Asthma-related Emergency Department Visits Research Articles

Interaction of asthma, co-occurring mental illness, and geography on California emergency department visits, 2005–2014

Aim: To determine temporal changes in the frequency of asthma and mental illness in California emergency department (ED) visits and examine predictors of both asthma diagnosis and non-routine discharge from asthma visits. Methods: Public-use, all-payer ED data from non-federal, acute-care hospitals (2005–2014) were obtained for cross-sectional analysis. Due to substantial missing data, we used fully conditional specification multiple imputation with discriminant functions for age group, sex, race, and ethnicity. Multivariable logistic regression was used to examine asthma diagnosis (yes/no) among all ED visits and non-routine discharge (sent home vs. all else) among visits with asthma diagnosis. Primary independent variables were mental illness and the 3-digit zipcode of the patient’s residence. Covariates included demographics, payer type, and hospital characteristics. Results: During 2005–2014 there were 96,180,176 visits at 349 hospitals, and asthma diagnosis increased from 3.3% of ED visits in 2005 to 5.9% in 2014. However, asthma as a primary diagnosis decreased from 1.7% to 1.4% of ED visits. Among visits with asthma diagnosis (n = 4,419,629), co-occurring mood disorders increased from 2.1% in 2005 to 9.2% in 2014. Predictors of asthma diagnosis included attention deficit/conduct disorders [adjusted odds ratio (AOR) 1.41, 95% confidence interval (1.40–1.42)] and mood disorders [AOR 1.37, (1.36–1.37)]. Compared to Los Angeles, cities/areas most associated with asthma diagnosis were Richmond [zipcode 948, AOR 1.22 (1.20–1.24)], Bakersfield [933, AOR 1.21 (1.19–1.24)], and San Bernardino [924, AOR 1.20 (1.19–1.22)]. Ninety-six percent of ED visits with asthma resulted in routine discharge. Predictors of non-routine discharge included suicide/self-harm [AOR 4.74 (4.67–4.81)], schizophrenia [1.97 (1.94–1.99)], and mood disorders [1.35 (1.34–1.36)]. Areas associated with non-routine discharge included the Bakersfield vicinity [932, 1.29 (1.17–1.41)] and Ventura [930, 1.23 (1.10–1.38)]. Conclusions: Increased co-occurring mental illness among asthma-related ED visits suggests a need to improve care among those having co-occurrence. Understanding regional differences in asthma-related ED visits and hospitalization may improve interventions.

EVs meet health: A complex-systems policy integration approach for electric vehicle adoption and its impact on respiratory and cardiovascular disease

The transition from gasoline-combustion to zero-emission vehicles represents one of the most ambitious public and private enterprises around the globe to mitigate air pollution and its subsequent effects on climate change. The present study uses the rapid transition in the state of California to analyze the connections between the increasing utilization of electric vehicles (EVs) and two critical health outcomes: Asthma and acute myocardial infarction (AMI) emergency department (ED) visits. We fit simultaneous quantile and interquartile-range regression models to health and sociodemographic data from the California Office of Health and Hazard Assessment and electric vehicles registration data, 2011–2017. Results show that changes in EV utilization, from 2011 to 2013 to 2015–2017, have larger and more favorable effects as asthma and AMI deteriorate across zip codes. Looking at zip codes located at the 75th and 25th percentiles of the change in the asthma- and AMI-related ED visits distribution, a 5-percentage points change in the EV-to-gasoline combustion utilization ratio is associated with a 25-percentage points (p<.01) and 12.5-percentage points (p<.01) decline in asthma- and AMI-related ED visits, respectively. Our findings also suggest that, should the U.S. meet the goals of Executive Order N-79-20 by 2035, we could observe about 37,000 fewer asthma-related ED visits (95% CI: 16,154–59,280) per year, with an overall possible annual savings of about $65.5 million dollars (95% CI: $29.1M – $106.7M), and a possible decline of about 19,292 AMI-related hospitalizations, with possible annual savings of about $425 million dollars (95% CI: $365M – $509M). Our findings are optimistic in that spillover effects from increasing EV utilization can reduce healthcare costs while improving population health. Research should point toward the development of public-private coalitional strategies to effectively bridge usually disparate sectors of the economy and policy-making like energy and health.

Association of metformin use with asthma development and adverse outcomes: A systematic review and meta-analysis.

