doses during the first hour following triage, and black patients were most likely to have received systemic corticosteroid treatment. All race/ethnicity groups were equally likely to be discharged from the ED with a prescription for inhaled corticosteroids (566 patients; black, 39%; Hispanic, 37%; white, 48%; p = 0.15). When the sample was restricted to only those patients who were not already receiving inhaled corticosteroids, we again found no differences (black, 12%; Hispanic, 11%; white, 13%; p = 0.86). After controlling for seven factors (ie, age, sex, education, estimated household income, insurance status, PCP status, and recent use of inhaled steroids) using multiple linear regression analysis, we found that the initial PEFR no longer differed significantly by race/ethnicity (black vs white: difference, -0.03; 95% CI, -0.06 to -0.004; p = 0.05; Hispanic vs white: difference, -0.03; 95% CI, -0.07 to -0.001; p = 0.05).

At the univariate level, hospitalization did not differ by race/ethnicity. However, the logistic regression model predicting hospitalization demonstrated that, all things being equal, black and Hispanic patients were more likely to be admitted to the hospital.