Primary Care Research

Primary care doctors often fail to prescribe "controller medications" for asthma patients after an emergency room visit

Use of inhaled corticosteroids (also called "controller medications") can prevent asthma flareups that send patients to the emergency department (ED). However, primary care doctors often fail to add controller medications to the regimen of asthmatic patients after a visit to the ED, according to a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00059). However, when inhaled corticosteroids were initiated in the ED or at hospital discharge, they were almost universally continued at followup by the primary care physician. Thus, the ED visit is an opportunity to improve the care, education, and lifestyle of many asthmatic patients.

Researchers retrospectively studied 629 patients, aged 6 to 45 years, treated for an acute asthma episode in the ED (index visit) during a 6-month period and followed them for up to 1 year. Overall, 414 of these patients were not previously receiving inhaled corticosteroid therapy. One-fourth of patients (24 percent) were prescribed an inhaled corticosteroid at the ED or upon hospital discharge. Of these 99 patients, 37 had a primary care follow-up visit within 6 months. Four patients had their inhaled corticosteroid dose changed and none had the medications discontinued. Of the 315 patients not prescribed an inhaled corticosteroid on ED or hospital discharge, 128 had a primary care followup visit within 6 months. Only 32 patients (25 percent) had an inhaled corticosteroid added to their therapeutic regimen to prevent further flareups and need for emergency care.

See "Inadequate follow-up controller medications among patients with asthma who visit the emergency department," by Rita K. Cydulka, M.D., M.S., Joshua H. Tamayo-Sarver, Ph.D., Christine Wolf, B.A., and others, in the October 2005 Annals of Emergency Medicine 46(4), pp. 316-322.

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