Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan?

Objectives Emergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently p...

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Bibliographic Details
Published in:BMJ open 2015-04, Vol.5 (4), p.e007435-e007435
Main Authors: Watase, Hiroko, Hagiwara, Yusuke, Chiba, Takuyo, Camargo, Carlos A, Hasegawa, Kohei
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Adult
Asthma
Asthma - drug therapy
Chronic Disease
Disease Management
Emergency medical care
Emergency Medicine
Emergency Service, Hospital - statistics & numerical data
Emergency services
Female
Glucocorticoids - therapeutic use
Hospitalization - statistics & numerical data
Hospitals
Humans
Japan
Logistic Models
Male
Medicine
Middle Aged
Mortality
Population
Studies
Young Adult
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Summary:Objectives Emergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently presented to the ED for asthma exacerbation in Japan. Design A multicentre chart review study of 23 EDs across Japan. Participants Adults aged 18–54 years who presented to the ED with asthma exacerbation from 2009 to 2011. Outcome measures Frequency of ED visits for asthma exacerbation in a 1-year period, including the index ED visit. Results Of the 1002 eligible patients, 218 (22%) had frequent ED visits, accounting for 48% of total ED visits for asthma exacerbation in the 1-year period. Specifically, 12% had 2 ED visits and 10% had ≥3 visits. In these patients, guideline-recommended chronic management was suboptimal. For example, among patients with ≥3 ED visits, only 63% were treated with inhaled corticosteroids and 49% were current smokers. In a multinomial logistic regression model, markers of chronic asthma severity (history of hospitalisation for asthma and use of inhaled corticosteroids) were significantly associated with a higher frequency of ED visits (both p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2014-007435