title: The asthma emergency department visit: treating a crisis in the midst of uncontrolled disease.
abstract: BACKGROUND
  Patients with asthma who require emergency department (ED) care are burdened with asthma symptoms, are at risk for hospitalization, and use expensive resources.
  
  
  OBJECTIVE
  To examine whether an ED-based surveillance system that characterized asthma symptoms and care before, during, and after an ED visit enhances our understanding of the natural history of asthma exacerbations.
  
  
  METHODS
  This cross-sectional follow-up enrolled 225 adult patients who presented to 1 of 6 Illinois EDs for asthma care. Clinical characteristics before ED presentation, care provided in the EDs, and 1-month follow-up status were assessed by self-administered questionnaire, medical record review, and telephone interview, respectively.
  
  
  RESULTS
  Persistent asthma symptoms were reported by 85.8% and 84.9% (P = .37) of patients before their ED visit and follow-up call, respectively. For patients with persistent symptoms before the ED visit and follow-up call, 54.4% and 73.8% (P = .02) reported using an inhaled corticosteroid, respectively. Inhaled corticosteroids were recommended for 49.4% of discharged patients with persistent symptoms. Relapse rates for return ED visits and return hospitalizations were 26.4% and 9.6%, respectively. Patients had low asthma-specific and general quality-of-life scores at follow-up.
  
  
  CONCLUSIONS
  Patients with asthma exacerbations most often had uncontrolled asthma before the ED visit that subsequently deteriorated, temporarily improved with ED treatment, and continued as uncontrolled asthma after the ED visit. Although improvements in care were reported 1 month after the ED visit, opportunities for additional improvement were observed.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA. richard_lenhardt@rush.edu
authors.forename: Richard O
authors.initials: RO
authors.lastname: Lenhardt
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Catrambone
authors.forename: James
authors.initials: J
authors.lastname: Walter
authors.forename: Michael F
authors.initials: MF
authors.lastname: McDermott
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires