Background: Most patients who have an asthma exacerbation leading to a visit to an emergency department (ED) will benefit from treatment with inhaled corticosteroids (ICS) at discharge. We investigated whether asthmatic children and adolescents were receiving ICS after discharge from the ED and identified the characteristics of patients and physicians associated with their use. Methods: A cohort of 4042 asthmatic patients aged 5-17 years was selected from the administrative database of the Régie de l'assurance maladie du Québec between 1997 and 1999. The proportion of patients using ICS 1, 3, and 6 months after ED discharge was estimated. Using GEE models the independent contribution of sociodemographic variables, markers of asthma severity, prior use of healthcare services and ICS, and physician characteristics was investigated on the likelihood of using ICS after ED discharge. Results: 68% of children and 51% of adolescents had a valid prescription for ICS in the month following discharge. At 6 months after discharge the corresponding figures were 77% and 60%. The strongest predictors of ICS use were age, with adolescents being less likely to use ICS than children (OR 0.49; 95% CI 0.43 to 0.56), prior use of ICS (OR 2.28; 95% CI 2.00 to 2.61), and filling a prescription for oral corticosteroids in the month following discharge (OR 2.29; 95% CI 2.03 to 2.58). However, patients who had an ED visit or a hospital admission for asthma during the 6 months before discharge were not more likely to use ICS after discharge. Conclusion: A large proportion of patients with clear markers of uncontrolled or severe asthma did not have a valid prescription for an ICS after discharge from the ED.

M Labrecque, M Lavallée, MF Beauchesne, A Cartier, LP Boulet. Can access to spirometry in asthma education centres influence the referral rate by primary physicians for education? Can Respir J 2006;13(8):427-431.BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators.The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners. METHODS: A one-year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second sixmonth period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs' services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period. RESULTS: The group of AECs randomly selected for spirometry in the second six-month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions. CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.