Hospital Medicine

Asthma Exacerbations Are Not Properly Treated After Emergency Department Visit

Patients with asthma are not receiving guideline-directed medical care after an emergency department (ED) visit and inpatient medicine (IM) admission, according to the results of a recent study presented at the 2020 American College of Allergy, Asthma, and Immunology Annual Scientific Meeting.

The rate of hospitalizations for asthma exacerbations is known to decrease with guideline-based medical therapies. In this retrospective evaluation, the researchers focused on how actual practice differs from expected practice based on guideline-directed medical therapy for patients with asthma exacerbations.

Included in this evaluation were 70 patient visits including adults aged 22 to 75 years, who had a primary diagnosis of asthma exacerbation. All individuals in the study were admitted to either an ED or IM at an urban tertiary care center between May 2013 and May 2015.

The researchers then utilized the 2007 National Heart Lung Blood Institute Expert Panel Review 3 (NHLBI-EPR 3) to retrospectively identify whether patients were given appropriate care for asthma. 

The researchers found that the 2 most significant discrepancies between the guidelines and practice was prescribing appropriate medical therapy and educating patients on proper inhaler technique. The results indicated that only 5.71% of patients received guideline-directed medical therapy, with 28.57% of patients prescribed to inappropriate medication for the severity of their asthma. Proper inhaler technique education was not given to 92.46% of patients.

“This study demonstrates that the vast majority of patients admitted to the ED or IM for asthma exacerbation did not receive guideline-directed medical therapy,” the researchers wrote. “Further studies are required to identify barriers to appropriate care and implement interventions focused on correcting this discrepancy.”

—Leigh Precopio


Monahan R, Thiagarajan K, Scott L, Kwong K, Banka L. P200 retrospective evaluation of adherence to asthma guidelines among adult patients after emergency department visit. Ann Allergy Asthma Immunol. 2020;125(5):S26. doi:10.1016/j.anai.2020.08.097