Asthma Education Delivered in the Emergency Department: Does it Encourage Asthma Self-management?

Abstract

Background: The rates of optimal asthma control and compliance to treatment in Israel are reportedly low. We postulated that adults attending our emergency department (ED) with asthma exacerbation were not using self-management strategies optimally. Objectives: This pilot study aims to: (a) verify the above hypothesis and, if applicable, (b) determine whether an asthma education intervention (AEI) administered in the ED would encourage post-discharge use of a written asthma action plan (AAP). Methods: Thirty-eight adults (>18 yr.) visiting the ED with asthma exacerbation received a 30-min AEI including a written AAP. Prior asthma education was assessed by questionnaire. Follow-up, carried out by phone ≥ 12 months after discharge, assessed AAP use, asthma control (GINA), and exacerbations in the past year. Results: At baseline, participants denied previous education on asthma selfmanagement and AAP use. Of 27 patients available for follow-up, only 5 (18.5%) were using the AAP, assisted by their care-provider. Eighteen subjects (66.7%) presented uncontrolled asthma while, as a whole, the group reported significantly more exacerbation episodes than at enrolment (mean (SD)=5.1 (6.5) vs. 2.7 (3.0) (p=0.0498)). Finally, compared with AAP non-users (n=22) AAP users (n=5) tended to have better asthma control (60% vs. 18%) and fewer episodes of exacerbations (mean (SD)=2.8 (2.2) vs 5.9 (6.9)) but the differences did not reach significance. Conclusion: Delivery to adults of a short AEI in the ED was of limited efficiency in post-discharge boosting of patient/doctor partnership, resulting in sub-optimal AAP use. Feasibility of the AEI in a crowded ED, however, justifies further research on AEI delivery coupled with alternative follow-up strategies targeting patient and doctor perception of AAPs.