By Dr. Larry Chiaramonte
A study conducted in South Carolina showed that fewer than 20% of poor children who ended up in emergency rooms with asthma attacks were prescribed the medications they need to keep it from happening again. Lead researcher Dr. Annie Lintzenich Andrews, a pediatrician at the Medical University of South Carolina, told reporters that ER doctors traditionally have been hesitant to perform preventive care, like prescribing drugs meant for long-term use. They are trained to treat emergencies, have little time, and — unlike a primary care doctor — cannot follow up with patients. Yet, since 2007 guidelines issued by the National Heart, Lung and Blood Institute have recommended that these patients be prescribed inhaled corticosteroids (ICS) upon release.
Of course, once you start a conversation like this, it leads to the whole rabbit hole of access to primary care and whether even primary care doctors have the time or expertise to deal with asthma.
Yet, the benefits are inarguable. Both Dr. Ehrlich and I have practiced with inner-city children over many years, and we can both attest that inadequate care is not confined to South Carolina. This is a pity because the economics of investing in better asthma control are well known. Conscientious day-to-day care reduces hospitalizations by 75%. He and I don’t see eye to eye about many things, but we do agree about one thing—wherever the money comes from to do it, the public sector or the private sector, keeping these children’s asthma under control keeps them in school where they perform better, it keeps their parents at work instead of sitting vigil at the ER. It’s money well spent.
While doctors may be reluctant to provide more than emergency treatment, we are losing an opportunity to make a real difference in the long run. The treatable moment is also the teachable moment, when the episode is fresh in the mind of patient and family. One way to overcome this deficiency is to add a specially trained asthma educator to the ER staff. This lay educator would coach the patient in how to use his new inhaler, give tips for housekeeping that can reduce environmental triggers, and other proven methods. It doesn’t all have to rest on the doctor’s shoulders.