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 Emergency Department Visits for Asthma
Risk Factors
Many studies have looked at risk factors for ED use for asthma among children, undoubtedly because their ED visit rates are high. Children with asthma on Medicaid use the ED more frequently than children with asthma who have other insurance [f]. In part, this may be due to a lack of continuity of care, particularly the lack of a single primary care provider.
Other studies have linked maternal depressive symptoms to increased ED use in some children [g]. In children who were part of a large HMO, previous hospitalizations and ED visits, six or more beta2-agonists refills in the past six months, and having three or more physicians prescribing asthma medicine in the last six months were predictive of greater risk of ED visits [h].
For adults, studies have identified poorly controlled asthma as a strong risk factor for obtaining ED care for asthma. Signs of poorly controlled asthma are waking at night from asthma, prior ED visits or hospital admissions for asthma, and a greater reliance on rescue (beta2-agonist) medicines.
Some studies have identified psychosocial risk factors for ED use as well. The feeling that a person's asthma limits their lifestyle, even between bouts of asthma, was the best predictor of ED use in one such study [i]. Another found that people who reported more depression and expected asthma treatment to cure their asthma were more likely to seek urgent care for asthma (nonroutine office visits and hospitalizations, as well as ED visits) [j].
Recent research suggests that some people with asthma may not accurately perceive how limited their respiratory function is (technically, low "perception of dyspnea"), and this subset of asthmatics may be more likely to obtain asthma care in the ED [k].
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