title: An analysis of characteristics of patients with exacerbation of asthma in a large university hospital in Japan.
abstract: BACKGROUND
  Considerable progress has been made in the management of asthma with the increasing use of inhaled corticosteroids. However, asthma exacerbation remains a problem. To analyze the characteristics of patients with exacerbation of asthma who visited our hospital in order to better understand the risk factors for fatal asthma.
  
  
  OBJECTIVE
  We studied 100 patients who presented at Dokkyo Medical University Hospital (DMUH) with asthma exacerbation.
  
  
  METHODS
  Entry sheets were completed by physicians and questionnaires by patients.
  
  
  RESULTS
  Before the exacerbation, the severity was assessed as Step 1 in 46% of patients, Step 2 in 15%, Step 3 in 11%, and Step 4 in 18%. With regard to primary care physicians, 45% were treated at DMUH and 36% had no primary care physicians. Among the DMUH group, the largest proportion was aged 60-69 years and was in Step 4 category. According to asthma control test (ACT) scores, disease was poorly controlled in 83%. Patients with no primary care physician were most often aged 20-39 years (p < 0.01), and severity was assessed as Step 1 in 86% (p < 0.01). However, 44% were poorly controlled according to ACT (p < 0.05).
  
  
  CONCLUSIONS
  Patients could be classified into two groups: older patients with severe intractable asthma, treated by a specialist and younger patients considered to have mild asthma, half of whom had poorly controlled asthma and no primary care physician. Systems are needed that allow the emergency physicians to evaluate the need for regular treatment in patients with exacerbation because such patients often visit the hospital at night or on a non-working day.
authors.affiliation: Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, 880 Kita-Kobayashi, Mibu, Tochigi 321-0293, Japan. sugiyama@dokkyomed.ac.jp
authors.forename: Kumiya
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Issei
authors.initials: I
authors.lastname: Yamada
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohara
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Tatewaki
authors.forename: Yumeko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Ryo
authors.initials: R
authors.lastname: Arai
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Kamiya
authors.forename: Fumiya
authors.initials: F
authors.lastname: Fukushima
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Hirata
authors.forename: Masafumi
authors.initials: M
authors.lastname: Arima
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000046:Academic Medical Centers; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D018450:Disease Progression; D004630:Emergencies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones