Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan?
OBJECTIVE
Emergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently presented to the ED for asthma exacerbation in Japan.


METHODS
A multicentre chart review study of 23 EDs across Japan.


METHODS
Adults aged 18-54 years who presented to the ED with asthma exacerbation from 2009 to 2011.


METHODS
Frequency of ED visits for asthma exacerbation in a 1-year period, including the index ED visit.


RESULTS
Of the 1002 eligible patients, 218 (22%) had frequent ED visits, accounting for 48% of total ED visits for asthma exacerbation in the 1-year period. Specifically, 12% had 2 ED visits and 10% had ≥3 visits. In these patients, guideline-recommended chronic management was suboptimal. For example, among patients with ≥3 ED visits, only 63% were treated with inhaled corticosteroids and 49% were current smokers. In a multinomial logistic regression model, markers of chronic asthma severity (history of hospitalisation for asthma and use of inhaled corticosteroids) were significantly associated with a higher frequency of ED visits (both p<0.05).


CONCLUSIONS
This multicentre study in Japan demonstrated that many patients are frequent ED users for asthma exacerbation. We also found that their asthma control management is suboptimal, most likely contributing to worse chronic severity and more frequent ED visits. Further dissemination and adoption of evidence-based guidelines are required to reduce asthma morbidity in this high-risk population.
Department of Radiology, University of Washington, Seattle, Washington, USA.
Hiroko
H
Watase
Department of Radiology, University of Washington, Seattle, Washington, USA Department of Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Yusuke
Y
Hagiwara
Department of Radiology, University of Washington, Seattle, Washington, USA Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Takuyo
T
Chiba
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Carlos A
CA
Camargo
Department of Radiology, University of Washington, Seattle, Washington, USA Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Kohei
K
Hasegawa
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D002908:Chronic Disease; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids
asthma exacerbation; emergency department; inhaled corticosteroids; multicenter study; risk factors