title: Children and Adults With Frequent Hospitalizations for Asthma Exacerbation, 2012-2013: A Multicenter Observational Study.
abstract: BACKGROUND
  Earlier studies reported that many patients were frequently hospitalized for asthma exacerbation. However, there have been no recent multicenter studies to characterize this patient population with high morbidity and health care utilization.
  
  
  OBJECTIVE
  To examine the proportion and characteristics of children and adults with frequent hospitalizations for asthma exacerbation.
  
  
  METHODS
  A multicenter chart review study of patients aged 2 to 54 years who were hospitalized for asthma exacerbation at 1 of 25 hospitals across 18 US states during the period 2012 to 2013 was carried out. The primary outcome was frequency of hospitalizations for asthma exacerbation in the past year (including the index hospitalization).
  
  
  RESULTS
  The cohort included 369 children (aged 2-17 years) and 555 adults (aged 18-54 years) hospitalized for asthma exacerbation. Over the 12-month period, 36% of the children and 42% of the adults had 2 or more (frequent) hospitalizations for asthma exacerbation. Among patients with frequent hospitalizations, guideline-recommended outpatient management was suboptimal. For example, among adults, 32% were not on inhaled corticosteroids at the time of index hospitalization and 75% had no evidence of a previous evaluation by an asthma specialist. At hospital discharge, among adults with frequent hospitalizations who had used no controller medications previously, 37% were not prescribed inhaled corticosteroids. Likewise, during a 3-month postdischarge period, 64% of the adults with frequent hospitalizations were not referred to an asthma specialist. Although the proportion of patients who did not receive these guideline-recommended outpatient care appeared higher in adults, these preventive measures were still underutilized in children; for example, 38% of the children with frequent hospitalizations were not referred to asthma specialist after the index hospitalization.
  
  
  CONCLUSIONS
  This multicenter study of US patients hospitalized with asthma exacerbation demonstrated a disturbingly high proportion of patients with frequent hospitalizations and ongoing evidence of suboptimal longitudinal asthma care.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. Electronic address: khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Bittner
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University Hospital, Portland, Ore.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Nonas
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Stoll
authors.affiliation: Division of Emergency Medicine, Harborview Medical Center, University of Washington, Seattle, Wash.
authors.forename: Taketo
authors.initials: T
authors.lastname: Watase
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Susan
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Novartis Pharmaceuticals, East Hanover, NJ.
authors.forename: Vivian
authors.initials: V
authors.lastname: Herrera
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult
keywords: Asthma; Asthma specialist; Hospitalization; Inhaled corticosteroids; Multicenter study