Asthma Education in the Emergency Department

Abstract

Study Objective: We surveyed emergency department–based asthma researchers to study the presence of formal asthma education programs (AEPs), and examined data from prospective cohort studies to compare sites with and without AEPs. Methods: We contacted site investigators in the Multicenter Airway Research Collaboration (MARC) in July 1998 by mail, fax, or telephone. Main outcomes were the percentage of sites using AEPs and the percentage of AEPs using each of 7 “key” teaching items in national guidelines. MARC data provided site and patient characteristics. Results: All 77 site investigators (100%) responded to the survey. Using a scale from 1 to 5 (mean±SD), respondents identified instruction in proper inhaler technique (4.8±0.5), “spacer” use (4.3±0.7), recognition of asthma triggers (4.3±0.8), and rationale for medications (4.6±0.6) as priorities for teaching. Twelve sites (16%; 95% confidence interval [CI] 8% to 26%) had AEPs; most (8) were at pediatric sites. Patients presenting to sites with AEPs were younger (22±16 years versus 25±15 years, P <.001), more likely to be uninsured (26% versus 23%, P <.001), and less likely to be taking inhaled corticosteroids (30% versus 37%, P <.001). AEP sites uniformly stressed “key” items, except for “written action plan” (50% of sites) and “peak flow diary” (33% of sites). Conclusion: Although asthma researchers agree that patient education is very important, few EDs involved in asthma research use AEPs. Sites with AEPs appear to serve patients at higher risk of poor asthma outcomes. Further study is needed to address the effectiveness of AEPs in the ED. [Emond SD, Reed CR, Graff LG IV, Clark S, Camargo CA Jr, on behalf of the MARC Investigators. Asthma education in the emergency department. Ann Emerg Med. September 2000;36:204-211.]

Introduction

Asthma is a common disease, accounting for almost 2 million emergency department visits and 460,000 hospitalizations in the United States annually.¹ Direct and indirect costs of acute asthma care are estimated to be at least $2 billion per year.² Efforts aimed at lessening asthma’s burden have focused on preventive care (especially use of inhaled corticosteroids) and educational strategies. In primary care and specialty clinic settings, asthma education has improved outcomes for patients with moderate and severe persistent asthma,3, 4, 5, 6 and may be useful for patients with less severe asthma.7, 8, 9 Patient education has been shown to be cost-effective.¹⁰ Unfortunately, most patients presenting to the ED with acute asthma do not have adequate primary care or exposure to asthma education.¹¹ In practice, the ED may be the only place to provide these patients with information on preventive care and self-management.¹² However, the delivery of effective patient teaching in the ED may be limited because of acute patient care needs, strained staff and other resources, and poor access to follow-up.

The 1997 National Asthma Education and Prevention Program’s (NAEPP) Expert Panel Report stressed the importance of reinforcing asthma teaching at every asthma encounter, including ED visits for acute asthma.¹³ This consensus statement was based on research that included relatively few studies of ED-based educational interventions.14, 15 To describe better ED-based asthma education programs (AEPs) in practice, we conducted a national survey to determine attitudes toward formal asthma education in the ED, the proportion of sites providing AEPs, and characteristics of these sites and the patients they serve. We expected that few sites had AEPs, and that the format and content of existing programs would vary widely.