Objective: To determine what proportion of patients who are seen in an emergency department (ED) for asthma receive inhaled corticosteroids or attend follow-up appointments.

Study Design: This was a retrospective cohort study of 2007-09 South Carolina (USA) Medicaid data.  Enrollees aged 2-18 years who had an ED visit for asthma were included.  Patients admitted for asthma or with an inhaled corticosteroid claim in the 2 months before the month of the ED visit were excluded.  Covariates were sex, race, age, rural residence and asthma severity.  Outcome measures were a prescription for an inhaled corticosteroid filled within the 2 months after the ED visit and attendance at a follow-up appointment within the 2 months after the ED visit.

Results: A total of 3435 patients were included.  Out of the study cohort, 57% were male, 76% were of a minority race/ethnicity, 69% lived in an urban areas, 18% had inhaled corticosteroid use and 12% completed follow-up.  Multivariate analyses demonstrated that patients with severe asthma were more likely to receive an inhaled corticosteroid (OR, 2.9; 95% CI, 2.3 to 3.7) and attend a follow-up appointment (OR, 2.0; 95% CI, 1.5 to 2.6).  Patients aged 2-6 years and those aged over 12 years were less likely to attend follow-up (OR, 0.71; 95% CI, 0.56 to 0.90 and OR, 0.62; 95% CI, 0.47 to 0.83, respectively) (all models P less than 0.0001).

Conclusions: Children with asthma seen in the ED have low rates of inhaled corticosteroid use and outpatient follow-up.  This indicates a need for further interventions to increase the use of inhaled corticosteroids in response to ED visits.