From the Guidelines
Having two emergency department visits for asthma in the past year is not explicitly listed as a risk factor for asthma-related death in the most recent and highest quality study available, which instead notes three or more ED visits in the past year as a risk factor 1. However, it is essential to consider the context and the overall clinical picture. The guidelines suggest that patients with a history of frequent emergency department visits for asthma should be evaluated for poorly controlled asthma and managed accordingly.
- Key points to consider in managing such patients include:
- Prompt referral to an asthma specialist
- Optimization of controller medications, such as inhaled corticosteroids and long-acting beta-agonists
- Development of a detailed asthma action plan
- Close follow-up and education about early recognition of worsening symptoms The underlying reason for the increased mortality risk in patients with frequent asthma exacerbations is the potential for airway remodeling, progressive loss of lung function, and fatal respiratory failure during subsequent attacks, as well as the persistence of airway inflammation due to inadequate controller therapy 1.
- Risk factors for asthma-related death, as outlined in the guidelines, include:
- Previous severe exacerbation
- Two or more hospitalizations or more than three ED visits in the past year
- Use of more than two canisters of short-acting beta-2 agonist per month
- Difficulty perceiving airway obstruction or the severity of worsening asthma
- Low socioeconomic status or inner-city residence
- Illicit drug use
- Major psychosocial problems or psychiatric disease
- Comorbidities, such as cardiovascular disease or other chronic lung disease 1.
From the Research
Asthma-Related Death Risk Factors
- Two emergency department visits for asthma in the past year may indicate a higher risk of asthma-related complications, but the provided studies do not directly address the risk of asthma-related death associated with this specific frequency of visits.
- A study from 1995 2 found that patients with multiple emergency department visits for asthma in the past year had more severe asthma, were more likely to have nocturnal asthma, and had higher rates of work and school absenteeism.
- Another study from 2014 3 characterized patients with asthma according to their frequency of ED visits and found that frequent ED users had suboptimal guideline-recommended management, including lack of evidence of prior evaluation by an asthma specialist and inadequate treatment with inhaled corticosteroids.
Emergency Department Visits and Asthma Severity
- The 1995 study 2 suggested that multiple emergency department visits are associated with increased asthma severity, as indicated by the need for hospital admission and the presence of nocturnal asthma.
- The 2014 study 3 also found that markers of chronic asthma severity were significant predictors of frequent ED visits.
- However, none of the provided studies directly link two emergency department visits for asthma in the past year to an increased risk of asthma-related death.
Asthma Management and Outcomes
- Studies from 2009 4 and 2012 5 demonstrated the effectiveness of combination therapies, such as salmeterol/fluticasone propionate, in improving asthma outcomes and reducing the risk of severe exacerbations.
- The 2005 review 6 of inhaled salmeterol/fluticasone propionate also highlighted its effectiveness in maintaining asthma control and improving lung function and symptoms.
- While these studies provide insight into effective asthma management strategies, they do not specifically address the risk of asthma-related death associated with two emergency department visits in the past year.