| Problem. Asthma is a disease affecting approximately 17 million individuals in the United States. Unfortunately, the disease is not well controlled which increases morbidity and mortality and impacts quality of life. Since the prevalence of asthma is rising, health care costs are also increasing with emergency department (ED) care accounting for 7 to 18% of these costs.;Purpose. The purpose of this study was to examine characteristics and management of adult asthmatics whose exacerbation was of sufficient severity to require management in the ED, including factors that predisposed to more frequent ED use.;Methodology. Subjects were a convenience sample of 257 patients who presented to the ED of a university affiliated medical center over a one-year period (1999) with a discharge diagnosis of asthma. The subjects were identified through the hospital electronic database. The independent variables investigated were related to four categories: demographics, severity of disease, psychologic comorbidity, and pharmacotherapy.;Results. The typical subject was an African-American female in her mid-thirties. Major findings were: (1) subjects appeared to lack essential knowledge needed to manage an asthma exacerbation, (2) few subjects appeared to be taking an inhaled corticosteroid or multiple asthma medications; (3) documentation was unavailable for important risk factors, (4) despite evidence of substantial differences between optimal asthma management as defined by national asthma expert panel (NAEP) guidelines, repeat ED visits were rare, with <15% subjects visiting the ED more than once in a 12-month interval.;Conclusions. Patient education needs to be provided regarding essential knowledge needed to monitor or manage an asthma exacerbation, including an action plan for medication adjustment and peak flow monitoring. Patients' use of daily medications suggests substantial differences between optimal management as defined by NAEP guidelines. Further education of primary care providers is needed regarding these recommendations, which include an algorithm for management of asthma exacerbations in the home, ED and during stable disease. Future research investigating actions taken by patients and providers prior to ED care is also needed. This research would improve understanding of specific education needed to decrease inappropriate ED utilization. |
