RISK-FACTORS FOR RECURRENT EMERGENCY DEPARTMENT VISITS FOR ASTHMA

Background - Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstructi on, and frequently require admission to hospital. Although even one vi sit is not desirable, there is a more disturbing subgroup who repeated ly visit the emergency department. Methods - To investigate the reason s for multiple emergency visits, a questionnaire was given to 448 cons ecutive patients presenting to the two largest adult emergency departm ents in Ottawa, Canada between November 1989 and April 1991. Within th is cohort, those who had made at least three visits in the past year w ere compared with controls (only one visit in the past year). Results - Although inhaled corticosteroid use increased with multiple visits ( indicating increased asthma severity), only 60% of those visiting at l east three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent amo ng the cases. The number of visits was associated with nocturnal asthm a on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits w ere not related to psychological health, environmental allergens/irrit ants, or lack of perceived asthma severity. Conclusions - The recommen dations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be add ressed before highly effective medications can have an important impac t on the frequency of emergency department visits.