Multicenter Study of Chronic Asthma Severity Among Emergency Department Patients With Acute Asthma

Abstract

Objective. The initiation of controller therapy for asthma depends on chronic asthma severity. To facilitate initiation of inhaled corticosteroids (ICSs), the preferred controller therapy, in the emergency department (ED), the objective of the study was to describe chronic asthma severity, as defined by the national asthma guidelines, among children presenting to the ED with acute asthma. Methods. Investigators at 14 U.S. sites prospectively enrolled consecutive children 2–17 years presenting to the ED with acute asthma. Three factors (daytime symptoms, nighttime symptoms, and medication usage) were used to categorize children into four chronic asthma severity groups: intermittent, mild persistent, moderate persistent or severe persistent. Results. This multistate cohort of 311 children had a mean age of 7.7 years, was 51% Black, and 89% had a primary care provider (PCP). Regarding chronic severity, 18% were intermittent and 82% persistent: 37% mild persistent, 24% moderate persistent, and 20% severe persistent. Chronic severity groups did not differ by demographics or PCP status. Patients with persistent asthma were more likely to report moderate-severe asthma symptoms (58% versus 19%; p < .001), poor asthma control (2% versus 18%; p = .002), and more ED visits (median, 2 versus 1; p < .001) in the past year. The groups did not differ in acute asthma severity, ED treatment, or admission rate. Rate of discharge prescription for ICSs was low, albeit higher among children with persistent asthma (24% versus 4%; p = .003). Conclusions. The high prevalence of persistent asthma among ED patients exceeds the prevalence reported previously, and supports ED initiation of ICS, as recommended by national guidelines.

• adolescent
• antiasthmatic agents
• asthma
• asthma (epidemiology)
• asthma (prevention and control)
• child
• practice guideline
• preschool child
• severity of illness index

Acknowledgments

Dr. Sills was supported by AHRQ grant R03 HS016418; Dr. Ginde by NIH grant KL2 RR025779; and Dr. Camargo by NIH grant HL-03533. The Multicenter Airway Research Collaboration was supported by NIH grant HL-63253, and by an unrestricted grant from GlaxoSmithKline (Research Triangle Park, NC).

Conflict of interest: Dr. Camargo has received financial support from a variety of groups for participation in conferences, consulting, and investigator-initiated medical research. During 2007 to 2009, industry sponsors with an interest in asthma were AstraZeneca, Critical Therapeutics, Dey, Genentech, GSK, Merck, Novartis, Respironics, Sanofi-Aventis, and Schering-Plough. Drs. Sills, Ginde, and Clark do not report any potential conflicts of interest.