Asthma exacerbations in North American adults: Who are the "frequent fliers" in the emergency department?

Sharon K. Griswold, Carla R. Nordstrom, Sunday Clark, Theodore J. Gaeta, Michelle L. Price, Carlos A. Camargo

Research output: Contribution to journalArticlepeer-review

104 Scopus citations

Abstract

Objective: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. Design: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. Results: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. Conclusions: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.

Original languageEnglish (US)
Pages (from-to)1579-1586
Number of pages8
JournalCHEST
Volume127
Issue number5
DOIs
StatePublished - May 2005

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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