Asthma and diabetes are prevalent chronic diseases affecting a significant population globally. Research has suggested that metformin, a commonly used medication for diabetes management, may also have beneficial effects in enhancing asthma outcomes. Considering the comorbidity of asthma and diabetes, a comprehensive analysis was performed to investigate the efficacy of metformin in reducing adverse outcomes of asthma patients with diabetes. To gather relevant data, we conducted a systematic search of the PubMed, Embase, and CENTRAL databases for observational studies published prior to September 2023. We specifically looked for studies involving individuals diagnosed with both asthma and diabetes, comparing the incidence and severity of asthma exacerbations in metformin users versus nonusers. The inclusion criteria encompassed studies that recruited participants aged 18 years and older. The primary outcome of interest was the risk of newly developing asthma, while secondary outcomes included the adjusted risk of asthma-induced exacerbations, emergency room visits, and hospitalizations. All data analyses and visualizations were performed using the R programming language. We identified and included 7 studies involving a total of 1,176,398 patients in our analysis. The pooled effect size indicated a potential reduction in the incidence of newly developed asthma among patients with type 2 diabetes who used metformin, although this finding did not reach statistical significance. Similar conclusions have also been observed in other outcomes, such as exacerbation, asthma-related emergency department visits, risk of systemic corticosteroid prescription. The only positive outcome is that the use of metformin can reduce the chance of patients being hospitalized due to asthma. In most outcome indicators, it cannot be assumed that the use of metformin can reduce asthma-related adverse events. However, the conclusion is not so certain, and longer observation and more evidence are still required. Metformin still shows some potential in the intervention of respiratory diseases.

Using syndromic surveillance to rapidly assess the impact of a June 2023 wildfire smoke event on respiratory-related emergency department visits, Massachusetts, United States

Abstract A statewide air quality advisory was issued in Massachusetts for 6–7 June 2023 due to smoke originating from wildfires in Canada. Of particular concern was fine particulate matter, which has an aerodynamic diameter of ⩽2.5 μm (PM2.5) and has been linked to adverse respiratory outcomes. The objective of this study was to rapidly assess the impact of this wildfire smoke event on respiratory-related emergency department (ED) visits among Massachusetts residents. For exposure, daily air quality index (AQI) data from the US Environmental Protection Agency were used. Massachusetts counties, where for each day from 6 to 8 June 2023, the daily AQI was ⩾101 (i.e. unhealthy air quality), were considered exposed. For each exposed period, two unexposed reference periods where AQI &lt; 101 (i.e. ‘good’ or ‘moderate’ air quality) were identified within the two weeks prior to the exposed period, with the same days of the week and in the same county. Data from the Massachusetts Department of Public Health’s syndromic surveillance system were used to examine daily counts of ED visits for asthma, air-quality-related respiratory illness, and all causes by county of residence, age group, race, and Hispanic/Latino ethnicity. For each outcome, the numbers of ED visits were compared between the exposed and reference periods. Overall, there were no large increases in ED visits for any conditions examined during this wildfire smoke event. However, residents who were aged 18–64 years, Hispanic/Latino or White experienced small but not statistically significant increases in asthma-related ED visits. These potential differences in the effect on asthma-related ED visits by age and race/ethnicity may be relevant for analyses of future events. This study provides an example of how real-time, publicly available exposure data can be used in conjunction with outcome data from syndromic surveillance to rapidly examine the impact of wildfires and other acute environmental events on health.

Neighborhood Deprivation and Crime on Asthma Exacerbations and Utilization in Mild Adult Asthma

Social determinants of health (SDOH) have a significant impact on asthma outcomes, with factors such as income level and neighborhood environment playing crucial roles. This study aimed to assess the impact of Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related Emergency Department and urgent care (ED/UC) visits in adults with mild asthma. This retrospective cohort study utilized administrative data from Kaiser Permanente Southern California among 198,873 mild adult asthma patients between January 1, 2013, and December 31, 2018. Robust Poisson regression models, adjusted for age and sex, were employed to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and BMI categories to explore potential disparities in asthma outcomes. Among the cohort, 12,906 patients (6.5%) experienced AAE in one year, with Black patients having the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (aRRs: 1.11-1.27), with similar trends across BMI categories and race or ethnicity, except for Black patients. TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within one year. Higher NDI quintiles were associated with higher ED/UC visit risk (aRRs: 1.23-1.75), while TCI associations were weaker. Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing healthcare utilization, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma.

The Status of Asthma in the United States.

Asthma imposes a substantial health and economic burden on patients and their families and on the health care system. An assessment of the status of asthma in the US may lead to effective strategies to improve health and quality of life among people with asthma. The objective of our study was to assess the historical trends and current state of asthma illness and death among children and adults in the US. We assessed asthma-related emergency department visits and hospitalizations among children and adults by using data from the 2010-2021 National Health Interview Survey (NHIS), the 2010-2020 Nationwide Emergency Department Sample (NEDS), the National (Nationwide) Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ). Asthma death rates were calculated by using 2010-2021 National Vital Statistics System data. Asthma prevalence increased significantly among adults from 2013 through 2021 (P = .04 for the annual percentage change [APC] slope) and decreased among children from 2010 through 2021 (P values for slopes: 2010-2017, P = .03; 2017-2021, P = .03). Prevalence of current asthma was higher among non-Hispanic Black people (children, 12.5%; adjusted prevalence ratio [APR] = 2.19; 95% CI, 1.68-2.84 and adults, 10.6%; APR = 1.25; 95% CI, 1.09-1.43) compared with non-Hispanic White people (children, 5.7%; adults, 8.2%). Prevalence of asthma attacks and use of asthma-related health care declined among adults and children. Asthma prevalence and asthma-related emergency department visits, hospitalization, and death rates differed by select characteristics. Although asthma attacks, ED visits, hospitalizations, and deaths have declined since 2010 among all ages, current asthma prevalence declined only among children, and significant disparities in health and health care use still exist.

Results of the RVA Breathes randomized controlled trial.

This study tested a randomized controlled trial of RVA Breathes, a community asthma program, in reducing asthma-related healthcare utilization among children living in an area with a high poverty rate. Participants included 250 caregivers (78% African American/Black; 73.3% household income<$25,000/year) and their children with asthma (5-11 years). Inclusion criteria included an asthma-related emergency department (ED) visit, hospitalization, unscheduled doctor's visit, or systemic steroids in the past 2 years. Families were randomized to a full active intervention (asthma education with community health workers [CHWs], home remediation with home assessors, and a school nurse component; n = 118), partial active intervention (asthma education and home remediation; n = 69), or a control group (n = 63) for 9 months. Measures on healthcare utilization and asthma-related factors were collected. Follow-up assessments occurred across a 9-month period. Although we did not find any significant effects, there was a trend toward significance for a group by time effect with objective healthcare utilization as the outcome (F4,365 = 2.28, p = .061). The full intervention group experienced a significant decrease from baseline to 9-month follow-up compared with the other groups (p < .001). Only the full intervention group experienced a significant increase in reported asthma action plans across time (no significant group effect). In the context of the unprecedented COVID-19 pandemic, which led to a substantial global decrease in healthcare utilization, the study's main hypotheses were not supported. Nevertheless, findings support the benefit of community asthma programs that integrate care across multiple settings and connect families with CHWs.

A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children’s hospital: a retrospective cohort study

BackgroundDespite asthma guidelines’ recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent.MethodsWe performed a retrospective cohort study of children aged 1–17 years presenting with asthma to the Children’s Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 – August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not.Results1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28).ConclusionsPatients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.

Neighborhood-level variability in asthma-related emergency department visits in Central Texas

The extent to which incidence rates of asthma-related emergency department (ED) visits vary from neighborhood to neighborhood and predictors of neighborhood-level asthma ED visit burden are not well understood. We aimed to describe the census tract-level spatial distribution of asthma-related ED visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates. Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across census tracts in Travis County, Texas, and assess the contribution of census tract characteristics to their distribution. There were distinct patterns in ED visit incidence rates at the census tract scale. These patterns were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. However, racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. The census tract predictors of ED visit incidence rates differed by racial and ethnic group. Variability in asthma ED visit incidence rates are apparent at smaller spatial scales. Most of the variability in census tract-level asthma ED visit rates in Central Texas is not explained by racial and ethnic composition or other neighborhood characteristics.

The relationship between neighborhood economic deprivation and asthma-associated emergency department visits in Maryland.

Asthma represents a substantial public health challenge in the United States, affecting over 25 million adults. This study investigates the impact of neighborhood economic deprivation on asthma-associated Emergency Department (ED) visits in Maryland, using the Distressed Communities Index (DCI) for analysis. A retrospective analysis of Maryland's Emergency Department Databases from January 2018 to December 2020 was conducted, focusing on asthma-associated ED visits. The study involved 185,317 ED visits, majority of which were females (56.3%) and non-Hispanic whites (65.2%). A significant association was found between increased neighborhood socioeconomic deprivation and asthma-related ED visits. The poorest neighborhoods showed the highest rates of such visits. Compared to prosperous areas, neighborhoods classified from Comfortable to Distressed had progressively higher odds for asthma-related ED visits (Comfortable: OR = 1.14, Distressed OR = 1.65). Other significant asthma predictors included obesity, female gender, tobacco smoking, and older age. There is a substantive association between higher asthma-related ED visits and high neighborhood economic deprivation, underscoring the impact of socioeconomic factors on health outcomes. Addressing healthcare disparities and improving access to care in economically distressed neighborhoods is crucial. Targeted interventions, such as community health clinics and asthma education programs, can help mitigate the impact of neighborhood disadvantage.

Pollen and viruses contribute to spatio-temporal variation in asthma-related emergency department visits

BackgroundAsthma exacerbations are an important cause of emergency department visits but much remains unknown about the role of environmental triggers including viruses and allergenic pollen. A better understanding of spatio-temporal variation in exposure and risk posed by viruses and pollen types could help prioritize public health interventions. ObjectiveHere we quantify the effects of regionally important Cupressaceae pollen, tree pollen, other pollen types, rhinovirus, seasonal coronavirus, respiratory syncytial virus, and influenza on asthma-related emergency department visits for people living near eight pollen monitoring stations in Texas. MethodsWe used age stratified Poisson regression analyses to quantify the effects of allergenic pollen and viruses on asthma-related emergency department visits. ResultsYoung children (<5 years of age) had high asthma-related emergency department rates (24.1 visits/1,000,000 person-days), which were mainly attributed to viruses (51.2%). School-aged children also had high rates (20.7 visits/1,000,000 person-days), which were attributed to viruses (57.0%), Cupressaceae pollen (0.7%), and tree pollen (2.8%). Adults had lower rates (8.1 visits/1,000,000 person-days) which were attributed to viruses (25.4%), Cupressaceae pollen (0.8%), and tree pollen (2.3%). This risk was spread unevenly across space and time; for example, during peak Cuppressaceae season, this pollen accounted for 8.2% of adult emergency department visits near Austin where these plants are abundant, but 0.4% in cities like Houston where they are not; results for other age groups were similar. ConclusionsAlthough viruses are a major contributor to asthma-related emergency department visits, airborne pollen can explain a meaningful portion of visits during peak pollen season and this risk varies over both time and space because of differences in plant composition.

The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use.

Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related emergency department (ED) visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to the within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. Methods: An administrative database was used to define census tract population-based incidence rates of asthma-related ED visits. We estimate the associations between census tract incidence rates and 1) average fine and coarse particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and 2) racial and ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We also examine for the attenuation of incidence risk ratios (IRRs) associated with race/ethnicity when controlling for air pollution exposure. Measurements and Main Results: Fine and coarse particulate matter and SO2 are all associated with census tract-level incidence rates of asthma-related ED visits, and multipollutant models show evidence of independent risk associated with coarse particulate matter and SO2. The association between census tract incidence rate and Black resident share (IRR, 1.51 [credible interval (CI), 1.48-1.54]) is attenuated by 24% when accounting for air pollution (IRR, 1.39 [CI, 1.35-1.42]), and the association with Latinx resident share (IRR, 1.11 [CI, 1.09-1.13]) is attenuated by 32% (IRR, 1.08 [CI, 1.06-1.10]). Conclusions: Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.

