***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The use of administrative data bases to perform epidemiological studies in asthma has increased in recent years . The absence of clinical parameters to measure the level of asthma severity and control is a major limitation of data base studies . A study was undertaken to develop and vali date two data base indexes to measure the control and severity of asthma . Methods : Data base indexes of asthma severity and control were derived from definitions in the Canadian Asthma Consensus Guidelines based on dispensed prescriptions and on medical services recorded in two large administrative data bases from the Canadian province of Québec ( Régie de l’Assurance Maladie du Québec ( RAMQ ) and MED-ECHO ) over 12 months . The data base indexes of asthma severity and control were vali date d against the pulmonary function test results of 71 patients with asthma r and omly selected from two asthma clinics , and they were also applied to a cohort of patients with asthma followed up for 139 283 person-years selected from the RAMQ and MED-ECHO data bases between 1 January 1997 and 31 December 2004 . Results : According to the data base indexes , 49.3 % , 29.6 % and 21.1 % of patients recruited at the asthma clinics were found to have mild , moderate and severe asthma , respectively , while 53.5 % were found to have controlled asthma . The mean predicted value of the forced expiratory volume in 1 s ( FEV1 ) ranged from 89.8 % for mild asthma to 61.5 % for severe asthma ( p<0.001 ) , whereas the range from controlled to uncontrolled asthma was 89.5 % to 67.3 % ( p<0.001 ) . The ratio of the FEV1 to the forced vital capacity ( FEV1/FVC ratio ) measured in 56 patients ranged from 75.8 % for mild asthma to 61.8 % for severe asthma ( p = 0.030 ) , whereas the range from controlled to uncontrolled asthma was 75.3 % to 65.7 % ( p<0.001 ) . Conclusion : In the absence of clinical data , these data base indexes could be used in epidemiological studies to assess the severity and control of asthma BACKGROUND Isl and and mainl and Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States . OBJECTIVE We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA ( an acronym of the Spanish for " Take Control , Empower Yourself and Achieve Management of Asthma " ) in reducing asthma morbidity in poor Puerto Rican children with asthma . METHODS Low-income children with persistent asthma were selected from a national health plan insurance cl aims data base by using a computerized algorithm . After baseline , families were r and omly assigned to either the intervention or a control group . RESULTS No significant differences between control and intervention group were found for the primary outcome of symptom-free days . However , children in the CALMA intervention group had 6.5 % more symptom-free nights , were 3 times more likely to have their asthma under control , and were less likely to visit the emergency department and be hospitalized as compared to the control group . Caregivers receiving CALMA were significantly less likely to feel helpless , frustrated , or upset because of their child 's asthma and more likely to feel confident to manage their child 's asthma . CONCLUSION A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity Our objective was to vali date the Council of State and Territorial Epidemiologists ( CSTE ) definition of " probable " asthma and the Health Plan Employer Data and Information Set ( HEDIS ) definition of persistent asthma for diagnosis of pediatric asthma , and examine modifications that improve case recognition . CSTE and HEDIS criteria were applied to a cross-sectional study of 3,905 Medicaid children with physician-confirmed diagnosis of asthma/no asthma using a vali date d survey instrument based upon National Asthma Education and Prevention Program ( NAEPP ) Guidelines . Modified criteria were applied to another group of 1,458 non-Medicaid children from a managed care organization ( MCO ) . Of 1,852 Medicaid children with physician-confirmed asthma , 906 had persistent asthma . CSTE identified 61 % of children with " probable " asthma ; HEDIS identified 44 % of children with persistent asthma . Correct identification increased with greater disease severity . A modified CSTE increased sensitivity from 0.61 to 0.90 , while maintaining high specificity . Three new HEDIS algorithms increased sensitivity from 0.44 to > 0.84 , with specificity > 0.89 . When applied prospect ively to MCO children , these new algorithms demonstrated improved sensitivity . In conclusion , studies using current CSTE or HEDIS algorithms for case recognition underestimate asthma prevalence and overestimate asthma severity in children . Modified algorithms improve the identification of " probable " and persistent asthma OBJECTIVE To assess the practice -level effects of ( 1 ) a physician peer leader intervention and ( 2 ) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement . And , to compare findings with previously reported patient-level outcomes of trial enrollees . STUDY SETTING Data were included on children 5 - 17 years old with asthma in 40 primary care practice s , affiliated with managed health care plans enrolled in the Pediatric Asthma Care Patient Outcomes Research Team ( PORT ) r and omized trial . STUDY DESIGN Primary care practice s were r and omly assigned to one of two care improvement arms or to usual care . Automated cl aims data were analyzed for 12-month periods using a repeated cross-sectional design . The primary outcome was evidence of at least one controller medication dispensed among  patients  with persistent asthma . Secondary outcomes included controller dispensing among all identified asthmatics , evidence of chronic controller use , and the dispensing of oral steroids . Health service utilization outcomes included numbers of ambulatory visits and hospital-based events . PRINCIPAL FINDINGS The proportion of children with persistent asthma prescribed controllers increased in all study arms . No effect of the interventions on the proportion receiving controllers was detected ( peer leader intervention effect 0.01 , 95 percent confidence interval [ CI ] : -0.07 , 0.08 ; planned care intervention effect -0.03 , 95 percent CI : -0.09 , 0.02 ) . A statistical trend was seen toward an increased number of oral corticosteroid bursts dispensed in intervention practice s. Significant adjusted increases in ambulatory visits of 0.08 - 0.10 visits per child per year were seen in the first intervention year , but only a statistical trend in these outcomes persisted into the second year of follow-up . No differences in hospital-based events were detected . CONCLUSIONS This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions , using automated data . The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees . Analysis of automated data on nonenrollees adds information about practice -level impact of care improvement strategies . Benefits of practice -level interventions may accrue disproportionately to the subgroup of trial enrollees . The effect of such interventions may be less apparent at the level of practice s or health plans Objective . Although the Health Plan Employer Data Information Set ( HEDIS ) is a common method for evaluating the quality of asthma care , its accuracy in characterizing persistent asthma in children is unknown . The objective of this study was to compare the assessment of asthma severity ( persistent vs nonpersistent asthma ) using the HEDIS criteria versus clinical criteria using National Heart , Lung , and Blood Institute ( NHLBI ) guidelines . Methods . In a cross-sectional study , we analyzed baseline data from interviews with the  parents of 896 children who had asthma and participated in a r and omized controlled trial . Patients had an active clinical diagnosis of asthma , were between 2 and 12 years of age , and had no other pulmonary diseases . Patients had persistent asthma by parent report according to the HEDIS criteria when , within the last year , they had 1 asthma inpatient admission or emergency department visit or 4 asthma medication dispensing events , or 4 outpatient asthma visits and at least 2 asthma medication dispensing events . Patients had persistent asthma by parent report according to the NHLBI criteria when , within the last 2 months , they had nighttime asthma symptoms > 2 nights/mo or daytime asthma symptoms > 2 days/wk . We calculated the sensitivity of each HEDIS criterion , separately and then combined , using the NHLBI criteria as a gold st and ard . Results . On the basis of HEDIS criteria , 656 ( 73 % ) patients had persistent asthma , compared with 338 ( 38 % ) using NHLBI criteria . Although the HEDIS criteria for persistent asthma were fairly sensitive ( 0.89 ) , they were not very specific ( 0.70 ) . For children without daily controller medications ( n = 346 ) , the sensitivity was even lower ( 0.45 ) , but the specificity was similar ( 0.68 ) . We found that the test characteristics were fairly consistent across different age group strata ( 2–4 , 5–9 , and 10–12 years of age ) . Conclusions . HEDIS criteria used to determine the quality of asthma care should be interpreted with caution . Although the criteria for persistent disease — used to determine which children require daily controller medications — are fairly sensitive , they are not very specific and include children who may not require such medications Introduction Asthma is associated with a substantial economic burden on the German Statutory Health Insurance . Aims and objectives To determine costs and re source utilization associated with asthma and to analyze the impact of disease severity on subgroups based on age and gender . Methods A cl aims data base analysis from the statutory health insurance perspective was conducted . Patients with an ICD-10-GM code of asthma were extracted from a 10 % sample of a large German sickness fund . Five controls for each asthma patient matched by age and gender were r and omly selected from the same data base . Costs and re source utilization were calculated for each individual in the asthma and control group . Incremental asthma-related costs were calculated as the mean cost difference . Based on prescribed asthma medication , patients were classified as intermittent or persistent . In addition , age groups of ≤5 , 6–18 , and > 18 years were analyzed separately and gender differences were investigated . Results Overall , 49,668 individuals were included in the asthma group .  On average , total annual costs per patient were € 753 higher ( p = 0.000 ) compared to the control group ( € 2,168 vs. € 1,415 ) . Asthma patients had significantly higher ( p = 0.000 ) outpatient ( € 217 ) , inpatient ( € 176 ) , and pharmacy costs ( € 259 ) . Incremental asthma-related total costs were higher for patients with persistent asthma compared to patients with intermittent asthma ( € 1,091 vs. € 408 ) . Women aged > 18 years with persistent asthma had the highest difference in costs compared to their controls ( € 1,207 ; p < 0.0001 ) . Corresponding healthcare re source utilization was significantly higher in the asthma group ( p = 0.000 ) . Conclusions The treatment of asthma is associated with an increased level of healthcare re source utilization and significantly higher healthcare costs . Asthma imposes a substantial economic burden on sickness funds BACKGROUND The risk of invasive pneumococcal disease among persons with asthma is unknown . METHODS We conducted a nested case-control study to examine the association between asthma and invasive pneumococcal disease . The study population included persons 2 to 49 years of age who were enrolled in Tennessee 's Medicaid program ( TennCare ) for more than one year during the study period ( 1995 through 2002 ) and who resided in counties participating in a prospect i ve laboratory-based program of surveillance for invasive pneumococcal disease . For each subject with invasive pneumococcal disease , 10 age-matched controls without invasive pneumococcal disease were r and omly selected from the same population . TennCare files were queried to identify the presence of coexisting conditions that confer a high risk of pneumococcal disease . For the purpose of our study , asthma was defined by documentation of one or more inpatient or emergency-department diagnoses of asthma , two outpatient diagnoses , or the use of asthma-related medications . High-risk asthma was defined as asthma requiring admission to a hospital or a visit to an emergency department , the use of rescue therapy or long-term use of oral corticosteroids , or the dispensing of three or more prescriptions for beta-agonists within the year before enrollment in the study . RESULTS A total of 635 persons with invasive pneumococcal disease and 6350 controls were identified , of whom 114 ( 18.0 percent ) and 516 ( 8.1 percent ) , respectively , had asthma . Persons with asthma had an increased risk of invasive pneumococcal disease ( adjusted odds ratio , 2.4 ; 95 percent confidence interval , 1.9 to 3.1 ) as compared with controls . Among those without coexisting conditions , the annual incidence of invasive pneumococ 
    Output:
    
Conclusion There is no best practice method for the categorisation of asthma severity with cl aims data .
Rather , a combination of algorithms seems to be a pragmatic approach .