Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas approximately 2 in 5 reported having a written asthma action plan. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. The average age was 7.9 years 60% were male, and 33% were black. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. Information was collected on demographics asthma history usual asthma care frequency of symptoms during the last 4 weeks current asthma treatment, management, and control and past emergency asthma care.
An in-person questionnaire was administered to the parent or guardian during the ED visit. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan.
Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting. Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate however, most of these studies have been conducted in the inner cities of large urban areas. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs).
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