Why do asthmatic children need referral to an emergency room?

Asthmatic attacks continue to be a major cause of referral to the emergency room (ER), despite currently available effective treatments. We have prospectively evaluated 100 consecutive children who were referred to the ER with acute asthma and were followed by their primary physicians. Only 46% were able to recognize acute attacks, and 26% had the knowledge and skills for self‐management. The prophylactic therapy recommended was usually appropriate, but the compliance was poor and mean serum theophylline levels (STL) was 6. 8 μg/ml, with subtherapeutic values (<10 μg/ml) in 44 (88%). We studied an additional group of 50 consecutive children who were on a routine follow‐up in the hospital asthma clinic. All were examined periodically and were instructed on the disease. The compliance of these children was much better and STL were within the therapeutic range in 73%, significantly higher than in the ER patients (p < 0.001). Their need for ER treatment or hospitalization was much lower than the former group. Poor compliance is a major factor causing referral of asthmatic children to ER, and careful education can improve patient compliance with reduced referral and subsequent hospitalization.