Medicina pulmonar y respiratoria

Factors Associated with an Emergency Department or Urgent Care Visit for Asthma, United States in 2010

Abstract

Joseph D. Espiritu*, Ahmad Allemyar, Mohammed Helwani, Michael Elliott and Pamela Xaverius

Background and Objective: To identify the factors associated with asthma-related emergency department (ED)/ urgent care visits and to explore the relationship between ED/urgent care visits and both inhaled corticosteroid (ICS) use and symptom control.

Methods: Cross-sectional design used to analyze whether ED/urgent care visits are associated with ICS use in the Behavioral Risk Factor Surveillance System (BRFSS)-Asthma Call-Back Survey (ACBS) 2010 using complex sample multivariate logistic regression.

Results: Thirty-one percent of asthmatics had uncontrolled symptoms and 9.5% required ED/ urgent care in the previous 12 months. Only 41.1% of those with uncontrolled symptoms were on ICS. Bivariate analysis found women, Blacks and non-Hispanic minorities, those with income below $25,000, ICS users, and those with uncontrolled symptoms during the past 2 weeks were more likely to have visited an ED/urgent care center. Multivariate analysis showed women, low income, being ever taught to recognize signs and symptoms, and the interaction between ICS use and symptom control were all associated with an ED/urgent care visit.

Conclusion: Asthmatics with controlled symptoms on ICS were more likely to have visited an ED/urgent care center compared to controlled asthmatics not on ICS. This implies that ICS use may be a marker of exacerbation risk in symptom-controlled asthmatics. While many asthmatics have uncontrolled symptoms and required emergent/ urgent care, a significant number of uncontrolled asthmatics were not on ICS medications. In order to reduce health care utilization, morbidity, and mortality in asthma patients, preventative and treatment efforts should focus on highrisk groups (i.e., women, low income, and ICS-requiring asthmatics).