A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department?

Kohei Hasegawa, Ashley F. Sullivan, Eva Tovar Hirashima, Theodore J. Gaeta, Christopher Fee, Stuart J. Turner, Susan Massaro, Carlos A. Camargo, Kirk A. Stiffler, Stewart O. Sanford, Hannah Todorowski, Howard A. Smithline, Michael G. Gonzalez, Nathan Shapiro, Daniel J. Pallin, Mark J. Leber, Jeanne M. Basior, D. Matthew Sullivan, John T. Powell, Brigitte M. BaumannClaire Pearson, John E. Gough, Michael J. Drescher, Richard O. Gray, Richard M. Nowak, Rashid F. Kysia, Muhammad Waseem, Robert A. Silverman, Frank LoVecchio, Eva Tovar Hirashima, Patrick Shen, Rita K. Cydulka, Mark Clark, Sunday Clark, Eric J. Wasserman, Annette O. Arthur, Stephanie Nonas, Joseph S. Myslinski, Francis L. Counselman, J. Adrian Tyndall, Blanca Grand, Nancy E. Wang, Megan Healy, Bernard L. Lopez, P. Charles Inboriboon, Talmage M. Holmes, Suzanne S. Teuber, Mark I. Langdorf, Brian Snyder, Rose M. Chasm, Cameron Crandall, Dan Mosely, Ava E. Pierce, Ronald S. Benenson

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Background: Despite the substantial burden of asthma-related emergency department (ED) visits, there have been no recent multicenter efforts to characterize this high-risk population. Objective: We aimed to characterize patients with asthma according to their frequency of ED visits and to identify factors associated with frequent ED visits. Methods: A multicenter chart review study of 48 EDs across 23 US states. We identified ED patients ages 18 to 54 years with acute asthma during 2011 and 2012. Primary outcome was frequency of ED visits for acute asthma in the past year, excluding the index ED visit. Results: Of the 1890 enrolled patients, 863 patients (46%) had 1 or more (frequent) ED visits in the past year. Specifically, 28% had 1 to 2 visits, 11% had 3 to 5 visits, and 7% had 6 or more visits. Among frequent ED users, guideline-recommended management was suboptimal. For example, of patients with 6 or more ED visits, 85% lacked evidence of prior evaluation by an asthma specialist, and 43% were not treated with inhaled corticosteroids. In a multivariable model, significant predictors of frequent ED visits were public insurance, no insurance, and markers for chronic asthma severity (all P < .05). Stronger associations were found among those with a higher frequency of asthma-related ED visits (eg, 6 or more ED visits). Conclusion: This multicenter study of US adults with acute asthma demonstrated many frequent ED users and suboptimal preventive management in this high-risk population. Future reductions in asthma morbidity and associated health care utilization will require continued efforts to bridge these majorgaps in asthma care.

Original languageEnglish (US)
Pages (from-to)733-740.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume2
Issue number6
DOIs
StatePublished - 2014

Keywords

  • Acute asthma
  • Emergency department
  • Epidemiology exacerbation
  • Health care utilization
  • Racial disparity
  • Socioeconomic status

ASJC Scopus subject areas

  • Immunology and Allergy

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    Hasegawa, K., Sullivan, A. F., Tovar Hirashima, E., Gaeta, T. J., Fee, C., Turner, S. J., Massaro, S., Camargo, C. A., Stiffler, K. A., Sanford, S. O., Todorowski, H., Smithline, H. A., Gonzalez, M. G., Shapiro, N., Pallin, D. J., Leber, M. J., Basior, J. M., Sullivan, D. M., Powell, J. T., ... Benenson, R. S. (2014). A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department? Journal of Allergy and Clinical Immunology: In Practice, 2(6), 733-740.e3. https://doi.org/10.1016/j.jaip.2014.06.012