• Hiroko Watase, Yusuke Hagiwara, Takuyo Chiba, Carlos A Camargo, Kohei Hasegawa, and Japanese Emergency Medicine Network Investigators.
• Department of Radiology, University of Washington, Seattle, Washington, USA.
• BMJ Open. 2015 Jan 1;5(4):e007435.

ObjectivesEmergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently presented to the ED for asthma exacerbation in Japan.DesignA multicentre chart review study of 23 EDs across Japan.ParticipantsAdults aged 18-54 years who presented to the ED with asthma exacerbation from 2009 to 2011.Outcome MeasuresFrequency of ED visits for asthma exacerbation in a 1-year period, including the index ED visit.ResultsOf the 1002 eligible patients, 218 (22%) had frequent ED visits, accounting for 48% of total ED visits for asthma exacerbation in the 1-year period. Specifically, 12% had 2 ED visits and 10% had ≥3 visits. In these patients, guideline-recommended chronic management was suboptimal. For example, among patients with ≥3 ED visits, only 63% were treated with inhaled corticosteroids and 49% were current smokers. In a multinomial logistic regression model, markers of chronic asthma severity (history of hospitalisation for asthma and use of inhaled corticosteroids) were significantly associated with a higher frequency of ED visits (both p<0.05).ConclusionsThis multicentre study in Japan demonstrated that many patients are frequent ED users for asthma exacerbation. We also found that their asthma control management is suboptimal, most likely contributing to worse chronic severity and more frequent ED visits. Further dissemination and adoption of evidence-based guidelines are required to reduce asthma morbidity in this high-risk population.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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