Pharmacoeconomic management of patient with severe asthma in the Emergency Department: retrospective multicentric and cost of illness study.

OBJECTIVE: The aim of the study was to develop a cost-of-illness model that would investigate the costs associated with the management of patients suffering from asthma and severe asthma in the context of acute episodes managed in the emergency room. PATIENTS AND METHODS: A total of 795 records were collected between adults and paediatric patients. The data collection form reported an identification code for each patient included, gender, age, main discharge diagnosis, medical examinations carried out in the emergency room, the hospitalizations, and, if required by the patient condition, an outpatient visit performed by a pneumologist after the acute event that led the patient to the emergency room. In addition, the data collection form included information related to the pharmacological therapy taken by the patient. RESULTS: Among adult patients who had an admission with an asthma diagnosis, the average cost for the management of an adult patient in a green code in the emergency room is €330.39. As for the yellow code and the red code, the cost rises respectively to €444.04 and €808.25. The paediatric population has a slightly higher cost. As for the green code, the average cost stands at €355.87, for the yellow code €562.34 and €1,041.96 for the red code. CONCLUSIONS: Asthma and severe asthma impose a high burden on patients and society due to its chronicity, losses of productivity, and an increase in use of healthcare resources. We carried out the present observational retrospective analysis on asthma and severe asthma patients with the aim of assessing the economic impact from the Italian NHS perspective focusing also on the prescribed pharmacological therapies in the target conditions.

[Arrhythmias in the elderly]. / Le aritmie nell'anziano.

A survey was made on a population of 6059 subjects aged more than 60 years with the aim to assess 1. the prevalence of heart arrhythmias and 2. the relationships between arrhythmias and some other ecg alterations. Arrhythmias resulted present in 29.0% of the whole population with a significantly higher prevalence among males (30.7% vs 28.1%, P less than 0.05) and among subjects over 75 years of age (33.2% vs 23.9%, P less than 0.001). Supraventricular extrasystoles (SE, 11.55%), atrial fibrillation (AF, 10.44%) and ventricular extrasystoles (VE, 8.91%) were the most frequent arrhythmias, followed by sinus bradycardia (SB, 2.04%), sinus arrhythmia (SA, 1.35%), atrial flutter (AFL, 1.09%) and junctional rhythms (JR, 0.20%). AF and AFL resulted significantly more frequent among females, whilst SE, VE and SB were more frequent among males. All the above arrhythmias, with the exception of AFL and JR resulted significantly more frequent among subjects over 75. A significantly higher prevalence of ecg signs of left ventricular hypertrophy, ischemia, previous myocardial infarction (MI) and of the so-called "minor" T-wave changes (MTC) was found among the subjects with arrhythmia as compared with those free from rhythm disturbances. Ecg signs of MI and MTC were significantly more frequent among males and MTC were more frequent among females and among subjects over 75. It is concluded that in an old person the presence of an arrhythmia should lead to a careful evaluation of the general and cardiological clinical situation in order to avoid 1. to prescribe an unnecessary and potentially dangerous antiarrhythmic treatment, and 2. to misdiagnose an underlying clinical condition liable to a decisive improvement under adequate treatment.