Characteristics of acute asthma patients attended frequently compared with those attended only occasionally in an emergency department.
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.
Faculty of Medicine, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Andréia Kist
AK
Fernandes
Felipe
F
Mallmann
Ana Maria Pasquali
AM
Steinhorst
Fernando Lopes
FL
Nogueira
Eduardo Müller
EM
Avila
Dumitriu Zunino
DZ
Saucedo
Francisco Juchem
FJ
Machado
Marcelo Gregório
MG
Raymundi
Sérgio Saldanha Menna
SS
Barreto
Paulo de Tarso Roth
Pde T
Dalcin
D000208:Acute Disease; D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy*; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents