Asthma Emergency Department Visits Research Articles

Assessing the Impact of Specific PM2.5-Bound Metallic Elements on Asthma Emergency Department Visits: A Case-Crossover Study in Taiwan

ObjectivesThis study aims to assess the specific PM2.5-bound metallic elements that contribute to asthma emergency department visits by using a case-crossover study design. MethodsThis study analyzed data from 11,410 asthma emergency department visits as case group and 22,820 non-asthma onset dates occurring one week and two weeks preceding the case day as controls from 2017 to 2020. PM2.5 monitoring data and 35 PM2.5-bound metallic elements from six different regions in Taiwan were collected. Conditional logistic regression models were used to assess the relationship between asthma and PM2.5-bound metallic elements. ResultsOur investigation revealed a statistically significant risk of asthma emergency department visits associated with PM2.5 exposure at lag 0, 1, 2, and 3 during autumn. Additionally, PM2.5-bound hafnium (Hf), thallium (Tl), rubidium (Rb), and aluminum (Al) exhibited a consistently significant positive correlation with asthma emergency department visits at lags 1, 2, and 3. In stratified analyses by area, age, and sex, PM2.5-bound Hf showed a significant and consistent correlation. ConclusionsThis study provides evidence of PM2.5-bound metallic elements effects in asthma exacerbations, particularly for Hf. It emphasizes the importance of understanding the origins of these metallic elements and pursuing emission reductions to mitigate regional health risks.

A census tract-level assessment of social determinants of health, traffic exposure, and asthma exacerbations in New York State's Medicaid Population (2005–2015)

To evaluate the association between social determinants, environmental exposure metrics, and the risk of asthma emergency department (ED) visits in the New York State (NYS) Medicaid population using small-area analysis.Traffic densities for each census tract in NYS were calculated using the length of road segments within each tract and total area of the tract to produce a measure of average number of vehicles per square meter per day. Data on social determinants of health including internal and external environments and other demographic factors were obtained from various sources. Poisson regression analyses were conducted to identify significant factors associated with asthma ED visits in Medicaid claim and encounter data for years 2005–2015.High traffic density in NYS excluding New York City (NYC) correlated with increased risk of asthma ED visits (RR 1.69; 95% CI: 1.42, 2.00), mitigated by adjusting for environmental and social determinants (RR 1.00; 95% CI: 0.85, 1.19). Similar trends were observed in NYC only (RR 1.19; 95% CI: 1.00, 1.41), with the adjusted risk remaining elevated (RR 1.14; 95% CI: 0.98, 1.33) albeit not statistically significant. Living in census tracts with high concentrated disadvantage index, high proportions of minorities, and less green space predicted higher asthma ED visits. We mapped predicted rates and model residuals to identify areas of high risk.Our results support previous findings that environmental and social risk factors in poor and urban areas contribute to asthma exacerbations in the NYS Medicaid population, even if they may not necessarily contribute to its development.

Quantifying Multipollutant Health Impacts Using the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE): A Case Study in Atlanta, Georgia.

Air pollution risk assessments do not generally quantify health impacts using multipollutant risk estimates, but instead use results from single-pollutant or copollutant models. Multipollutant epidemiological models account for pollutant interactions and joint effects but can be computationally complex and data intensive. Risk estimates from multipollutant studies are therefore challenging to implement in the quantification of health impacts. Our objective was to conduct a case study using a developmental multipollutant version of the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) to estimate the health impact associated with changes in multiple air pollutants using both a single and multipollutant approach. BenMAP-CE was used to estimate the change in the number of pediatric asthma emergency department (ED) visits attributable to simulated changes in air pollution between 2011 and 2025 in Atlanta, Georgia, applying risk estimates from an epidemiological study that examined short-term single-pollutant and multipollutant (with and without first-order interactions) exposures. Analyses examined individual pollutants (i.e., ozone, fine particulate matter, carbon monoxide, nitrogen dioxide (), sulfur dioxide, and particulate matter components) and combinations of these pollutants meant to represent shared properties or predefined sources (i.e., oxidant gases, secondary pollutants, traffic, power plant, and criteria pollutants). Comparisons were made between multipollutant health impact functions (HIF) and the sum of single-pollutant HIFs for the individual pollutants that constitute the respective pollutant groups. Photochemical modeling predicted large decreases in most of the examined pollutant concentrations between 2011 and 2025 based on sector specific (i.e., source-based) estimates of growth and anticipated controls. Estimated number of avoided asthma ED visits attributable to any given multipollutant group were generally higher when using results from models that included interaction terms in comparison with those that did not. We estimated the greatest number of avoided pediatric asthma ED visits for pollutant groups that include (i. e., criteria pollutants, oxidants, and traffic pollutants). In models that accounted for interaction, year-round estimates for pollutant groups that included ranged from 27.1 [95% confidence interval (CI): 1.6, 52.7; traffic pollutants] to 55.4 (95% CI: 41.8, 69.0; oxidants) avoided pediatric asthma ED visits. Year-round results using multipollutant risk estimates with interaction were comparable to the sum of the single-pollutant results corresponding to most multipollutant groups [e.g., 52.9 (95% CI: 43.6, 62.2) for oxidants] but were notably lower than the sum of the single-pollutant results for some pollutant groups [e.g., 77.5 (95% CI: 66.0, 89.0) for traffic pollutants]. Performing a multipollutant health impact assessment is technically feasible but computationally complex. It requires time, resources, and detailed input parameters not commonly reported in air pollution epidemiological studies. Results estimated using the sum of single-pollutant models are comparable to those quantified using a multipollutant model. Although limited to a single study and location, assessing the trade-offs between a multipollutant and single-pollutant approach is warranted. https://doi.org/10.1289/EHP12969.

Exposure to hourly ambient air pollutants and risk of emergency department visits for asthma: A multicenter time-stratified case-crossover analysis

BackgroundExposure to daily ambient air pollutants has been linked with increased risk of asthma morbidity and mortality. However, the association between exposure to air pollution and risk of emergency department (ED) visits for asthma on an hourly level remains unclear. MethodsWe conducted a time-stratified case-crossover design and included a total of 121,112 asthma ED visits from 11 hospitals in three cities located in Zhejiang province, China, between January 1, 2016 and September 30, 2021. We used conditional logistic regressions combined with a distributed lag linear model to estimate the association between risk of asthma ED visits and hourly exposure to fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) after adjusted for meteorological factors and public holiday. ResultsHourly exposure to PM2.5, PM10, NO2, SO2, and CO was associated with an increased risk of asthma ED visits. This association was most pronounced in the concurrent hour of exposure (lag 0 h), rapidly attenuated over a period of 3–12 h, and diminished thereafter. Each interquartile range increase in air pollutant over 0–72 h was associated with increased risk of asthma ED visits by 7.0% (95% confidence interval [CI]: 5.4%, 8.6%) for PM2.5, 6.7% (95% CI: 5.1%, 8.2%) for PM10, 18.1% (95% CI: 15.4%, 21.0%) for NO2, 6.5% (95% CI: 4.8%, 8.2%) for SO2, and 7.4% (95% CI: 5.6%, 9.1%) for CO. ConclusionOur findings suggest that hourly exposure to PM2.5, PM10, NO2, SO2, and CO, but not O3, is associated with increased risk of ED visits for asthma shortly after exposure.

Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial

ObjectiveTo test the effectiveness of a telemedicine-based program in reducing asthma morbidity among children who present to the emergency department (ED) for asthma, by facilitating primary care follow-up and promoting delivery of guideline-based care. Study DesignWe included children (3-12 years) with persistent asthma who presented to the ED for asthma, were then randomly assigned to Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced Usual Care (eUC). TEAM-ED included: 1) school-based telemedicine follow-ups, completed by a primary care provider, 2) “point-of-care” prompting to promote guideline-based care, and 3) an opportunity for two additional telemedicine follow-ups. The primary outcome was the mean number of symptom-free days (SFDs) over 2 weeks at 3, 6, 9, and 12 months. ResultsWe included 373 children from 2016 through 2021 (participation rate 68%; 54% Black, 32% Hispanic, 77% public insurance, mean age: 6.4 years). Demographic characteristics and asthma severity were similar between groups at baseline. Most (91%) TEAM-ED children had ≥1 telemedicine visit; 41% completed 3 visits. At 3 months, caregivers of children in TEAM-ED reported more follow-up visits (66%vs.48%, aOR:2.07 [1.28-3.33]), preventive asthma medication actions (90%vs.79%, aOR:3.28 [1.56-6.89]), and use of a preventive medication (82%vs.69%, aOR:2.716 [1.45-5.08]), compared with eUC. There was no difference between groups in medication adherence or asthma morbidity. When only pre-pandemic data were included, there was greater improvement in SFDs over time for children in TEAM-ED versus eUC. ConclusionsTEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with pre-pandemic data. The lack of overall improvement in morbidity and adherence indicates the need for additional ongoing management support.

Altered Symptom Perception in Children With Asthma Is Associated With Poor Childhood Opportunity and Adverse Outcomes

Effective asthma self-management requires that children recognize their asthma symptoms when they occur. However, some children have altered symptom perception, which impairs their ability to respond to their asthma symptoms in a timely manner. To characterize the prevalence and features of altered symptom perception in children aged 5 to 18 years. We hypothesized that children with altered symptom perception would have more features of uncontrolled asthma, more health inequity, and poorer longitudinal asthma outcomes over 12months. Children (N= 371) completed an outpatient research visit for clinical characterization. Altered symptom perception was defined by discordance between child responses on the 6-item Asthma Control Questionnaire and medical provider-elicited symptoms. Electronic medical records were reviewed for 12 months for the occurrence of an asthma exacerbation treated with systemic corticosteroids and an asthma exacerbation prompting an emergency department visit. Approximately 15% of children had altered symptom perception and their asthma features were similar to those of children with uncontrolled asthma. Children with altered symptom perception were uniquely distinguished by non-White race and more severe prior exacerbations. These children also resided in ZIP codes with the poorest childhood opportunity (ie, poorest education, health and environmental features, and socioeconomic features). Outcomes of children with altered symptom perception were equally disparate with approximately 2-fold higher odds of a future exacerbation and approximately 3-fold higher odds of an emergency department visit for asthma. Altered symptom perception is present in a small but significant number of children with asthma and is related to poorer childhood opportunity and other health inequities that require additional intervention.

A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits.

Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible. Our goal was to reduce asthma-related ED visits by patients ages 2 to 18 years by 3% annually. The setting was a multisite large urban high-risk primary care network affiliated with a children's hospital. We implemented 5 sequential interventions within our network of pediatric primary care centers to increase: use of asthma action plans by clinicians, primary care-based Asthma Specialty Clinic visits (extended asthma visits in the main primary care site), use of a standard asthma note at all visits, documentation of the Asthma Control Test, and step-up therapy for children with poorly controlled asthma. At baseline in 2010, there were 21.7 asthma-related ED visits per 1000 patients per year. By 2019, asthma-related ED visits decreased to 14.5 per 1000 patients per year, a 33% decrease, with 2 center line shifts over time. We achieved and sustained our goal metrics for 4 of 5 key interventions. We reduced ED utilization for asthma in a large, high-risk pediatric population. The interventions implemented and used over time in this project demonstrate that sustainable outcomes can be achieved in a large network of primary care clinics.

Factors associated with aeroallergen testing among adults with asthma in a large health system.

Aeroallergen testing informs precision care for adults with asthma, yet the epidemiology of testing in this population remains poorly understood. We sought to identify factors associated with receiving aeroallergen testing, the results of these tests, and subsequent reductions in exacerbation measures among adults with asthma. We used electronic health record data to conduct a retrospective, observational cohort study of 30,775 adults with asthma who had an office visit with a primary care provider or an asthma specialist from January 1, 2017, to August 26, 2022. We used regression models to identify (1) factors associated with receiving any aeroallergen test and tests to 9 allergen categories after the index visit, (2) factors associated with positive test results, and (3) reductions in asthma exacerbation measures in the year after testing compared with before testing. Testing was received by 2201 patients (7.2%). According to multivariable models, receiving testing was associated with having any office visit with an allergy/immunology specialist during the study period (odds ratio [OR]= 91.3 vs primary care only [P< .001]) and having an asthma emergency department visit (OR= 1.62 [P= .004]) or hospitalization (OR= 1.62 [P= .03]) in the year before the index visit. Age 65 years or older conferred decreased odds of testing (OR= 0.74 vs age 18-34 years [P= .008]) and negative test results to 6 categories (P≤ .04 for all comparisons). Black race conferred increased odds of testing (OR=1.22 vs White race [P= .01]) and positive test results to 8 categories (P< .04 for all comparisons). Exacerbation measures decreased after testing. Aeroallergen testing was performed infrequently among adults with asthma and was associated with reductions in asthma exacerbation measures.

