Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1995 May;50(5):520–524. doi: 10.1136/thx.50.5.520

Risk factors for recurrent emergency department visits for asthma.

R E Dales 1, I Schweitzer 1, P Kerr 1, L Gougeon 1, R Rivington 1, J Draper 1
PMCID: PMC1021222  PMID: 7597665

Abstract

BACKGROUND--Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstruction, and frequently require admission to hospital. Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergency department. METHODS--To investigate the reasons for multiple emergency visits, a questionnaire was given to 448 consecutive patients presenting to the two largest adult emergency departments in Ottawa, Canada between November 1989 and April 1991. Within this cohort, those who had made at least three visits in the past year were compared with controls (only one visit in the past year). RESULTS--Although inhaled corticosteroid use increased with multiple visits (indicating increased asthma severity), only 60% of those visiting at least three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent among the cases. The number of visits was associated with nocturnal asthma on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits were not related to psychological health, environmental allergens/irritants, or lack of perceived asthma severity. CONCLUSIONS--The recommendations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be addressed before highly effective medications can have an important impact on the frequency of emergency department visits.

Full text

PDF
520

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bailey W. C., Richards J. M., Jr, Manzella B. A., Windsor R. A., Brooks C. M., Soong S. J. Promoting self-management in adults with asthma: an overview of the UAB program. Health Educ Q. 1987 Fall;14(3):345–355. doi: 10.1177/109019818701400308. [DOI] [PubMed] [Google Scholar]
  2. Benatar S. R. Fatal asthma. N Engl J Med. 1986 Feb 13;314(7):423–429. doi: 10.1056/NEJM198602133140706. [DOI] [PubMed] [Google Scholar]
  3. Billings J., Zeitel L., Lukomnik J., Carey T. S., Blank A. E., Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993 Spring;12(1):162–173. doi: 10.1377/hlthaff.12.1.162. [DOI] [PubMed] [Google Scholar]
  4. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Differences in hospital asthma management. Lancet. 1988 Apr 2;1(8588):748–750. doi: 10.1016/s0140-6736(88)91549-8. [DOI] [PubMed] [Google Scholar]
  5. Dales R. E., Burnett R., Zwanenburg H. Adverse health effects among adults exposed to home dampness and molds. Am Rev Respir Dis. 1991 Mar;143(3):505–509. doi: 10.1164/ajrccm/143.3.505. [DOI] [PubMed] [Google Scholar]
  6. Dales R. E., Kerr P. E., Schweitzer I., Reesor K., Gougeon L., Dickinson G. Asthma management preceding an emergency department visit. Arch Intern Med. 1992 Oct;152(10):2041–2044. [PubMed] [Google Scholar]
  7. Dekker C., Dales R., Bartlett S., Brunekreef B., Zwanenburg H. Childhood asthma and the indoor environment. Chest. 1991 Oct;100(4):922–926. doi: 10.1378/chest.100.4.922. [DOI] [PubMed] [Google Scholar]
  8. Dodge R. R., Burrows B. The prevalence and incidence of asthma and asthma-like symptoms in a general population sample. Am Rev Respir Dis. 1980 Oct;122(4):567–575. doi: 10.1164/arrd.1980.122.4.567. [DOI] [PubMed] [Google Scholar]
  9. Garrett J. E., Mulder J., Veale A. Trends in the use of an urban accident and emergency department by asthmatics. N Z Med J. 1988 May 25;101(846):253–255. [PubMed] [Google Scholar]
  10. Garrett J. E., Mulder J., Wong-Toi H. Characteristics of asthmatics using an urban accident and emergency department. N Z Med J. 1988 Jun 8;101(847 Pt 1):359–361. [PubMed] [Google Scholar]
  11. Garrett J. E., Mulder J., Wong-Toi H. Characteristics of asthmatics using an urban accident and emergency department. N Z Med J. 1988 Jun 8;101(847 Pt 1):359–361. [PubMed] [Google Scholar]
  12. Hargreave F. E., Dolovich J., Newhouse M. T. The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol. 1990 Jun;85(6):1098–1111. doi: 10.1016/0091-6749(90)90056-a. [DOI] [PubMed] [Google Scholar]
  13. Mayo P. H., Richman J., Harris H. W. Results of a program to reduce admissions for adult asthma. Ann Intern Med. 1990 Jun 1;112(11):864–871. doi: 10.7326/0003-4819-112-11-864. [DOI] [PubMed] [Google Scholar]
  14. McWhorter W. P., Polis M. A., Kaslow R. A. Occurrence, predictors, and consequences of adult asthma in NHANESI and follow-up survey. Am Rev Respir Dis. 1989 Mar;139(3):721–724. doi: 10.1164/ajrccm/139.3.721. [DOI] [PubMed] [Google Scholar]
  15. Nowak R. M., Pensler M. I., Sarkar D. D., Anderson J. A., Kvale P. A., Ortiz A. E., Tomlanovich M. C. Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma. Ann Emerg Med. 1982 Feb;11(2):64–69. doi: 10.1016/s0196-0644(82)80298-9. [DOI] [PubMed] [Google Scholar]
  16. O'Halloran S. M., Heaf D. P. Recurrent accident and emergency department attendance for acute asthma in children. Thorax. 1989 Aug;44(8):620–626. doi: 10.1136/thx.44.8.620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rea H. H., Scragg R., Jackson R., Beaglehole R., Fenwick J., Sutherland D. C. A case-control study of deaths from asthma. Thorax. 1986 Nov;41(11):833–839. doi: 10.1136/thx.41.11.833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rebuck A. S., Chapman K. R., Abboud R., Pare P. D., Kreisman H., Wolkove N., Vickerson F. Nebulized anticholinergic and sympathomimetic treatment of asthma and chronic obstructive airways disease in the emergency room. Am J Med. 1987 Jan;82(1):59–64. doi: 10.1016/0002-9343(87)90378-0. [DOI] [PubMed] [Google Scholar]
  19. Sibbald B. Patient self care in acute asthma. Thorax. 1989 Feb;44(2):97–101. doi: 10.1136/thx.44.2.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Toelle B. G., Peat J. K., Salome C. M., Mellis C. M., Bauman A. E., Woolcock A. J. Evaluation of a community-based asthma management program in a population sample of schoolchildren. Med J Aust. 1993 Jun 7;158(11):742–746. doi: 10.5694/j.1326-5377.1993.tb121954.x. [DOI] [PubMed] [Google Scholar]
  21. Turner-Warwick M. Epidemiology of nocturnal asthma. Am J Med. 1988 Jul 29;85(1B):6–8. doi: 10.1016/0002-9343(88)90231-8. [DOI] [PubMed] [Google Scholar]
  22. Weiss K. B. Seasonal trends in US asthma hospitalizations and mortality. JAMA. 1990 May 2;263(17):2323–2328. [PubMed] [Google Scholar]
  23. Wilson S. R., Scamagas P., German D. F., Hughes G. W., Lulla S., Coss S., Chardon L., Thomas R. G., Starr-Schneidkraut N., Stancavage F. B. A controlled trial of two forms of self-management education for adults with asthma. Am J Med. 1993 Jun;94(6):564–576. doi: 10.1016/0002-9343(93)90206-5. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES