Raising the Bar for Asthma Care in the Emergency Department

Abstract

Asthma remains a significant public health problem in the United States. The most recent national estimates indicate that there were 1.8 million asthma-related emergency department (ED) visits and 439,000 asthma hospitalizations in 2010. These persistently high morbidity figures may reflect trends in increasing asthma prevalence as well as inadequate control of chronic asthma. To reduce the societal burden, clearly we need to do a better job of preventing and managing asthma exacerbations. EDs are an importance venue for asthma care because they provide around-the-clock care and are often the last resort for minority and uninsured patients with asthma. But how well are patients with asthma exacerbations managed in the ED? As outlined in the National Asthma Education and Prevention Program Expert Panel Report 3 (NAEPP EPR3) guidelines sponsored by the National Institutes of Health (NIH), management of asthma exacerbation in the ED includes several key components, such as peak expiratory flow (PEF) measurement, inhaled short-acting b-agonists, anticholinergics, and systemic corticosteroids. The extent to which these guidelinerecommended care processes are followed in the real world is of great interest to many stakeholders, including patients, clinicians, health insurers, quality improvement organizations, researchers, and policy makers. In fact, tracking the real-world effectiveness of interventions is one of the central goals of comparative effectiveness research in asthma. In this context, 2 studies have examined the quality of care for adults with asthma exacerbations and found that, overall, patients received approximately 50%70% of recommended care processes in the outpatient or ED setting. The adherence to guidelines seems to be better (>80%) among children with asthma exacerbations in acute care settings. In this issue of the JACI: In Practice, Hasegawa et al examined the quality of care in 1380 adults who presented to 23 Japanese EDs with acute asthma. By abstracting available data from medical records, they showed that overall concordance with NIH asthma guidelines was approximately 72%, with low use of PEF measurement (9%), anticholinergics (2%), and systemic