Follow-up after Acute Asthma Episodes

Emergency departments (EDs) are commonly used for the acute and chronic management needs of patients with asthma in the United States and account for nearly 2 million visits each year (1–5). Traditionally, the role of emergency physicians in caring for patients with acute asthma has been to provide emergency treatment and then to suggest follow-up visits with the primary care provider for ongoing preventive care. However, rates of follow-up with primary care providers are often low (6). Effective and timely outpatient care of asthma can prevent adverse asthma outcomes, specifically ED visits and hospitalizations (7, 8). For example, Ford et al. (7) assessed the effect of an asthma education program on African American and white adults with asthma and found patients who received an asthma education intervention demonstrated a decrease in ED visits after the education intervention versus patients who did not receive the educational intervention, with the most significant period of improvement observed in the first 4 months of receiving the educational intervention program. A case-control study on children ages 0 to 14 years was conducted to identify outpatient management practices associated with increased or decreased risk of adverse outcomes. It was noted that patients with written asthma management plans were half as likely to have a hospitalization or an ED visit as those who lacked a plan (9). The current systematic review is an attempt to identify effective strategies for patient follow-up after an asthma exacerbation that lead to improved clinical outcomes and decreased rates of subsequent exacerbations. Studies in both children and adults are included. Although follow-up after an asthma ED visit was the specific subject of the review, studies that report followup interventions after an asthma hospitalization that could be used after an ED visit are also included. The goal is to formulate specific follow-up management recommendations based on this review.