Thorax 55:566-573 doi:10.1136/thorax.55.7.566
  • Original article

Factors associated with hospital admissions and repeat emergency department visits for adults with asthma

  1. Robert J Adams,
  2. Brian J Smith,
  3. Richard E Ruffin
  1. Department of Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia
  1. Dr R Adams, Channing Laboratory, Brigham & Women's Hospital, 181 Longwood Avenue, Boston, Massachusetts 02115–5584, USA email:robert.adams{at}
  • Received 23 July 1999
  • Revision requested 6 October 1999
  • Revised 6 March 2000
  • Accepted 22 March 2000


BACKGROUND A small proportion of patients with asthma account for a disproportionate number of acute health service events. To identify whether factors other than severity and low socioeconomic status were associated with this disproportionate use, a prospective study was undertaken to examine management and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12 month period.

METHODS A total of 293 patients with moderate or severe asthma managed at least in part at two teaching hospitals completed surveys of clinical status, acute events, sociodemographic, and psychological variables.

RESULTS Twenty three percent had a single admission to hospital and 16% had two or more hospital admissions. Twenty six percent had one emergency department visit and 32% had two or more visits to the emergency department. In a multiple logistic regression model, adjusted for age, sex, education and income, odds ratios (95% CI) for baseline factors associated with hospital admissions over the next 12 months were: moderate severity compared with severe asthma 0.6 (0.2 to 0.9); no hospital admissions in the past 12 months 0.1 (0.01 to 0.2); not possessing a written asthma action plan 4.0 (1.5 to 10.7); less use of an avoidance coping style 0.4 (0.3 to 0.7); lower preferences for autonomy in asthma management decisions 1.4 (0.96 to 2.0). Adjusted odds ratios (95% CI) for repeat emergency department visits were: moderate asthma severity 0.3 (0.1 to 0.8); current regular use of oral corticosteroids 10.0 (3.1 to 32.4); a hospital admission in the past 12 months 2.9 (1.8 to 4.8); not possessing a written asthma action plan 2.2 (1.1 to 5.6); less dislike of asthma medications 0.7 (0.5 to 0.9).

CONCLUSIONS In addition to factors relating to severity, not possessing a written asthma action plan, avoidance coping, and attitudes to self-management were related to acute use of health services in this at risk group. Interventions need to address or take these factors into account to reduce asthma morbidity.


  • Funding: This study was funded by the University of Adelaide, The Queen Elizabeth Hospital Research Foundation. Dr Adams is a recipient of the Thoracic Society of Australia and New Zealand/Allen & Hanbury's Respiratory Research Fellowship.