Why Patients With Asthma Go to the Emergency Room

JAMA. 1980;243(8):732. doi:10.1001/jama.1980.03300340012005.
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To the Editor.—  The article titled "Education for Self-treatment by Adult Asthmatics" by Maiman et al (241:1919, 1979) assesses the ability of a nurse educator to teach asthmatics who attend an emergency room in crisis thus reducing further emergency room visits by stressing self-medication to the patient. The article failed to note that the usual emergency room treatment (237:1141, 1977) itself teaches the patient to return there with his next attack.The usual treatment includes one or more of the following therapies: subcutaneous epinephrine injections, intravenous aminophylline, intermittent positive-pressure breathing with an aerosolized β-adrenergic bronchodilator, or oxygen. Since these treatment modalities are usually not available for home use, any attempt to teach the patient to self-medicate runs counter to his emergency room experience. This conditioning to use emergency room treatment is unfortunate, because (1) oral elixir of theophylline (dose of 400 mg) is well tolerated and produces in 20 minutes an


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