• Michael D Brown, Mathew J Reeves, Karen Meyerson, and Steven J Korzeniewski.
• Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Grand Rapids, Michigan, USA.
• Ann. Allergy Asthma Immunol. 2006 Jul 1;97(1):44-51.

BackgroundPatients with asthma who visit the emergency department (ED) may benefit from education that optimizes self-management and treatment.ObjectiveTo conduct a randomized trial of asthma education (AE) after an ED visit.MethodsPatients who present with acute asthma and history consistent with moderate to severe persistent asthma or recent ED visits were stratified by age (adult, child) and randomly assigned to intervention or usual care during the ED visit. The intervention was conducted by trained asthma educators and included a facilitated office visit with the primary care physician followed by a home visit. Intention-to-treat analysis was conducted, with time to first asthma relapse (either ED or unscheduled urgent office visit) during the 6-month follow-up period used as the primary outcome.ResultsOf the 239 patients analyzed, 46% were adults, 46% were male, 30% were African American, and 56% had moderate to severe persistent asthma. Follow-up information was obtained on 191 patients (80%) at 6 months; 23.1% of the intervention group vs 31.1% of the usual care group had an urgent asthma visit (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.48-1.29). Overall, 39% of the 117 patients assigned to the intervention group did not comply with any of the post-ED activities. Subgroup analysis suggested greater benefit among children (HR, 0.62; 95% CI, 0.33-1.19) than adults (HR, 1.08; 95% CI, 0.50-2.33).ConclusionsDelivery of a comprehensive AE program after an ED visit was ineffective in adult patients; however, it may be effective in children. Further research on alternative AE delivery strategies appears warranted to reduce the burden of asthma visits to the ED.

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