Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Franklin, Jeffery M.; Grunwell, Jocelyn R.; Bruce, Alice C.; Smith, R.C.; Fitzpatrick, Anne M.

doi:10.1016/j.anai.2017.04.008

Cited by 19 publications

(12 citation statements)

References 45 publications

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“…This high cost is primarily due to high asthma related emergency department (ED) and hospitalization rates. Although one out of five US children with asthma receive ED treatment, ED utilization for asthma care is disproportionately higher among minority, and low income children with 12‐month revisit rates ranging from 6% to 34% for inner‐city children . These revisits are costly, anxiety provoking, and largely preventable .…”

Section: Introductionmentioning

confidence: 99%

“…Although one out of five US children with asthma receive ED treatment, 2 ED utilization for asthma care is disproportionately higher among minority, and low income children 3 with 12-month revisit rates ranging from 6% to 34% for inner-city children. 4,5 These revisits are costly, anxiety provoking, and largely preventable. 6,7 Discerning the risk factors associated with increased asthma ED revisits is complex since risks include adverse environmental exposures, child sociodemographic and health characteristics, and caregiver asthma management practices and beliefs.…”

Section: Introductionmentioning

confidence: 99%

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Children with poorly controlled asthma: Randomized controlled trial of a home‐based environmental control intervention

Butz

Bollinger

Ogborn

et al. 2019

Pediatric Pulmonology

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Background Few trials have tested targeted environmental control (EC) interventions based on biomarkers of second hand smoke (SHS) exposure and allergen sensitization in reducing asthma emergency department (ED) visits in children with poorly controlled asthma. Methods Overall, 222 children with poorly controlled asthma were randomized into a home‐based EC intervention (INT) or control (CON) group and followed for ED visits over 12 months. All children received allergen‐specific IgE serologic testing and SHS exposure biomarker testing to inform the EC intervention. Pharmacy data was examined for asthma medication fills. Cox proportional hazards and multivariate regression models were performed to examine factors associated with repeat ED visits. Results There was no difference in increased risk of >1 ED visit at 12 months between INT and CON groups. Most children (75%) had moderate/severe persistent asthma. Over half (56%) had SHS exposure and 83% tested positive for >1 allergen sensitization. Among children without SHS exposure, the median time to first recurrent ED visit differed by group (CON: 195; INT: >365 days) after adjusting for child age, allergic sensitization, medication fills prior to baseline, controller medication use, and the interaction between group status and SHS exposure. Children who had positive allergic sensitizations, younger, had increased controller medication use and randomized to the CON group and had no SHS exposure had increased risk for a repeat ED visit over 12 months. Conclusions In this study, a home‐based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Children with poorly controlled asthma: Randomized controlled trial of a home‐based environmental control intervention

Butz

Bollinger

Ogborn

et al. 2019

Pediatric Pulmonology

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“…14 Although predictors of uncontrolled asthma have been previously investigated in various studies, there are still some gaps in knowledge. The majority of research investigating asthma control is conducted among children referred for asthma 4,15 or among children in the general population 5,6,8,12 but not among children that are referred with atopic diseases other than asthma to secondary care. The aim of this crosssectional study was 1) to investigate the prevalence of uncontrolled asthma among children referred for asthma and among children referred for atopic diseases other than asthma, and 2) to investigate the predictors, including atopic comorbidities, associated with uncontrolled asthma among these children.…”

Section: Introductionmentioning

confidence: 99%

<p>Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases</p>

Kansen¹,

Le²,

Uiterwaal³

et al. 2020

JAA

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Background: Uncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma. Methods: All children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses. Results: We included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively). Conclusion: Uncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.

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“…Younger age in children has been associated with an increased risk of asthma attack [ 17 , 18 ], as has obesity [ 19 ]. African American and Puerto Rican race/ethnicity has been associated with a moderately increased risk of asthma attacks and emergency department visits [ 17 , 19 , 20 ], and this effect in African American individuals persists in some studies when controlling for poverty, healthcare provision, area of residence and level of parental education [ 17 , 20 ]. However, an evaluation of readmission rates in African American children found that 80% of their increased risk could be explained after balancing biological, environmental, disease management, access to care, and socioeconomic factors, indicating that the increased risk is likely multifactorial [ 21 ].…”

Section: Predictors Of Asthma Attacksmentioning

confidence: 99%

“…Decreased FEV 1 /FVC ratio has been associated with increased risk of asthma attacks [ 28 , 32 ], and FEV 1 <80% predicted may be associated with emergency room use, particularly in black children [ 20 ].…”

Section: Predictors Of Asthma Attacksmentioning

confidence: 99%

Asthma attacks in children are always preceded by poor asthma control: myth or maxim?

Keyser

Szefler

2020

Breathe

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Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Cited by 19 publications

References 45 publications

Children with poorly controlled asthma: Randomized controlled trial of a home‐based environmental control intervention

Children with poorly controlled asthma: Randomized controlled trial of a home‐based environmental control intervention

<p>Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases</p>

Asthma attacks in children are always preceded by poor asthma control: myth or maxim?

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