Assessing the Effect of Precipitation on Asthma Emergency Department Visits in New York State From 2005 to 2014: A Case-Crossover Study.

The Earth's precipitation patterns are changing, and regional precipitation is expected to continue to increase in New York State (NYS). Heavy precipitation may negatively affect asthma prevalence through its effect on seasonally varying allergens. We employed a threshold analysis using a time-stratified semi-symmetric bi-directional case-crossover study design to assess the effect of increase in precipitation on asthma (ICD-9 code 493.xx, N=970,903) emergency department (ED) visits between 2005 and 2014 during non-winter months in NYS. Spatially contiguous gridded meteorological data from North American Land Data Assimilation System (NLDAS) were utilized. We used conditional logistic regression models and stratified the analyses by seasons. During non-winter months, we found a small, statistically significant risk of asthma ED visits for precipitation levels above 50mm, with differences by season. These results suggest that heavy precipitation may be related to an increased risk of asthma ED visits. Gridded meteorological estimates provide a means of addressing the gaps in exposure classification, and these findings provide opportunities for further research on interactions with aeroallergens and meteorological conditions in the context of climate and health.

Population-level trends in asthma and chronic obstructive pulmonary disease emergency department visits and hospitalizations before and during the coronavirus disease 2019 pandemic in the United States

BackgroundPrevious studies have identified reductions in exacerbations of chronic lung disease in many locales after onset of the coronavirus disease 2019 (COVID-19) pandemic. ObjectiveTo evaluate the population-level impacts of COVID-19 on asthma and chronic obstructive pulmonary disease (COPD) exacerbations—with a focus on disadvantaged communities—in the United States. MethodsWe analyzed 2016 to 2020 county-level data on asthma and COPD acute care use, with myocardial infarction hospitalizations as a comparator condition. We linked this with county-level lower respiratory disease mortality data. We calculated rates of emergency department (ED) visits, hospitalizations, and deaths and evaluated changes using linear regressions adjusted for year and county-fixed effects.For a supplementary analysis, we calculated ED visit rates nationwide for asthma, COPD, or any diagnosis using the 2016 to 2020 National Hospital Ambulatory Medical Care Survey. ResultsOur county-level data included 685 counties in 13 states. Rates of each outcome fell in 2020. In adjusted analyses, we found large reductions in asthma and COPD ED visit rates (eg, a 21.5 per 10,000-person reduction in COPD ED visits; 95% confidence interval, −23.8 to −19.1), with smaller reductions in hospitalizations and chronic lower respiratory mortality. Disadvantaged communities had mostly higher baseline rates of respiratory morbidity and larger absolute reductions in some outcomes.Among 90,808 ED visits in the National Hospital Ambulatory Medical Care Survey, asthma ED visits/y fell 33% during the pandemic and COPD visits by 51%; overall ED visits fell by only 7%. ConclusionOnset of the COVID-19 pandemic coincided with reductions in acute care utilization for asthma and COPD. Understanding the mechanism of this reduction might inform future efforts to prevent exacerbations.

Extreme weather and asthma: a systematic review and meta-analysis.

Climate change's influence on extreme weather events poses a significant threat to the morbidity and mortality of asthma patients. The aim of this study was to examine associations between extreme weather events and asthma-related outcomes. A systematic literature search for relevant studies was performed using the PubMed, EMBASE, Web of Science and ProQuest databases. Fixed-effects and random-effects models were applied to estimate the effects of extreme weather events on asthma-related outcomes. We observed that extreme weather events were associated with increasing risks of general asthma outcomes with relative risks of 1.18-fold for asthma events (95% CI 1.13-1.24), 1.10-fold for asthma symptoms (95% CI 1.03-1.18) and 1.09-fold for asthma diagnoses (95% CI 1.00-1.19). Extreme weather events were associated with increased risks of acute asthma exacerbation with risk ratios of asthma emergency department visits of 1.25-fold (95% CI 1.14-1.37), of asthma hospital admissions of 1.10-fold (95% CI 1.04-1.17), of asthma outpatient visits of 1.19-fold (95% CI 1.06-1.34) and of asthma mortality of 2.10-fold (95% CI 1.35-3.27). Additionally, an increase in extreme weather events increased risk ratios of asthma events by 1.19-fold in children and 1.29-fold in females (95% CI 1.08-1.32 and 95% CI 0.98-1.69, respectively). Thunderstorms increased the risk ratio of asthma events by 1.24-fold (95% CI 1.13-1.36). Our study showed that extreme weather events more prominently increased the risk of asthma morbidity and mortality in children and females. Climate change is a critical concern for asthma control.

Pollen and asthma morbidity in Atlanta: A 26-year time-series study

BackgroundCompared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. ObjectivesWe evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993–2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5–17, 18–64, 65+), and insurance status (Medicaid vs non-Medicaid). MethodsSpeciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0–2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. ResultsFrom 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1–8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993–2000), in younger people, and in Black patients; however, results varied by pollen taxa. ConclusionsSome, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.

The relationship between childhood asthma and socioeconomic status: a Korean nationwide population-based study.

This study aimed to investigate associations of socioeconomic status (SES) with asthma exacerbation and asthma-related hospital utilization factors among children with asthma in the Republic of Korea. This study retrospectively analyzed population-level data from the Korean National Health Insurance Service, collected from 2013 through 2019. SES was classified into five categories according to the national health insurance premiums quantiles (0 [lowest] to 4 [highest]). The hazard ratios (HRs) for asthma exacerbation, emergency department (ED) visits, hospital admission, and intensive care unit (ICU) admission were analyzed with respect to SES. Among the five SES groups, SES group 0 (medical aid), had the highest tallies and proportions of children who experienced asthma exacerbations (n = 1,682, 4.8%), ED visits (n = 932, 2.6%), hospital admission (n = 2,734, 7.7%) and ICU admission (n = 14, 0.04%). Compared with SES group 4, SES group 0 had adjusted HRs of 3.73 (p = 0.0113) and 1.04 (p < 0.0001) for ventilator support/tracheal intubation and administration of systemic corticosteroids, respectively. Relative to group 4, the adjusted HRs for ED visits, hospital admission, and ICU admission in group 0 were 1.88 (p < 0.0001), 2.20 (p < 0.0001), and 7.12 (p < 0.0001), respectively. In the survival analysis, group 0 had a significantly higher risk of ED presentation, hospital admission, and ICU admission than the other groups (log-rank p < 0.001). Compared with children of higher SES, those in the lowest SES group had increased risk of asthma exacerbation, hospital admission, and receiving treatment for severe asthma symptoms.

Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence

Fine particulate air pollution (PM2.5) is decreasing in most areas of the United States, except for areas most affected by wildfires, where increasing trends in PM2.5 can be attributed to wildfire smoke. The frequency and duration of large wildfires and the length of the wildfire season have all increased in recent decades, partially due to climate change, and wildfire risk is projected to increase further in many regions including the western United States. Increasingly, empirical evidence suggests differential health effects from air pollution by class and race; however, few studies have investigated such differential health impacts from air pollution during a wildfire event. We investigated differential risk of respiratory health impacts during the 2008 northern California wildfires by a comprehensive list of socio-economic status (SES), race/ethnicity, and smoking prevalence variables. Regardless of SES level across nine measures of SES, we found significant associations between PM2.5 and asthma hospitalizations and emergency department (ED) visits during these wildfires. Differential respiratory health risk was found by SES for ED visits for chronic obstructive pulmonary disease where the highest risks were in ZIP codes with the lowest SES levels. Findings for differential effects by race/ethnicity were less consistent across health outcomes. We found that ZIP codes with higher prevalence of smokers had greater risk of ED visits for asthma and pneumonia. Our study suggests that public health efforts to decrease exposures to high levels of air pollution during wildfires should focus on lower SES communities.

