Why do asthmatic children need referral to an emergency room?

Abstract

Asthmatic attacks continue to be a major cause of referral to the emergency room (ER), despite currently available effective treatments. We have prospectively evaluated 100 consecutive children who were referred to the ER with acute asthma and were followed by their primary physicians. Only 46% were able to recognize acute attacks, and 26% had the knowledge and skills for self-management. The prophylactic therapy recommended was usually appropriate, but the compliance was poor and mean serum theophylline levels (STL) was 6.8 micrograms/ml, with subtherapeutic values (< 10 micrograms/ml) in 44 (88%). We studied an additional group of 50 consecutive children who were on a routine follow-up in the hospital asthma clinic. All were examined periodically and were instructed on the disease. The compliance of these children was much better and STL were within the therapeutic range in 73%, significantly higher than in the ER patients (p < 0.001). Their need for ER treatment or hospitalization was much lower than the former group. Poor compliance is a major factor causing referral of asthmatic children to ER, and careful education can improve patient compliance with reduced referral and subsequent hospitalization.

Association Between Outpatient Follow-Up and Pediatric Emergency Department Asthma Visits

“…Although the ED is an appropriate setting for asthma care in emergent situations, some studies suggest that some ED asthma visits can potentially be avoided with appropriate outpatient care (3)(4)(5). It is estimated that the cost of an ED asthma visit is five times greater than the cost of an outpatient asthma visit (6).…”

Medication Adherence and Health Care Utilization in Pediatric Chronic Illness: A Systematic Review

“…37 In a study comparing groups of children who had asthma seen in the ED to those seen in asthma clinic, selfreported non-adherence was higher in those seen in the ED. 38 Similarly, caregiver report of more non-adherence was associated with more ED visits for children who had asthma. 39 In contrast, a third study using a self-report measure of adherence found no relationship between non-adherence and ED visits when included in a multivariate model.…”

Clinical effects of a Long‐term Educational Program for Children with Asthma – Aironet®. A 1‐yr randomized controlled trial

“…We now have available several effective drugs for the pharmacological treatment of asthma, but patients’ information and education remain a cornerstone of long‐term management, as international guidelines underline (1–6). Educational programs for children with asthma and their families are intended to improve the knowledge of asthma, assess the severity of symptoms, know which medications to use, and decide when to seek medical care.…”