title: Factors associated with emergency department visits in asthma exacerbation.
abstract: OBJECTIVE
  Despite quality improvement initiatives to prevent asthma-related emergency department (ED) visits, rates have not declined. We sought to determine factors associated with ED visits in an underserved population.
  
  
  METHODS
  We performed a case-control analysis of asthma patients at three ambulatory care centers serving low-income populations. Cases consisted of asthmatic patients aged 18 to 45 years with ≥1 ED visit for an asthma exacerbation between August 1, 2008 and July 31, 2010. Controls were patients with asthma aged 18 to 45 years with ≥1 outpatient visit during the same period but with no asthma-related ED visit. Data were collected by chart review and included demographics, past referral for asthma education or to a pulmonologist, recent tobacco use, influenza vaccination, and asthma medication prescriptions in the year before the index visit.
  
  
  RESULTS
  Among 244 cases and 475 controls, there were no significant differences in age, sex, or ethnicity. Cases were more likely than controls to have ever been referred for asthma education (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57-6.50) or to a pulmonologist (OR 2.31, 95% CI 1.15-4.66). In the year before the index visit, cases were more likely than controls to receive other medications in addition to inhaled corticosteroids (ICS; OR 1.74, 95% CI 1.14-2.66) but less likely to receive influenza vaccination (OR 0.49, 95% CI 0.34-0.71), a short-acting β-agonist (OR 0.43, 95% CI 0.24-0.78), or ICS alone (OR 0.53, 95% CI 0.34-0.84).
  
  
  CONCLUSIONS
  Markers of severe disease were associated with ED visits, as well as a lack of an influenza vaccination and failure to prescribe either ICS or short-acting β-agonists.
authors.affiliation: From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wells
authors.affiliation: From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio.
authors.forename: Jane
authors.initials: J
authors.lastname: Garb
authors.affiliation: From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio.
authors.forename: Janice
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio.
authors.forename: Reva
authors.initials: R
authors.lastname: Kleppel
authors.affiliation: From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D016022:Case-Control Studies; D018450:Disease Progression; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010353:Patient Education as Topic; D014505:Urban Population; D014611:Vaccination; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D007252:Influenza Vaccines