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. 1989 Aug;44(8):620–626. doi: 10.1136/thx.44.8.620

Recurrent accident and emergency department attendance for acute asthma in children.

S M O'Halloran 1, D P Heaf 1
PMCID: PMC461987  PMID: 2799741

Abstract

Asthmatic children aged over 5 years making repeated visits to the accident and emergency department of a children's hospital were compared prospectively, on the basis of a clinical questionnaire and pulmonary function tests, with a control group of outpatients with asthma to find the reasons for their repeated attendance. Recurrent attenders (n = 145) had more severe asthma than control subjects (n = 118), with greater airway obstruction at rest (FEV1 79% v 85% predicted) and bronchial lability (47% v 38%). Significantly more of the "emergency" group used pressurised aerosols and fewer dry powder inhalers to administer bronchodilators. There were no differences in prophylactic treatment. Seventy one per cent of parents in the emergency group had feared that their child would die during an attack, compared with 56% of control subjects. Eighty one per cent of children were self referred to the accident and emergency department. Most parents had found hospital to be the quickest means of obtaining treatment in an emergency. There were no differences between the two groups in parents' knowledge about asthma, home conditions, or social disadvantage. Although children who repeatedly attend hospital accident and emergency departments for treatment of acute attacks have more severe asthma than controls and show some deficiencies in treatment, the major determinant of attendance appeared to be the parents' conviction that appropriate treatment could not be obtained elsewhere.

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Selected References

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

  1. Anderson H. R., Bailey P. A., Cooper J. S., Palmer J. C. Influence of morbidity, illness label, and social, family, and health service factors on drug treatment of childhood asthma. Lancet. 1981 Nov 7;2(8254):1030–1032. doi: 10.1016/s0140-6736(81)91225-3. [DOI] [PubMed] [Google Scholar]
  2. Anderson H. R., Bailey P. A., Cooper J. S., Palmer J. C., West S. Morbidity and school absence caused by asthma and wheezing illness. Arch Dis Child. 1983 Oct;58(10):777–784. doi: 10.1136/adc.58.10.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anderson H. R., Bailey P., West S. Trends in the hospital care of acute childhood asthma 1970-8: a regional study. Br Med J. 1980 Nov 1;281(6249):1191–1194. doi: 10.1136/bmj.281.6249.1191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Anderson H. R. Increase in hospitalisation for childhood asthma. Arch Dis Child. 1978 Apr;53(4):295–300. doi: 10.1136/adc.53.4.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burney P. G. Asthma mortality in England and Wales: evidence for a further increase, 1974-84. Lancet. 1986 Aug 9;2(8502):323–326. doi: 10.1016/s0140-6736(86)90012-7. [DOI] [PubMed] [Google Scholar]
  6. Carswell F. Thirty deaths from asthma. Arch Dis Child. 1985 Jan;60(1):25–28. doi: 10.1136/adc.60.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chambers S., Dunbar J., Taylor B. Inhaled powder compared with aerosol administration of fenoterol in asthmatic children. Arch Dis Child. 1980 Jan;55(1):73–74. doi: 10.1136/adc.55.1.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Conway S. P., Littlewood J. M. Admission to hospital with asthma. Arch Dis Child. 1985 Jul;60(7):636–639. doi: 10.1136/adc.60.7.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Crompton G. K., Grant I. W. Edinburgh emergency asthma admission service. Br Med J. 1975 Dec 20;4(5998):680–682. doi: 10.1136/bmj.4.5998.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Evans D., Levison M. J., Feldman C. H., Clark N. M., Wasilewski Y., Levin B., Mellins R. B. The impact of passive smoking on emergency room visits of urban children with asthma. Am Rev Respir Dis. 1987 Mar;135(3):567–572. doi: 10.1164/arrd.1987.135.3.567. [DOI] [PubMed] [Google Scholar]
  11. Hill D. J., Landau L. I., McNicol K. N., Phelan P. D. Asthma--the physiological and clinical spectrum in childhood. Respiratory function studies in its assessment. Arch Dis Child. 1972 Dec;47(256):874–881. doi: 10.1136/adc.47.256.874. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Jones R. S. Assessment of respiratory function in the asthmatic child. Br Med J. 1966 Oct 22;2(5520):972–975. doi: 10.1136/bmj.2.5520.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lee D. A., Winslow N. R., Speight A. N., Hey E. N. Prevalence and spectrum of asthma in childhood. Br Med J (Clin Res Ed) 1983 Apr 16;286(6373):1256–1258. doi: 10.1136/bmj.286.6373.1256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Med M. Prenatal development of lumbar intervertebral articulation. Folia Morphol (Praha) 1982;30(3):285–290. [PubMed] [Google Scholar]
  15. Mitchell E. A. International trends in hospital admission rates for asthma. Arch Dis Child. 1985 Apr;60(4):376–378. doi: 10.1136/adc.60.4.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. 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]
  17. Reddihough D. S., Landau L., Jones H. J., Rickards W. S. Family anxieties in childhood asthma. Aust Paediatr J. 1977 Dec;13(4):295–298. doi: 10.1111/j.1440-1754.1977.tb01166.x. [DOI] [PubMed] [Google Scholar]
  18. Reed S., Diggle S., Cushley M. J., Sleet R. A., Tattersfield A. E. Assessment and management of asthma in an accident and emergency department. Thorax. 1985 Dec;40(12):897–902. doi: 10.1136/thx.40.12.897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Sears M. R., Rea H. H., Fenwick J., Beaglehole R., Gillies A. J., Holst P. E., O'Donnell T. V., Rothwell R. P., Sutherland D. C. Deaths from asthma in New Zealand. Arch Dis Child. 1986 Jan;61(1):6–10. doi: 10.1136/adc.61.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Speight A. N., Lee D. A., Hey E. N. Underdiagnosis and undertreatment of asthma in childhood. Br Med J (Clin Res Ed) 1983 Apr 16;286(6373):1253–1256. doi: 10.1136/bmj.286.6373.1253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Storr J., Barrell E., Lenney W. Asthma in primary schools. Br Med J (Clin Res Ed) 1987 Jul 25;295(6592):251–252. doi: 10.1136/bmj.295.6592.251. [DOI] [PMC free article] [PubMed] [Google Scholar]

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