Factors associated to recurrent visits to the emergency department for asthma exacerbations in children: implications for a health education programme.

Introduction: Recurrent emergency department (ED) visits for asthma exacerbations produce anxiety as well as high costs to the health system and the family.
Objective: To identify factors associated with recurrent ED visits for asthma exacerbations in children in Bogotá, Colombia.
Methods: Data obtained from a survey of parents of 223 patients with asthma (mean +/- SD: 4.8+/-3.5 years of age) attending an asthma clinic were analysed. Demographic data and a broad asthma knowledge and attitudes questionnaire were completed by the parents.
Results: Of the 223 asthmatic patients enrolled, 60 (26.9 %) had 3 or more visits to the ED for asthma in the last 6 months ("recurrent ED visits"). After controlling by age, educational level of the father, and severity of the disease; parents of children with "recurrent ED visits" were more prone to report that they attended ED because the asthma exacerbations were severe enough to go to the primary care physician (OR, 2.45; CI 95 %, 1.13-5.30; p=0.02); that asthma medications should be administered only when the children are symptomatic (OR, 3.26; CI 95 %, 1.45-7.36; p=0.004), and conversely they were less prone to have knowledge that asthma exacerbations can be avoided if medications are administered in the asymptomatic periods (OR, 0.31; CI 95 %, 0.14-0.68; p=0.003).
Conclusions: An educational programme intended to reduce the recurrent ED visits for asthma exacerbations should consider the inclusion of an explanation about the chronic nature of the disease and the importance of long-term therapy.