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Asthma Exacerbation In U.S. Adults: Who Are The Frequent Utilizers Of The Emergency Department?

2014; Elsevier BV; Volume: 133; Issue: 2 Linguagem: Inglês

10.1016/j.jaci.2013.12.621

1097-6825

Kohei Hasegawa, Ashley Sullivan, Stuart Turner, Susan Massaro, Carlos A. Camargo,

Respiratory and Cough-Related Research

Little is known about adults who frequently visit the emergency department (ED) for acute asthma. We aimed to characterize asthma patients according to frequency of ED visits in the past year. Multicenter chart review study of adults, age 18-54 years, presenting with acute asthma to 9 EDs across US in 2012. We classified subjects into 3 ED utilization groups based on the number of ED visits for asthma in the past year: no prior use, 1 ED visit, and 2+ ED visits. The 229 patients were classified into three groups: 111 had no ED visits in the past year (48%), 60 with 1 visit (27%), and 58 with 2+ visits (25%). Frequent ED visits were associated with several markers of chronic asthma severity (history of systemic corticosteroid use, history of intubation for asthma, hospitalization for asthma in past year), and current asthma medications (inhaled corticosteroid, leukotriene modifiers) (all P<0.001). In a multivariable model, independent predictors for 2+ ED visits were older age, history of systemic corticosteroid use, and hospitalization for asthma in past year. Patients with 2+ ED visits accounted for 84% (95%CI, 80%-88%) of all ED visits for acute asthma in the past year. In this multicenter study, patients with 2+ ED visits accounted for 25% of ED patients with acute asthma, but 84% of all ED visits in the past year. Frequent utilizers of the ED for acute asthma had several markers of worse chronic asthma severity. Integrated strategies aimed at reducing potentially-preventable asthma ED visits are warranted.