title: Modifiable factors associated with severe asthma exacerbations in urban patients.
abstract: BACKGROUND
  Rates of asthma morbidity, mortality, and resource use are highest among African American individuals residing in inner-city locations, yet factors associated with adverse outcomes are not well established.
  
  
  OBJECTIVE
  To identify modifiable factors associated with asthma exacerbations.
  
  
  METHODS
  A total of 104 adult patients who presented to an inner-city hospital or emergency department (ED) with an asthma exacerbation from October 1, 2009, through June 31, 2010, completed surveys of clinical status, acute events, sociodemographic characteristics, current asthma knowledge, self-efficacy, attitudes toward asthma self-management, and perceived barriers to asthma care questionnaires. Associations with asthma hospitalizations and ED visits were assessed.
  
  
  RESULTS
  The mean age of the patients was 42 years, 91% were African American, 33% were insured, 57% were taking a controller medication, and 63% had an income level below the federal poverty line. On bivariate analysis, males, years of asthma, history of smoking, self-classification of asthma severity, history of admission to intensive care unit or intubation, use of peak flow meter or asthma action plan, controller medication use, and history of oral corticosteroid bursts were positively associated, whereas self-efficacy was negatively associated with number of ED visits or hospitalizations. No association was found for asthma knowledge, perceived barriers to care, or attitudes toward asthma management. On multivariate analysis, low self-efficacy remained associated with both asthma hospitalizations and ED visits.
  
  
  CONCLUSIONS
  Short-term use of health services for asthma is negatively associated with asthma self-efficacy. Self-management programs that enhance self-efficacy, rather than those that focus on knowledge or attitudes, may be effective in reducing adverse asthma outcomes for inner-city, predominantly African American populations.
authors: Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Florida 33612, USA. neetutalreja@gmail.com
authors: Neetu
authors: N
authors: Talreja
authors: Ayman O
authors: AO
authors: Soubani
authors: Robert L
authors: RL
authors: Sherwin
authors: Alan P
authors: AP
authors: Baptist
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011203:Poverty / Q000706:statistics & numerical data; D012648:Self Care; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data