Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Apr 28;5(4):e007435.
doi: 10.1136/bmjopen-2014-007435.

Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan?

Hiroko Watase  1 , Yusuke Hagiwara  2 , Takuyo Chiba  3 , Carlos A Camargo Jr  4 , Kohei Hasegawa  5 ; Japanese Emergency Medicine Network Investigators
Collaborators, Affiliations
Observational Study

Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan?

Hiroko Watase et al. BMJ Open. .

Abstract

Objectives: Emergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently presented to the ED for asthma exacerbation in Japan.

Design: A multicentre chart review study of 23 EDs across Japan.

Participants: Adults aged 18-54 years who presented to the ED with asthma exacerbation from 2009 to 2011.

Outcome measures: Frequency of ED visits for asthma exacerbation in a 1-year period, including the index ED visit.

Results: Of the 1002 eligible patients, 218 (22%) had frequent ED visits, accounting for 48% of total ED visits for asthma exacerbation in the 1-year period. Specifically, 12% had 2 ED visits and 10% had ≥3 visits. In these patients, guideline-recommended chronic management was suboptimal. For example, among patients with ≥3 ED visits, only 63% were treated with inhaled corticosteroids and 49% were current smokers. In a multinomial logistic regression model, markers of chronic asthma severity (history of hospitalisation for asthma and use of inhaled corticosteroids) were significantly associated with a higher frequency of ED visits (both p<0.05).

Conclusions: This multicentre study in Japan demonstrated that many patients are frequent ED users for asthma exacerbation. We also found that their asthma control management is suboptimal, most likely contributing to worse chronic severity and more frequent ED visits. Further dissemination and adoption of evidence-based guidelines are required to reduce asthma morbidity in this high-risk population.

Keywords: asthma exacerbation; emergency department; inhaled corticosteroids; multicenter study; risk factors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The schematic of strategy used to identify emergency department (ED) visit frequency.
Figure 2
Figure 2
Number of patients with asthma exacerbation and cumulative number of emergency department (ED) visits for asthma exacerbation, according to ED visit frequency.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Asthma. http://www.cdc.gov/asthma/ (accessed 10 Mar 2015).
    1. Fukutomi Y, Nakamura H, Kobayashi F et al. . Nationwide cross-sectional population-based study on the prevalences of asthma and asthma symptoms among Japanese adults. Int Arch Allergy Immunol 2010;153:280–7. 10.1159/000314369 - DOI - PubMed
    1. Weiss KB, Sullivan SD, Lyttle CS. Trends in the cost of illness for asthma in the United States, 1985–1994. J Allergy Clin Immunol 2000;106:493–9. 10.1067/mai.2000.109426 - DOI - PubMed
    1. Adachi M, Fukuda T, Morikawa A et al. . [Asthma mortality and burden of asthma in Japan]. Allergology & Immunology 2005;12:1438–47.
    1. Ministry of Health, Labor and Welfare. http://www.mhlw.go.jp/new-info/kobetu/kenkou/ryumachi/jititai.html (accessed 10 Mar 2015).

Publication types