Profile of children requiring emergency treatment for asthma

Background: Emergency department care for asthma is expensive and continuity of care is often inefficient. Identification of patients-at-risk for emergency treatment is required in order to intervene before visits to the emergency department. Objective: To identify the antecedent factors in patients requiring emergency department treatment for wheezing and to determine the level of care before emergency visits. Methods: A prospective survey of patients treated for wheezing in the emergency department of an academic children's hospital from January 1, 1994 to December 31, 1994. Data were compiled from a data form completed from the information obtained from the medical record, phone calls and letters. Results: During 1994, 1474 patients were treated for asthma and accounted for 1870 visits to the emergency department. Thirty-six percent of the total number of visits were made by 16% of the patients who made repeat visits. Two-thirds of the patients were 5 years or younger. Over 190 patients had been hospitalized for wheezing during the preceding 12-month period. Forty-four percent of the patients were referred to the emergency department by primary care physicians and 6.7% were referred by asthma specialists, either allergists or pulmonologists. The major predisposing factor was a family history of asthma in 70%. Beta agonists were the medications most frequently used prior to the emergency visits. Inhaled corticosteroids were used daily by 16% of the patients and oral corticosteroids were used daily by 7% of the patients. Conclusion: Thirty-six percent of the visits were due to 16% of patients who were seen repeatedly in the emergency department for wheezing and a number of patients (192) had been admitted previously for wheezing. These findings suggest that there is a subset of patients who are known to have recurrent wheezing, but lack adequate management to avoid expensive hospital services. Very few of these patients were followed by asthma specialists and there was a marked underuse of anti-inflammatory drugs. This study characterized a subset of patients-at-risk for requiring emergency treatment for wheezing. There is a need to institute aggressive interventions to improve the quality of care and prevent costly emergency department visits.