Optimising long-term management in acute asthma presentations to the emergency department: an interview study on patient beliefs.

Abstract

Background: Emergency department (ED) attendances with acute asthma are an opportunity for simple medication changes to improve long-term self-management, but patients' beliefs and behaviours need to be considered for interventions to be successful. We explored the health beliefs and behaviours of adult patients who have presented to the ED with asthma and considered their attitudes to ED-based interventions designed to improve long-term asthma control.

Methods: 19 semi-structured face-to-face or online patient interviews were conducted in 2021/2022. Eligible participants were patients over age 16 who had attended and were discharged from the ED with an asthma exacerbation. Purposive sampling was undertaken to ensure representation of patients of different ages, ethnicity and gender. Interviews were analysed with reflective thematic analysis.

Results: Themes that reflected the beliefs and behaviours of the patients were: (1) experiences of an asthma exacerbation-the emotional response and self-management during an episode; (2) discharge dilemma-expectations and communication on discharge from ED, impacted by time, language and capacity in the acute environment; (3) do what is best for me-openness to change such as of medication, if rationale and support is provided; and (4) perceptions of asthma medication-reliance on salbutamol, concerns about inhaled corticosteroids, openness to maintenance and reliever therapy inhalers and device preferences.

Conclusion: Patients do not expect longer-term care to be provided in the ED. However, patients trust healthcare professionals to recommend appropriate treatment and are willing to accept a change in medication or inhaler device in this context.