Assessment of Predictor Factors Associated with Multiple Emergency Department Attendance with Asthma Attack: A Qualitative and Multicentric Prospective Observational Study

Abstract

Prabakar Vaittinada Ayar,1,2 Camille Taillé,2,3 Pradeebane Vaittinada Ayar,4 Matthieu Gay,1 Alhassane Diallo,2,5 Aïchata Fofana Dara,6 Olivier Peyrony,2,7 Olivier Chassany,2,6,8 Enrique Casalino2,9 1Emergency Department, Beaujon University Hospital-APHP, Paris, France; 2University of Paris, Paris, France; 3Respiratory Diseases Department, Bichat University Hospital-APHP, Paris, France; 4NORCE Norwegian Research Centre, Bjerknes Centre for Climate Research, Bergen, Norway; 5Epidemiology Department, Biostatistics and Clinical Research, Bichat University Hospital-APHP, Paris, France; 6UMR 1123, Inserm, Paris, France; 7Emergency Department, Saint-Louis University Hospital-APHP, Paris, France; 8Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital-APHP, Paris, France; 9Emergency Department, Bichat University Hospital-APHP, Paris, FranceCorrespondence: Prabakar Vaittinada Ayar, Email [email protected]: Identified factors associated with multiple emergency department (ED) visits (≥) for asthma, which is associated with death.Patients and Methods: We first conducted a qualitative study. We invited French-speaking adults (≥ 18 years old) with a diagnosis of asthma for more than 6 months. The identified concepts were transcribed into items. A Delphi method allowed for selecting items for a self-reported questionnaire. In an observational multicentric cross-sectional quantitative study, the resulting 20-item questionnaire and 12-item General Health Questionnaire, exploring psychological distress, were administered to adults visiting an ED for asthma exacerbation. Multivariable logistic regression was used to assess factors associated with ED visits.Results: Data saturation was obtained after 8 patient interviews. Patients who came to the ED seemed unfamiliar with their illness or treatments but were concerned by the disease. The questionnaire was administered to 182 patients. On multivariable logistic regression, multiple and systematic ED visits were associated with asthma exacerbation (adjusted odds ratio (aOR) = 6.89, 95% confidence interval [CI]: 2.25– 21.09), asthma perceived as a handicap (aOR=3.19, 95% CI: 1.55– 6.57) and reported atopy (OR=2.09, 95% CI: 1.03– 4.26). High educational level and lack of maintenance inhaled corticosteroids were protective for multiple ED visits.Conclusion: Inadequate medical care is frequent in patients attending the ED for an asthma exacerbation, associated with strong psychological impact. Questioning the reasons for consulting the ED may help quickly identify patients requiring asthma education and improve their referral.Keywords: asthma, emergency department, multiple attendance, psychological burden

Keywords

• asthma
• emergency department
• multiple attendance
• psychological burden