Acute Effects of Ambient Air Pollution on Asthma Emergency Department Visits in Ten U.S. States.

Previous studies of short-term ambient air pollution exposure and asthma morbidity in the United States have been limited to a small number of cities and/or pollutants and with limited consideration of effects across ages. To estimate acute age group-specific effects of fine and coarse particulate matter (PM), major PM components, and gaseous pollutants on emergency department (ED) visits for asthma during 2005-2014 across the United States. We acquired ED visit and air quality data in regions surrounding 53 speciation sites in 10 states. We used quasi-Poisson log-linear time-series models with unconstrained distributed exposure lags to estimate site-specific acute effects of air pollution on asthma ED visits overall and by age group (1-4, 5-17, 18-49, 50-64, and y), controlling for meteorology, time trends, and influenza activity. We then used a Bayesian hierarchical model to estimate pooled associations from site-specific associations. Our analysis included asthma ED visits. We observed positive associations for multiday cumulative exposure to all air pollutants examined [e.g., 8-d exposure to : rate ratio of 1.016 with 95% credible interval (CI) of (1.008, 1.025) per increase, : 1.014 (95% CI: 1.007, 1.020) per increase, organic carbon: 1.016 (95% CI: 1.009, 1.024) per increase, and ozone: 1.008 (95% CI: 0.995, 1.022) per increase]. and ozone showed stronger effects at shorter lags, whereas associations of traffic-related pollutants (e.g., elemental carbon and oxides of nitrogen) were generally stronger at longer lags. Most pollutants had more pronounced effects on children ( y old) than adults; had strong effects on both children and the elderly ( y old); and ozone had stronger effects on adults than children. We reported positive associations between short-term air pollution exposure and increased rates of asthma ED visits. We found that air pollution exposure posed a higher risk for children and older populations. https://doi.org/10.1289/EHP11661.

Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas

Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. We explored the relationship between NEVI andpediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County,Calif; Fulton County, Ga; and New York City,NY. We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.

An assessment of the predictive value of low risk criteria for children with intermittent asthma.

Current asthma guidelines recommend short acting beta agonist medication (SABA) be used in combination with an inhaled corticosteroid to reduce risk for severe asthma exacerbations. This may not be appropriate for patients at low risk for severe exacerbations. This study is a cohort study using computerized claims data from Texas Children's Health Plan. Inclusion criteria were members 1 to <18 years with a diagnosis of asthma in a baseline year between 2016 and 2018 and who had ≤2 SABA canisters or equivalent dispensed, no oral corticosteroid or inhaled corticosteroid dispensing, no asthma hospitalizations, and no asthma emergency department visits in the baseline year. Follow up year outcomes of asthma hospitalizations and emergency department visits were determined for the year following the baseline year. Forty-five thousand two hundred and thiry health plan members 1 to <18 years met inclusion criteria. The rate of follow up year asthma hospitalization was 1.1 per thousand for those with no baseline SABA dispensing and 1.5 per thousand for those with >0 and ≤2 SABA canister dispensings (p = 0.3). Follow up year Emergency Department visits rates were 14 per thousand and 17 per thousand, respectively (p = 0.08). In analyses adjusted for age group, the follow up year asthma hospitalization rate was not different comparing the 0 SABA to the >0 and ≤2 SABA canister dispensings group (odds ratio: 0.99, 95% confidence interval: 0.54-1.81). Asthma patients at low risk for severe exacerbations can be identified. This information can be useful to guide treatment decisions.

Low parental numeracy and severe asthma exacerbations in a prospective study of Puerto Rican youth

