title: Factors associated with patient visits to the emergency department for asthma therapy.
abstract: BACKGROUND
  Acute asthma attacks remain a frequent cause of emergency department (ED) visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED.
  
  
  METHODS
  A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients' reasons for visiting the ED.
  
  
  RESULTS
  Four hundred fifty (N=450) patients were recruited, 39.1% of whom were males with a mean age of 42.3 ± 16.7. The mean duration of asthma was 155.90 ± 127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7%) of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7%) and to obtain oxygen (75.1%). Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year), p-value=0.0145 and p-value=0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0.0401) and education about asthma (p-value =0.0117).
  
  
  CONCLUSIONS
  This study demonstrates that many avoidable risk factors lead to uncontrolled asthma and frequent ED visits.
authors.affiliation: Department of Medicine, Pulmonary Division-ICU, King Saud University for Health Sciences, Riyadh, Saudi Arabia. Jahdalih@gmail.com
authors.forename: Hamdan
authors.initials: H
authors.lastname: Al-Jahdali
authors.forename: Ahmed
authors.initials: A
authors.lastname: Anwar
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Harbi
authors.forename: Salim
authors.initials: S
authors.lastname: Baharoon
authors.forename: Rabih
authors.initials: R
authors.lastname: Halwani
authors.forename: Abdulllah
authors.initials: A
authors.lastname: Al Shimemeri
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Muhsen
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010349:Patient Compliance; D010353:Patient Education as Topic; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents