“Asthma affects approximately 9% of adults in the US,” researchers wrote in Annals of Allergy, Asthma & Immunology. “Despite various available treatments, many patients still experience acute asthma attacks requiring emergency treatment. Between 2016 and 2018, 12% of individuals in the US with asthma reported having at least one urgent care (UC) or emergency department (ED) visit in the last year. Nationwide data from 2010-2015 indicate that 1.8 million (1.32%) of all ED visits and 155,891 (1.12%) of ED visits resulting in hospitalization were related to asthma.”

Despite this high rate of use, however, Dennis Williams, PharmD, and colleagues noted that motivations for seeking acute care are unclear. A better understanding of the characteristics of patients who are more likely to seek asthma care in acute settings and their motivations for doing so would enable clinicians to better educate patients on self-management, resulting in improved outcomes and a decreased healthcare burden. Further, such understanding may impact the design and recruitment for clinical trials or intervention programs.

To gather information on care-seeking behavior in patients with asthma, the researchers developed a cross-sectional survey targeting patients who sought care for an acute asthma attack at an ED, hospital, or UC.

Severity & Treatment of Acute Asthma

After 3,748 electronic invitations to participate were sent out, 504 eligible patients completed the survey. Patients were primarily women (72%), and most ranged in age from 30 to 64. In terms of racial demographics, 79% identifi ed as White, 13% as Black, 3% as Asian, and 12% as Hispanic. Most patient participants had health insurance and reported receiving a prescription for oral corticosteroids (OCS) in the past year.

When patients were asked to rate the severity of their asthma, with 0 being the “worst asthma ever” and 10 being the “best asthma ever,” the median rating was 6. In terms of disease control, only 1% reported that their asthma was well-controlled, and more than a quarter (27%) said it was moderately controlled.

Most patients (72%) said they had uncontrolled asthma. Participants aged less than 65 years were more likely to have uncontrolled asthma (72% vs 60% for ages ≥65 years), and 73% of White patient participants had uncontrolled asthma compared with 67% of Black participants and 64% of Hispanic participants.

Half of the patients reported experiencing an acute asthma attack at least once a month within the past 2 years. When asked to provide information on their last asthma attack and how they chose to address it, 37% addressed their symptoms by taking medicine at home, 20% went to UC, 15% went to the ED, and 5% were hospitalized.

Top Motivators for Seeking Acute Care

The severity of the exacerbation symptoms was the most critical influence that patients cited when considering, with 76% of patient participants sharing this as their top motivator. Other motivators included perceiving help at a medical facility as faster than helping oneself at home (29%), the accessibility of medication (28%), time (19%), and cost (14%).

When broken out among subgroups, the severity of symptoms ranked highly across all groups. Faster access than home care was important to those aged younger than 65 years, Hispanic, Black, high-income earners, and those identifying as severe asthmatics. Time was an important contributor to care-seeking behavior in those aged 18-39 years, Hispanic and Asian respondents, and high-income earners.

When asked about an asthma action plan (AAP), 48% of survey participants said they had one in place. However, only 14% of the patients who chose to seek care in a medical setting for the acute asthma attack said they consulted their AAP during the onset of symptoms. This is despite 79% of patient participants with an AAP saying they were comfortable using it.

“Regardless of age, race, ethnicity, income, or disease severity, the decision to seek acute care appeared to be motivated by symptom severity and the need for fast access to care after trying rescue medications,” Dr. Williams and colleagues wrote.