title: Time to seeking emergency department care for asthma: self-management, clinical features at presentation, and hospitalization.
abstract: OBJECTIVE
  Understanding the events preceding emergency department (ED) asthma visits can guide patient education regarding managing exacerbations and seeking timely care. The objectives of this analysis were to assess time to seeking ED care, self-management of asthma exacerbations, and clinical status on presentation.
  
  
  METHODS
  A total of 296 patients was grouped according to time to seeking ED care: ≤1 day (22%), 2-5 days (44%), and >5 days (34%) and was compared for clinical and psychosocial characteristics. Asthma severity at presentation was obtained from patient report with the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) and from physicians' ratings using decision to hospitalize as an indicator of worse status. RESULTS. Mean age was 44 years, 72% were women, 10% had been in the ED in the prior week, and 28% came to the ED by ambulance. Patients who waited longer were more likely to be older, have more depressive symptoms, and have been in the ED in the prior week. They also were more likely to have taken more medications, but they were not more likely to have visited or consulted their outpatient physicians. Patients who waited longer reported worse ACQ (p < .0001) and AQLQ (p = .0002) scores and were more likely to be hospitalized for the current exacerbation (odds ratio 1.9, 95% CI 1.1, 3.2, p = .03).
  
  
  CONCLUSIONS
  Patients who waited longer to come to the ED had worse asthma on presentation, had more functional limitations, and were more likely to be hospitalized. The ability to gauge severity of exacerbations and the use of the ED in a timely manner are important but often overlooked are self-management skills that patients should be taught.
authors.affiliation: Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 10021, USA. mancusoc@hss.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Margaret G E
authors.initials: MG
authors.lastname: Peterson
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Gaeta
authors.forename: José L
authors.initials: JL
authors.lastname: Fernández
authors.forename: Robert H
authors.initials: RH
authors.lastname: Birkhahn
mesh_terms: D000328:Adult; D000367:Age Factors; D000552:Ambulances / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D003863:Depression / Q000150:complications / Q000453:epidemiology; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D044469:Racial Groups / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors