Grant: CIHR Fellowship

Despite improved understanding of asthma mechanisms and the risk factors associated with exacerbations, asthma continues to represent one of the leading causes of Emergency Department (ED) visits which result in significant health care costs. Our studies have suggested that most Canadian emergency physicians follow the recommendations contained within the current guidelines; however, follow-up care by primary care physicians (PCP) after ED visits for exacerbations is delayed (~30%). Ineffective reassessment, treatment adjustment and patient monitoring after an asthma exacerbation could leave patients at increased risk for future loss of asthma control. The objective of this study is to determine if simple guidance provided to PCPs increases compliance with current ambulatory treatment guidelines and improve asthma control. This randomized controlled trial will include asthmatics 18-55 years of age with no evidence of chronic obstructive pulmonary disease. Patients will be eligible if they visit EDs in Edmonton and Calgary and receive treatment that results in discharge. All patients should have a PCP with whom to follow-up and will be prescribed systemic and inhaled corticosteroids (ICS). While in the ED patients will be divided into: Intervention group: PCPs will receive a personalized faxed letter signed by a local opinion leader describing their patient's ED visit for asthma and will be provided with guidance about the role of ICS, asthma education and regular follow-up. Standard care group: PCPs will receive a faxed ED patient record without advice. All patients will receive a Discharge Plan and will be told to review asthma management with their PCP. Phone calls will be performed at 30 and 90 days to compare relapses, symptoms improvement, follow-up and hospitalizations; and patients' health-related quality of life. This work will provide ED and PCP with an opportunity to decrease management gaps and base their practice on the highest level of evidence.