Boosting Referrals to Asthma Specialists for Patients Seen at the Emergency Room for an Asthma Exacerbation

Juan Carlos Cardet

Status: Enrolling

Conditions: Asthma Attack; Asthma; Asthma Control; Asthma Exacerbations

Treatments: Behavioral: ER-Initiated Telehealth Referral

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT07396987

ORIGINS

Details and patient eligibility

About

This study is testing a new way to help adults with asthma get follow up care after an emergency room (ER) visit for an asthma attack. Many people who come to the ER for asthma never see an asthma specialist afterward, even though specialists can offer treatments such as advanced inhalers or biologic medicines that may prevent future attacks.

The study will compare two approaches. One group will receive a telehealth appointment with an asthma specialist that is scheduled for them before they leave the ER. The other group will receive the usual care, which typically includes a standard referral but no scheduled appointment. All participants will be offered a prescription for standard controller medication at discharge.

The main question the study aims to answer is whether arranging a telehealth visit directly from the ER increases the number of patients who complete a follow up appointment with an asthma specialist within three months. The study will also look at whether this approach improves asthma control, reduces repeat ER visits, and helps patients better understand and use their asthma medications.

This research may help identify a practical way to improve access to asthma specialists and reduce the burden of asthma for patients who frequently rely on emergency care.

Enrollment: 40 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥18 years
• Asthma diagnosis ≥1 year
• Seen in ER for asthma exacerbation
• Persistent asthma on controller therapy
• ≥1 asthma exacerbation in prior year

Exclusion criteria

• Patients who have seen an asthma specialist (allergist or pulmonologist) for asthma in the past 1 year
• Diagnosis of other pulmonary diseases (e.g., COPD, interstitial lung disease, etc.)

We will allow for current smokers, vapers and cannabis users as long as they meet one of the COPD-allowable pathways below.

COPD-allowable pathways:

If none of the below are satisfied, then exclude for COPD.

Documentation: PFTs must be within 36 months of enrollment date; smoking history must be calculated and entered in this form based on patient input. Pack- year history will be collected for characterization/analysis but will not determineeligibility.

We will allow for COPD as long as they are:

• never smokers/vapers/cannabis users;
• former or current smokers/vapers/cannabis users with normal PFTs with FEV1/FVC >=70% documented in a medical record within 36 months of the enrollment date
• former or current smoker/vapers/cannabis users with obstruction noted on PFTs (i.e., FEV1/FVC <70%) but who demonstrates BOTH acute bronchodilator reversibility (i.e., >10% increase in either FEV1%predicted or FVC% predicted) AND have a normal diffusing capacity (DLCO)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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40 participants in 2 patient groups

Intervention Arm

Experimental group

Description:

Participants will receive two components: 1. Emergency Room (ER) staff will directly contact the asthma specialist's scheduling team to arrange a follow-up appointment within 1-3 weeks. 2. The follow-up appointment will be conducted via telehealth (including phone calls) to assess follow-up care and asthma control of all participants. Both Arms: • All participants will be offered a prescription for twice-daily ICS/LABA (fluticasone/salmeterol) controller therapy at ER discharge after signing informed consent. These medications are standard of care for asthma. Asthma-related surveys and study-specific questionnaires, "medication side effects (open-ended)" and "follow-up care questions" will be administered during the ER visit and again at the 3-month follow-up phone call.

Treatment:

Behavioral: ER-Initiated Telehealth Referral

Usual Care Arm

No Intervention group

Description:

Participants will receive an EMR-based referral to an outpatient allergy clinic, with the option of a telehealth or in-person visit at their discretion. This referral will be offered during the 3-month follow-up phone call to ensure clinical equipoise. Both Arms: • All participants will be offered a prescription for twice-daily ICS/LABA (fluticasone/salmeterol) controller therapy at ER discharge after signing informed consent. These medications are standard of care for asthma. Asthma-related surveys and study-specific questionnaires, "medication side effects (open-ended)" and "follow-up care questions" will be administered during the ER visit and again at the 3-month follow-up phone call.