A randomized controlled trial of a family-based community health worker delivered intervention for urban adolescents with uncontrolled asthma

ABSTRACT Black adolescents with asthma are at elevated risk for health disparities. This study used mixed methods to test an evidence-based, family intervention adapted for home-based delivery by community health workers (CHWs). Fifty-nine families were randomly assigned to receive the adapted intervention, Reach for Control (RFC), or home-based case management. Paired t-tests showed adolescents in both groups had significant decreases in asthma-related emergency department visits. Families in RFC also had significant improvements in asthma management. Qualitative interviews suggested high satisfaction with CHW delivery, but treatment dose was low. Additional studies are needed to develop effective interventions for this population.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

The increasing burden of asthma acute care in Singapore: an update on 15-year population-level evidence

BackgroundIn Singapore, there is currently scarce population-based research informing the recent trends of asthma-related healthcare burdens. In this study, we investigated the past 25-year trends of asthma-related hospitalisations, emergency department (ED) visits and deaths in Singapore and projected the future burdens from 2023 to 2040.MethodsWe acquired annually-measured data from the Singapore Ministry of Health Clinical and National Disease Registry, containing 25-year asthma-related hospitalisation and death rates as well as 15-year ED visit rates. We conducted change-point analysis and generalised linear modelling to identify time intervals with stable trends and estimate asthma-related healthcare utilisation and mortality rates. To project future asthma-related burdens, we developed a probabilistic model which combined projections of future population size with the estimated rate outcomes from the last stable period.ResultsOur results show that the asthma hospitalisation rate in Singapore had remained at approximately 80 episodes per 100,000 from 2003 to 2019 and are likely to grow by 1.7% each year (95% CI: 0.7, 5.0%), leading to a total of 163,633 episodes from 2023 to 2040 which corresponds to an estimated $103,075,820 based on 2022 USD. Besides, Singapore’s asthma-related ED visit rate was 390 per 100,000 in 2019 and is expected to decline by 3.4% each year (95% CI: − 5.8, 0.0%), leading to a total of 208,145 episodes from 2023 to 2040 which corresponds to USD$15,053,795. In contrast, the 2019 asthma-related mortality rate in Singapore was approximately 0.57 per 100,000 and is likely to stay stably low (change per year: -1.3, 95% CI: − 11.0, 4.3%). Between 2023 and 2040, Singapore’s estimated total number of asthma-related deaths is 638 episodes.ConclusionsCurrently, the burden of asthma acute care in Singapore is high; Singapore’s asthma-related hospitalisation and ED visit rates are relatively higher than those of other developed economies, and its asthma admission rate is expected to increase significantly over time, possibly indicating excess resource use for asthma. The established national asthma programme in Singapore, together with recent efforts in reinforcing primary care at the national level, provides opportunities to reduce avoidable asthma admissions.

Seasonal pattern of emergency department visits by children with asthma.

It is important to understand the factors associated with seasonal asthma attacks among children so we can evaluate them appropriately. The study examined the seasonal variation of asthma-related emergency department visits by children in Istanbul. This descriptive study examined all paediatric patients with asthma who visited the paediatric emergency department of a tertiary hospital in Istanbul, Türkiye, between January 2017 and December 2022. Asthma diagnosis was based on physical examination and clinical history of the patients and asthma-related visits during winter, spring, summer, and autumn were considered repeated measurements. Data analysis was done using SPSS 25.0. Visits by asthmatic children to the emergency department constituted 4.9% of all visits. Some 56.9% of the asthmatic children were male and 43.1% were female. Asthma-related emergency department visits were 10.4% in 2017 and 3.6% in 2022. Visits to paediatric emergency departments due to asthma decreased from 19 685 in 2017 to 7485 in 2022. Between 2017 and 2022, children aged 0-5 years represented the highest proportion of visits (64-72.8%). Asthmatic children aged 0-5 years and 6-11 years were admitted to the hospital mostly in January (13.5%, 13.5%) and December (12.8%, 14.0%). In the age group 12-18 years, the visits occurred mostly in January (11.9%) and March (11.2%). The frequency and number of asthma-related visits to the paediatric emergency department decreased over the 6-year period of this study. There were increases in visits in October, November, December, and January, and decreases in June, July and August.

Impact of Guideline-Based Asthma Treatment on Health Services Use in Singapore Before and During COVID-19 Outbreak.

To date, the role of standard asthma care in reducing asthma-related health services use (HSU) during the COVID-19 pandemic remains unclear. This study examined the impact of guideline-based asthma treatment on the use of asthma-related emergency department (ED) visits, polyclinic visits (total visits and urgent visits characterized by nebuliser use) before and during the pandemic. Data from April 2017 to October 2020 was obtained from the National University Health System, one of the three healthcare clusters in Singapore. Using generalized linear models, we estimated the joint effects of the ratio of preventer to reliever dispensations (PRR) and COVID-19 on asthma-related ED visits per hospital per month, total asthma-related polyclinic visits and asthma-related urgent polyclinic visits per clinic per month. Findings show that before the onset of COVID-19, for every 0.5 unit increase in PRR, the number of asthma-related ED visits and urgent polyclinic visits decreased by 12.9% (95% CI: -13.0% to -12.9%) and 6.8% (95% CI: -6.9% to -6.7%), respectively, whereas total asthma-related polyclinic visits increased by 1.0% (95% CI: 0.9% to 1.0%). During the pandemic, a 0.5 unit increase of PRR decreased the number of asthma-related ED visits, urgent and total polyclinic visits by 16.9% (95% CI: -17.0% to - 16.9%), 9.3% (95% CI: -9.5% to -9.2%) and 0.7% (95% CI: -0.8% to -0.7%), respectively. These findings suggest that regardless of the COVID-19 pandemic, an increase in PRR consistently reduced the frequency of asthma-related urgent and emergent care, although it barely influenced routine asthma follow-up visits.

Asthma-related emergency admissions and associated healthcare resource use in Alberta, Canada

BackgroundThere is a lack of real-world research assessing asthma management following asthma-related emergency department (ED) discharges. The objective of this study was to characterise follow-up care, healthcare resource use (HCRU)...

Predicting pediatric severe asthma exacerbations: an administrative claims-based predictive model

Objective Previous machine learning approaches fail to consider race and ethnicity and social determinants of health (SDOH) to predict childhood asthma exacerbations. A predictive model for asthma exacerbations in children is developed to explore the importance of race and ethnicity, rural-urban commuting area (RUCA) codes, the Child Opportunity Index (COI), and other ICD-10 SDOH in predicting asthma outcomes. Methods Insurance and coverage claims data from the Arkansas All-Payer Claims Database were used to capture risk factors. We identified a cohort of 22,631 children with asthma aged 5–18 years with 2 years of continuous Medicaid enrollment and at least one asthma diagnosis in 2018. The goal was to predict asthma-related hospitalizations and asthma-related emergency department (ED) visits in 2019. The analytic sample was 59% age 5–11 years, 39% White, 33% Black, and 6% Hispanic. Conditional random forest models were used to train the model. Results The model yielded an area under the curve (AUC) of 72%, sensitivity of 55% and specificity of 78% in the OOB samples and AUC of 73%, sensitivity of 58% and specificity of 77% in the training samples. Consistent with previous literature, asthma-related hospitalization or ED visits in the previous year (2018) were the two most important variables in predicting hospital or ED use in the following year (2019), followed by the total number of reliever and controller medications. Conclusions Predictive models for asthma-related exacerbation achieved moderate accuracy, but race and ethnicity, ICD-10 SDOH, RUCA codes, and COI measures were not important in improving model accuracy.

Association of serotonin reuptake inhibitors with asthma control.

Background: Clinical trials demonstrated that selective serotonin reuptake inhibitors (SSRI) can improve asthma control in patients with comorbid major depressive disorder (MDD) and that this effect may be greater than the effect of SSRIs on depression. These findings suggest that SSRIs may improve asthma control in patients without MDD. Objective: The current retrospective study examined the effect of SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRI) on asthma control in adult patients. We hypothesized that patients would have fewer asthma exacerbations after treatment with an SSRI or SNRI. Methods: Electronic health record data of adult patients (N = 592) who were seen at a University of Texas Southwestern (UTSW) hospital or clinic and had (1) an SSRI or SNRI prescription, (2) a previous asthma diagnosis, and (3) no mood disorder diagnosis were extracted by using the UTSW Clinical Data Exchange Network. Wilcoxon signed rank tests were used to compare oral corticosteroid prescriptions and asthma-related emergency department (ED) visits and hospitalizations in the 12 months before and after the start of an SSRI/SNRI. Results: Therapy with SSRIs/SNRIs was associated with a significant decrease in oral corticosteroid use (p = 0.003), ED visits (p = 0.002), and hospitalizations (p < 0.001). Conclusion: Results from the current study add to the existing literature by demonstrating a reduced rate of severe exacerbations in patients with asthma by using an SSRI/SNRI without limiting the analytic sample to a high-illness-severity subgroup defined by symptoms of asthma or depression. Future work should include a prospective, placebo controlled study with individuals who have asthma and no comorbid mental health condition, verified by a mental health professional.