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Asthma Management Preceding an Emergency Department Visit

Robert E. Dales, MD, MSc, FRCPC; Pauline E. Kerr; Irwin Schweitzer, MSc; Ken Reesor, PhD, CPsych; Luce Gougeon, RRT; Garth Dickinson, MD, FRCPC
Arch Intern Med. 1992;152(10):2041-2044. doi:10.1001/archinte.1992.00400220067011.
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Background.—  The burden of illness from asthma in North America has not decreased despite advancements in understanding disease pathogenesis and improved pharmacotherapeutics. This study examined the adequacy of preventive measures applied to asthma.

Methods.—  Using a standardized self-administered questionnaire, 111 consecutive patients presenting to the emergency department because of asthma were surveyed about their "usual" level of disability from asthma, usual medications, self-management plans to deal with an asthma attack, and environmental control measures.

Results.—  Twenty-five percent of subjects suffered sleep disturbance more than 15 days per month, had work/school attendance affected more than 14 days per year, and previously visited an emergency department twice in the past year. Thirty-seven percent had no effective plans to deal with an attack and another 32% had plans that were never discussed with a physician. Although 78% reported that cigarette smoke aggravated their asthma, one third of these were exposed at home.

Conclusions.—  For a significant proportion of adults requiring emergency health services for asthma, preexisting management was poor by current standards. We recommend that patients be screened by emergency physicians and those with identifiable inadequacies in usual care be referred to physicians with expertise in asthma management.(Arch Intern Med. 1992;152:2041-2044)


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