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Source: DGNews  |  Posted 8 years ago

Prolonged Time Before Seeking Emergency Department Care for Asthma Results in Worse Outcomes

: Presented at ATS

By Debra Gordon, MS

DENVER -- May 20, 2011 -- Although appropriate asthma care is designed to avoid expensive visits to the emergency room (ER), patients without the skills to self-manage their asthma exacerbations who delay seeking ER care may become so ill that they require hospitalisation.

Carol Mancuso, MD, Hospital for Special Surgery, and Weill Cornell Medical College, New York, New York, presented findings here on May 17 at the American Thoracic Society (ATS) 2011 International Conference.

The study involved interviews with nearly 300 adult patients seen in the ER. Researchers queried the patients about how long they had had symptoms and how they tried to manage their symptoms on their own before heading to the hospital.

They found that about half of patients (44%) had had symptoms for 2 to 5 days, and a third (34%) for more than 5 days before they arrived to the ER.

Although 80% of patients had a physician who handled their asthma, those who had had symptoms for the greatest amount of time were less likely to check in with their doctors before coming to the ER than those who had had symptoms for a shorter period (23% vs 18%).

They were also less likely to have used beta agonists (80% vs 77%), although more likely to have tried other medications (45% vs 32%; P =.03) and other self-management techniques (32% vs 19%; P =.008). Yet most of the techniques patients attempted were not considered effective for managing exacerbations, the authors noted, suggesting a problem with the patients’ self-management skills.

Overall, multivariate analyses controlling for age, sex, and comorbidities found that patients whose symptoms had lasted longer before they arrived in the ER had a worse quality of life (3.2 vs 3.7; P =.0002) and asthma control scores (3.4 vs 4.0; P <.0001) than those who had a shorter symptom duration. They were also more likely to be hospitalised (73% vs 57%; P =.03), to arrive to the ER by ambulance, and to be admitted.

The results were exactly the opposite of what researchers expected to find. “We had anticipated that patients who waited longer and thus had more time would have been more likely to seek care from their regular doctors and would have used techniques to treat asthma that are known to be helpful,” said Dr. Mancuso.

Instead, the findings “emphasise that patients need to be taught how to gauge when exacerbations are serious and unlikely to get better with self management only. This way, patients who need the emergency room can come sooner and increase the chances that their flares can be controlled and they will not need to be hospitalised. In addition, by recognizing symptoms early, patients can also avoid the need for transportation by ambulance.”

[Presentation title: Prolonged Time Before Seeking Emergency Department Care for Asthma Results in Worse Outcomes. Abstract 3782]

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