Fear affects emergency care for child with asthma

Parents' psychological responses to asthma attacks are among the strongest motivators of seeking accident and emergency (A&E) services for their child, according to a study conducted in London.

In contrast, characteristics of the home environment, such as dampness, overcrowding, or living with a smoker, have little effect on use of emergency departments.

Children with asthma often use A&E services, Dr. Lindsay Forbes, from Springfield University Hospital, and associates note in their paper, published in the journal Thorax. To find out what triggers a visit to A&E, they studied children with asthma residing in south-east inner London, which has a high poverty rate.
The team identified 209 children ages 3 to 14 years old who were treated at an A&E for asthma over a 1-year period. Another 712 randomly chosen subjects who also had asthma but had not attended an A&E during the year prior to their enrollment. The data came from patients' records and questionnaires they were asked to completed.

The authors found that patients who had attended an outpatient clinic with a family doctor during the previous year were 13 times more likely to visit A&E.

Parents who reported feeling alone or experiencing panic or fear when their child's asthma got worse, or who believed they would get quicker service in an A&E, were 2- to 3-fold more likely to bring their child to the emergency department.

To reduce A&E use for asthma in children, Forbes and associates recommend that "health service planners should take a broader approach, considering what is the most appropriate setting for treating asthma attacks for children of different levels of attack severity, ensuring that services are accessible and address parents' concerns, and that the different parts of the health service communicate appropriate care pathways effectively and consistently to parents."