RT Journal Article
SR Electronic
T1 Risk factors for accident and emergency (A&E) attendance for asthma in inner city children
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 855
OP 860
DO 10.1136/thx.2006.058362
VO 62
IS 10
A1 Lindsay Forbes
A1 Sheila Harvey
A1 Roger Newson
A1 Deborah Jarvis
A1 Christina Luczynska
A1 John Price
A1 Peter Burney
YR 2007
UL http://thorax.bmj.com/content/62/10/855.abstract
AB Background: Inner city children make heavy use of accident and emergency (A&E) services for asthma. Developing strategies to reduce this requires a better understanding of the risk factors. Methods: A case-control study was carried out of children with asthma living in south-east London: 1018 children who attended A&E for asthma over 1 year and 394 children who had not attended A&E for asthma over the previous year. The main risk factors were socioeconomic status, home environment, routine asthma management and parents’ psychological responses to and beliefs about the treatment of asthma attacks. Results: A&E attendance was more common in children living in poorer households. No associations were found with home environment or with measures of routine asthma care. Children who had attended outpatients were much more likely to attend A&E (odds ratio (OR) 13.17, 95% CI 7.13 to 24.33). Other risk factors included having a parent who reported feeling alone (OR 2.58, 95% CI 1.71 to 3.87) or panic or fear (OR 2.62. 95% CI 1.75 to 3.93) when the child’s asthma was worse; and parental belief that the child would be seen more quickly in A&E than at the GP surgery (OR 2.48, 95% CI 1.62 to 3.79). Parental confidence in the GP’s ability to treat asthma attacks reduced the risk of attending A&E (OR 0.30, 95% CI 0.17 to 0.54). Conclusions: There is no evidence that passive smoking, damp homes or poor routine asthma care explains heavy inner city use of A&E in children with asthma. Reducing A&E use is unlikely to be achieved by improving these, but identifying appropriate settings for treating children with asthma attacks and communicating these effectively may do so.