Acute asthma – Who are the frequent users of emergency departments?

Published Online: September 13, 2014

Acute asthma continues to cause a substantial health burden in the U.S., accounting for 440,000 hospitalizations and 1.8 million emergency department (ED) visits annually. Most ED visits for acute asthma are theoretically preventable through high-quality outpatient management. Therefore, multiple ED visits for acute asthma reflect failure of less costly and more prevention-oriented outpatient care. A previous multicenter study in the late 1990s found that 73% of ED patients with acute asthma reported at least one prior ED visit for acute asthma in the previous year (i.e., they had “frequent” ED visits). Despite the substantial societal burden of asthma-related ED visits, there have been no recent multicenter studies to characterize this unique population.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Hasegawa and colleagues investigated patients who frequently visit the ED with acute asthma and identified factors associated with frequent ED visits in this high-risk population.

The authors conducted a multicenter chart review study of 48 EDs across 23 U.S. states, as part of the Multicenter Airway Research Collaboration (MARC). They identified ED patients aged 18 to 54 years with acute asthma during 2011-2012, and examined the frequency of ED visits for acute asthma in the previous year for each patient.

In this study of 1,890 adults presenting with acute asthma to 48 EDs, the authors found that 46% had at least one prior asthma-related ED visit in the past year. They also found that only a small subset of these frequent ED users received outpatient management by asthma specialists and guideline-recommended long-term control management. For example, of patients with 6 or more ED visits, only 15% had been seen by asthma specialists and 10% had undergone allergy testing in the past year. Additionally, patients with public insurance or no insurance, and higher chronic asthma severity were more likely to have a higher frequency of ED visits.

Based on this large multicenter study of asthma patients in 48 EDs, the burden of frequent ED users was smaller than the previous multicenter data. However, the high percentage of frequent ED users continues to reflect the failure of current measures to manage these patients. These findings should encourage healthcare providers and policy makers to continue efforts to bridge the care gaps to further reduce asthma morbidity. In addition, we found that public insurance and no insurance status were significantly associated with a higher frequency of ED visits. The pathway through which these factors affect ED visits is complex. For researchers, these observations should prompt further investigation of the special needs and healthcare barriers in this large patient population.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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