Trends in the use of an urban accident and emergency department by asthmatics.

To examine the possible relationship between the increase in asthma admission rates and the use of the accident and emergency department (A & E) for the management of asthma, a retrospective study of asthma admissions and A & E attendances was undertaken at Middlemore Hospital. Admission rates for adult asthma doubled between 1974 and 1985 (p less than 0.001). Yearly A & E attendance rates for adult asthma also doubled between 1977 (when data collection began) and 1985 (p less than 0.01), and could be largely explained on the basis of increased reattendance (p less than 0.001). These trends suggest that the hospital is being used in a primary care role for the treatment of acute asthma and that self-referral is encouraged. A dependence on A & E by frequent attenders may be a barrier to nonacute ongoing medical care in the community and may lead to the seeking of care for attacks later than if a general practitioner (GP) was used. Dependence on and attendance at A & E may lead to an increased risk of admission and thus may have contributed to the increase in the admission rate for asthma.