Asthma and lower airway diseaseImproved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005
Section snippets
Methods
We combined data from the ED component of the 1993 to 2005 National Hospital and Ambulatory Medical Care Survey (NHAMCS) to generate national estimates of ED visits for acute asthma. Our institutional review boards waived review of this analysis.
Methodological details are described elsewhere.9, 10 Briefly, the NHAMCS is a 4-stage probability sample of visits to US noninstitutional general and short-stay hospitals. The NHAMCS is conducted annually by the National Center for Health Statistics and
Results
Between 1993 and 2005, there were an estimated 23.8 million asthma-related ED visits in the United States, or an average 1.8 million visits per year. These visits represent 1.8% of all ED visits over this period. The annual rates of asthma-related ED visits per 1000 US population show an upward trend from 6.6 (95% CI, 5.4-7.7) in 1993 to 7.4 (95% CI, 6.1-9.0) in 1998 (Ptrend = .05). Rates have subsequently stabilized and may be declining, most recently to 6.0 (95% CI, 4.9-7.1) in 2005 (Fig 1).
Discussion
Most ED visits for acute asthma represent a treatment or maintenance failure8, 15 and are believed to be preventable through longitudinal disease management undertaken by both medical providers and the patient.16, 17 Rising trends in asthma morbidity in the 1980s and 1990s2 led to publication and widespread distribution of NAEPP guidelines in 1991, 1997, 2002, and most recently in 2007.6 ED visits for acute asthma are particularly disturbing because effective therapy is available, and ED
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C.A.C. is supported, in part, by grant HL-84401 (Bethesda, Md).
Disclosure of potential conflict of interest: A. A. Ginde receives grant support from the Emergency Medicine Foundation, Novo-Nordisk, and Bayer. J. A. Espinola declares that she has no conflict of interest. C. A. Camargo Jr has consultant arrangements with AstraZeneca and Critical Therapeutics; is on the advisory boards for Dey, Genentech, GlaxoSmithKline, and Merck; is on the speakers' bureau for AstraZeneca, GlaxoSmithKline, and Merck; and receives grant support from AstraZeneca, GlaxoSmithKline, Merck, Novartis, and Respironics.