Factors associated with emergency department visits due to acute asthma

Abstract

It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001) and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

Follow-up after acute asthma episodes: What improves future outcomes?

“…Studies have documented that the following factors, which could be addressed at a follow-up appointment, are related to an increased risk of asthma ED visits or hospitalizations: inadequate asthma knowledge [26][27][28] ; not having an action plan 9,26-30 ; incorrect use of metered-dose inhalers 31 ; adverse environmental exposures, especially regarding environmental tobacco smoke 32-34 and mites 9,35-37 ; and adverse psychosocial circumstances. 35,[38][39][40] This review focuses on studies that have tested various comprehensive or nonpharmacologic interventions to improve patient self-management.…”

CHOICE: Choosing Health Options In Chronic Care Emergencies

“…[27][28][29][30] Poorer quality of life (QoL) and perceived control of illness are also associated with greater health-care utilisation and increased ED attendances for asthma and chronic obstructive pulmonary disease (COPD). [31][32][33][34][35] The reasons for these associations are unclear. Psychological factors may influence people's decisions about when to use unscheduled care, or reduce their ability to cope in health emergencies, or may just be markers of greater morbidity.…”

Intrinsic GTP hydrolysis is observed for a switch 1 variant of Cdc42 in the presence of a specific GTPase inhibitor

“…Moreover, no significant chemical shift changes were observed when effectors were added to the Switch 1 variant Ras (T35A), suggesting that no or subtle conformational change(s) accompany Ras(T35A)-effector interactions. 11,12 In addition, Ras(T35A) exhibits a 12-fold decrease in binding affinity to a GAP effector compared to wt Ras, suggesting that the mutation causes a change in how Cdc42 interacts with its effectors. 13 PBD46 is a 46-residue effector peptide derivative of p21-activated serine/threonine kinase (PAK) that inhibits Cdc42-stimulated intrinsic GTP hydrolysis.…”

“…Similar observations have also applied for wt Ras versus Ras(T35A) in the presence of its effectors. 11,12 Previous studies examining the oncogenic transformation in fibroblasts as well as neurite induction of PC12 cells suggested that p21Ras(T35A) is a nononcogenic mutant of p21Ras. 13 Further, it was shown that p21Ras(T35A) did not activate transformation in NIH 3T3 cells.…”