Obesity Increases 30-Day ED Visit Rates After Asthma Hospitalization

Nearly a quarter of patients hospitalized with a severe asthma exacerbation had an emergency department visit within 90 days of discharge, according to an abstract presented at the American College of Chest Physicians’ CHEST Annual Meeting 2020.

“Our study indicates that despite appropriate therapy, most of the patients hospitalized for asthma exacerbation remain uncontrolled after hospital discharge,” the researchers wrote.

The retrospective observational study focused on 145 adults admitted to a community teaching hospital for asthma exacerbations. The average patient age was 41 years, 77% were women, 50% were obese, and 45% were African American. The average length of stay was 4.5 days, according to the abstract.

Overall, the 30-day readmission rate was 4%, the 30-day emergency department visit rate was 17%, and the 90-day emergency department visit rate was 24%. The 30-day emergency department visit rate was significantly higher for patients with obesity (23.6%) compared with patients without obesity (9.6%), the analysis showed.

Although long-acting β-agonist/inhaled corticosteroid inhalers upon discharge did not affect 30-day and 90-day emergency department visit rates overall, subgroup analysis did identify a trend toward decreased post-discharge emergency department visits when African-American patients transitioned from inhaled corticosteroids at hospital admission to long-acting β-agonist/inhaled corticosteroid inhalers at discharge. According to the abstract, 30-day emergency department visits decreased 6% with the stepped-up therapy in the patient subgroup, and 90-day emergency department visits decreased 11%.

“The future of severe asthma care must focus on identifying differences among asthma phenotypes and highly individualized asthma treatment,” the researchers wrote. “Obesity is a predictor of poor asthma control and high utilization of resources (emergency department visits). Stepping up inhaler therapy early may be beneficial, especially among the adult African-American population.”

—Jolynn Tumolo

Reference:

Durdevic M, Hirst P, Parikh S, et al. Retrospective analysis of asthma hospital admissions: obesity and step up therapy in uncontrolled asthma. Paper presented at: CHEST Annual Meeting; October 18-21, 2020; Virtual. https://journal.chestnet.org/article/S0012-3692(20)32250-9/fulltext