Randomized trial of a comprehensive asthma education program after an emergency department visit.
BACKGROUND
Patients with asthma who visit the emergency department (ED) may benefit from education that optimizes self-management and treatment.


OBJECTIVE
To conduct a randomized trial of asthma education (AE) after an ED visit.


METHODS
Patients who present with acute asthma and history consistent with moderate to severe persistent asthma or recent ED visits were stratified by age (adult, child) and randomly assigned to intervention or usual care during the ED visit. The intervention was conducted by trained asthma educators and included a facilitated office visit with the primary care physician followed by a home visit. Intention-to-treat analysis was conducted, with time to first asthma relapse (either ED or unscheduled urgent office visit) during the 6-month follow-up period used as the primary outcome.


RESULTS
Of the 239 patients analyzed, 46% were adults, 46% were male, 30% were African American, and 56% had moderate to severe persistent asthma. Follow-up information was obtained on 191 patients (80%) at 6 months; 23.1% of the intervention group vs 31.1% of the usual care group had an urgent asthma visit (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.48-1.29). Overall, 39% of the 117 patients assigned to the intervention group did not comply with any of the post-ED activities. Subgroup analysis suggested greater benefit among children (HR, 0.62; 95% CI, 0.33-1.19) than adults (HR, 1.08; 95% CI, 0.50-2.33).


CONCLUSIONS
Delivery of a comprehensive AE program after an ED visit was ineffective in adult patients; however, it may be effective in children. Further research on alternative AE delivery strategies appears warranted to reduce the burden of asthma visits to the ED.
Brown
Michael D
MD
Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Grand Rapids, Michigan, USA.
Reeves
Mathew J
MJ
Meyerson
Karen
K
Korzeniewski
Steven J
SJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000209:etiology / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006792:House Calls; D006801:Humans; D007223:Infant; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D015397:Program Evaluation; D013689:Telephone
D018927:Anti-Asthmatic Agents