BackgroundNumeracy is the mathematical knowledge required to understand and act on instructions from health care providers. Whether persistently low parental numeracy is linked to childhood asthma exacerbations is unknown. ObjectiveTo evaluate whether low parental numeracy at 2 time points is associated with asthma exacerbations and worse lung function in Puerto Rican youth. MethodsProspective study of 225 youth with asthma in San Juan (PR) who participated in 2 visits approximately 5.3 years apart, with the first at ages 6 to 14 years and the second at ages 9 to 20 years. Parental numeracy was assessed with a modified version of the Asthma Numeracy Questionnaire (score range = 0-3 points), and persistently low parental numeracy was defined as a score less than or equal to 1 point at both visits. Asthma exacerbation outcomes included more than or equal to 1 emergency department (ED) visit, more than or equal to 1 hospitalization, and more than or equal to 1 severe exacerbation (≥1 ED visit or ≥1 hospitalization) for asthma in the year before the second visit. Spirometry was conducted using an EasyOne spirometer (NDD Medical Technologies, Andover, Massachusetts). ResultsIn an analysis adjusting for age, sex, parental education, use of inhaled corticosteroids, and the time between study visits, persistently low parental numeracy was associated with more than or equal to 1 ED visit for asthma (odds ratio [ORs], 2.17; 95% confidence interval [CI], 1.10-4.26), more than or equal to 1 hospitalization for asthma (OR, 3.92; 95% CI, 1.42-10.84), and more than or equal to 1 severe asthma exacerbation (OR, 1.99; 95% CI, 1.01-3.87) in the year before the follow-up visit. Persistently low parental numeracy was not significantly associated with change in lung function measures. ConclusionPersistently low parental numeracy is associated with asthma exacerbation outcomes in Puerto Rican youth.

Asthma outcomes in pediatric patients with 30-day follow-up after an asthma hospitalization in a Medicaid-managed care program

Background National asthma guidelines recommend an outpatient follow-up after hospitalization for asthma. Our aim is determine if a follow-up visit within 30 days after an asthma hospitalization impacts risk for re-hospitalization and emergency department visits for asthma within the following year. Methods This was a retrospective cohort study of claims data of Texas Children’s Health Plan (a Medicaid managed care program) members age 1 to <18 years and hospitalized for asthma between January 1, 2012, and December 31, 2018. Primary outcomes were days to re-hospitalization and emergency department visit between 30 days and 365 days following the index hospitalization. Results We identified 1,485 children age 1 to <18 years hospitalized for asthma. Comparing those with a 30 day follow-up to those without, there was no difference in days to re-hospitalization (adjusted hazard ratio 1.23, 95% Confidence Interval (CI) 0.74–2.06) or emergency department visit for asthma (aHR 1.08, 95% CI 0.88–1.33). Inhaled corticosteroid and short acting beta agonist dispensing were greater in the group completing the 30 day follow-up (means of 2.8 and 4.8 respectively for those with follow-up, 1.6 and 3.5 respectively for those without, p < 0.0001). Conclusion Having a follow-up outpatient visit within 30 days of an asthma hospitalization is not associated with a decrease in asthma re-hospitalization or emergency department visit in the 30–365 day period following the index hospitalization. Non-adherence to regular use of inhaled corticosteroid medication was high in both groups. These findings suggest need for improvement in the quality and quantity of post hospital asthma follow-up.

Changes in asthma emergency department visits in the United States during the COVID-19 pandemic

Objective A better understanding of the impacts of the Coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits for asthma is needed to improve asthma control. Methods Using data from the National Syndromic Surveillance Program (NSSP), we assessed changes in average weekly asthma ED visits in the United States in 3 surveillance periods: 1) March 15, 2020–January 2, 2021; 2) January 3, 2021–January 1, 2022; and 3) January 2–March 5, 2022, relative to pre-pandemic comparison periods between December 30, 2018 and December 28, 2019. For each surveillance period, we assessed changes in asthma ED visits by age group and sex. Results For the surveillance period beginning March 15, 2020, average weekly asthma ED visits declined 31% relative to what was observed during the comparison period – that is, from 45,276 visits/week in 2019 to 31,374 visits/week in 2020. Declines of over 19% and 26% were observed for 2021 and 2022, respectively, relative to the comparison periods. In all surveillance periods, the largest declines occurred among children, especially those ages 0–4 (74%) and 5–11 (66%) years. Conclusions The COVID-19 pandemic impacted asthma ED visits in the United States. The impact was greater among children than adults, as ED visits among children were notably lower during all three pandemic surveillance periods than during the corresponding pre-pandemic periods. Additional information about the roles of behaviors of patients with asthma and changes in asthma care might improve our understanding of the reasons underlying these observed changes.