Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Abstract

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age > or = 12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by > or = 3 visits to the ED in the preceding year, and the occasional visitors (OV) by < or = 2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 +/- 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A dollar 3000 and 66.3% had < or = 8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled beta-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.

Regular Primary Care Lowers Hospitalisation Risk and Mortality in Seniors with Chronic Respiratory Diseases

“…In spite of this, CRDs have been found to be under-treated in the elderly [31][32][33][34] , which has been associated with elevated risks of all-cause mortality and hospitalisation [35][36][37][38] . Moreover, poor patient knowledge about asthma 39,40 and the absence of an asthma management plan 41,42 have been found to increase hospital emergency department visits for asthma. In light of these previous findings, the results of our study underline the importance of at least a minimum level of regular 'maintenance' primary medical care, as distinct from sporadic and 'reactive' medical care, in older patients with CRDs to manage their disease adequately and reduce the likelihood of hospitalisation and death.…”

A Prospective Multicenter Study of Written Action Plans among Emergency Department Patients with Acute Asthma

“…Many ED patients with asthma, particularly indigent and minority urban residents, do not have adequate primary care or exposure to asthma education (4–6). These high-risk patients often do not seek care until acute symptoms occur, so the ED may be the only place to begin preventive treatment and AP education (7–10).…”

Long-term smoking increases the need for acute care among asthma patients: a case control study

“…Diabetes, psychiatric disorders, and alcohol abuse, even though common risk factors of poorer control of asthma and acute care, were not increased in the ER-group (Table 1). Many co-morbidities such as anxiety and depression also have an impact on HRQoL and poor HRQoL on the other hand is a risk factor for ER visits [22,32,33]. Poor HRQoL also associates with known asthma triggers such as respiratory infections, environmental irritants, emotions, allergens, weather, and exercise.…”