From: Reuters
Published March 20, 2008 12:41 PM

Asthma often still uncontrolled after ER visit

By Amy Norton

NEW YORK (Reuters Health) - Adults treated in the emergency room for severe asthma often continue to have poorly controlled symptoms afterward, new research suggests.

In a study of 225 adults who visited an ER for an asthma flare-up, researchers found that most patients had suffered persistent symptoms during the previous month, and only about half of them were taking inhaled steroids to help prevent asthma attacks.

One month after the ER visit, many still had poorly controlled symptoms, the researchers report in the Annals of Allergy, Asthma and Immunology.


The findings suggest that emergency care for asthma can be better, and that the "bridge" between the ER and the doctor's office can be stronger, write Dr. Richard O. Lenhardt, of Rush University Medical Center in Chicago, and his colleagues.

In the ER, asthma exacerbations are usually treated with oral corticosteroid medication, Lenhardt explained, but this is a short- term solution. If patients do not get their asthma under better control, they are at risk of seeing their symptoms worsen again once they stop taking the oral drugs, he told Reuters Health.

The problem is that many people do not go to see their primary care doctor after their ER visit, according to Lenhardt. He said that emergency physicians may be able to do more to encourage patients to see their regular doctor as soon as possible.

The study involved 225 adults who had an asthma exacerbation treated at one of six Illinois ERs over six months. The researchers questioned them about their symptoms and medication use in the previous month, then called them one month after the ER visit to see how they were faring.

Nearly 86 percent of patients said they'd had persistent asthma symptoms in the month before the ER visit. Of this group, only 54 percent were using inhaled corticosteroids, despite the fact that national guidelines recommend that this be the primary therapy for such patients.

Even fewer -- about one-quarter -- were using inhaled corticosteroids daily to prevent symptoms, the study found.

One month after their ER visit, more patients were on inhaled corticosteroids, with three-quarters saying they used the medications and 59 percent reporting daily use. However, many patients still had problems with controlling their symptoms.

Just as many reported persistent symptoms after their ER visit as before, the researchers found. Furthermore, on a standard measure of quality of life, the average score for the study group was lower than what has been found for adults with asthma in general.

For adults who've had to get emergency asthma care, the bottom line is that they should talk to their doctor about how to get a better handle on the disease.

"It might mean they need more medication, better avoidance of allergens, better use of the current medications, and other reasons that could be sorted out by their primary care physician," Lenhardt said.

SOURCE: Annals of Allergy, Asthma and Immunology, March 2008.

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