Invited Commentary

Commentary on "Factors Associated with Emergency Department Visits in Asthma Exacerbation"

Authors: Jennifer Trevor, MD, Mark Dransfield, MD

Abstract

Although the more regular use of inhaled corticosteroids (ICS) in patients with moderate to severe asthma has led to a reduction in admission rates for exacerbations,1 rates of emergency department (ED) visits remain unacceptably and inexplicably high.2 Previous work has shown that nonwhite race, low socioeconomic status, and greater asthma severity are associated with ED visits, but these factors do not fully explain the variation in the use of emergency services.3,4 In this issue of the Southern Medical Journal, Wells et al further explore the conundrum by examining factors associated with ED visits in an underserved and low income population using retrospective data obtained from three ambulatory care centers.5 The purpose of the study was to provide data for quality improvement programs designed to reduce ED utilization among patients with asthma. The study was designed as a case–control analysis wherein cases consisted of asthmatics with one or more ED visit during a 2-year time period, and controls consisted of asthmatics with one or more outpatient clinic visits but no ED visits during the same 2 years.

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References

1. Szefler SJ. Advancing asthma care: the glass is only half full! J Allergy Clin Immunol 2011;128:485-494.
 
2. National Center for Health Statistics. Choice: Current Reviews for Academic Libraries 2011;49:544.
 
3. Eisner MD, Katz PP, Yelin EH, et al. Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity. Respir Res 2001;2:53-60.
 
4. Boudreaux ED, Emond SD, Clark S, et al. Acute asthma care among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status. Chest 2003;124:803-812.
 
5. Wells RE, Garb J, Fitzgerald J, et al. Factors associated with emergency department visits in asthma exacerbation. South Med J 2015;108:276-280.
 
6. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of asthma--summary report 2007. J Allergy Clin Immunol 2007;120(5 suppl):S94-S138.
 
7. Teichtahl H, Buckmaster N, Pertnikovs E. The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest 1997;112:591-596.
 
8. Althuis MD, Sexton M, Prybylski D. Cigarette smoking and asthma symptom severity among adult asthmatics. J Asthma 1999;36:257-264.
 
9. Chaudhuri R, Livingston E, McMahon AD, et al. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Am J Respir Crit Care Med 2003;168:1308-1311.
 
10. Oraka E, Iqbal S, Flanders WD, et al. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001Y2010. J Asthma 2013;50:488-496.
 
11. Schatz M, Rachelefsky G, Krishnan JA. Follow-up after acute asthma episodes: what improves future outcomes? J Emerg Med 2009;37(2 suppl):S42-S50.