Low rates of controller medication initiation and outpatient follow-up after emergency department visits for asthma

J Pediatr. 2012 Feb;160(2):325-30. doi: 10.1016/j.jpeds.2011.07.037. Epub 2011 Aug 31.


Objective: To determine what proportion of patients who are seen in an emergency department (ED) for asthma receive inhaled corticosteroids or attend follow-up appointments.

Study design: This was a retrospective cohort study of 2007-2009 South Carolina Medicaid data. Enrollees aged 2-18 years who had an ED visit for asthma were included. Patients admitted for asthma or with an inhaled corticosteroid claim in the 2 months before the month of the ED visit were excluded. Covariates were sex, race, age, rural residence, and asthma severity. Outcome measures were a prescription for an inhaled corticosteroid filled within the 2 months after the ED visit and attendance at a follow-up appointment within the 2 months after the ED visit.

Results: A total of 3435 patients were included. Out of the study cohort, 57% were male, 76% were of a minority race/ethnicity, 69% lived in an urban areas, 18% had inhaled corticosteroid use, and 12% completed follow-up. Multivariate analyses demonstrated that patients with severe asthma were more likely to receive an inhaled corticosteroid (OR, 2.9; 95% CI, 2.3-3.7) and attend a follow-up appointment (OR, 2.0; 95% CI, 1.5-2.6). Patients aged 2-6 years and those aged >12 years were less likely to attend follow-up (OR, 0.71; 95% CI, 0.56-0.90 and OR, 0.62; 95% CI, 0.47-0.83, respectively) (all models P < .0001).

Conclusion: Children with asthma seen in the ED have low rates of inhaled corticosteroid use and outpatient follow-up. This indicates a need for further interventions to increase the use of inhaled corticosteroids in response to ED visits.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Appointments and Schedules
  • Asthma / drug therapy*
  • Asthma / prevention & control
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Office Visits / statistics & numerical data
  • Outpatients / statistics & numerical data*
  • Patient Compliance / statistics & numerical data*
  • Retrospective Studies
  • Treatment Outcome


  • Adrenal Cortex Hormones