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Asthma In Northern Illinois: ER Visits And Urgent Care

: http://www.healthcarereportcard.illinois.gov/maps

Visits to the emergency room for asthma vary widely across Illinois. One reason could be how it's treated.

Asthma is an inflammatory lung condition that can cause bouts of coughing, wheezing, and shortness of breath. In severe cases, a patient's airways swell shut, requiring a visit to the emergency room.

The Illinois Hospital Report Card tracks these types of visits. Between 2015-2017, Stephenson County had among the highest rates of visits in the state.

Dr. James Kolka is Chief Physician Executive for FHN, a medical network based in Freeport. He says people with asthma use devices called peak flow meters to gauge how much air is going into their lungs. The reading helps determine a course of action if symptoms change.

"Say you fall into the yellow category, you might start prednisone on your own, and if you get worse -- and your peak flow the next day is in the red category -- you either see your doctor, call your doctor, or go to the emergency department," he said. 

Prednisone is a steroid used to treat inflammation.  In severe cases, emergency room doctors can administer bronchodilators, which open up the lungs, or put patients on a ventilator. But that isn't always needed.

Credit Wikimedia Commons
Peak flow meters are used by patients with asthma to measure how much air moves out of the lungs.

"People don't have a need for the high acuity services of an emergency department, but still need unscheduled care in a somewhat rapid manner," he said.

That's where urgent care centers come in handy. They can address less severe symptoms, sometimes at a lower price. But Stephenson County Public Health Administrator Craig Beintema says they aren't always an option in less dense areas.

"Asmodic conditions don't necessarily follow that 8-5 time that urgent clinics are open," he said.

And that could lead to more visits to the emergency room. Beintema says this partially explains the ER visit statistics. But it's not the only reason.

"I really believe that we've got so accustomed to emergency habits such as calling 911 or going to the emergency room, that many people may not realize just what urgent care does," he said.

That's why public health officials are emphasizing several forms of asthma prevention. These include early immunizations and avoiding habits like smoking. But for those with asthma, the key is having a plan to manage the symptoms. Winnebago County Public Health Administrator Sandra Martell explains.

"There are different phases, there might be times when the allergens may be higher or maybe it's an allergic type response or an exercise-induced asthma," she said. "Understanding the triggers, and then appropriately managing maintenance medications, and then what we call the rescue medications, should that need to happen."

Martell says a plan also includes knowing when to go to the ER. But what if you don't live near an urgent care facility? Beintema of Stephenson County explains.

"You could have a place that's in a smaller community, but may only have 5-10 people come a day, so it's a matter of how much resources can you put out in a remote area," he said.

For those suffering from symptoms near Freeport, FHN's urgent care center began last year. Doctors see 35 to 40 patients per day. But even if there is greater access to urgent care, Dr. Kolka says an emergency room may still be the best option.

"Very mild symptoms is okay, go to urgent care. But the thing about asthma is it could be a severe disease. It could be a fatal disease," he said.

Martell is optimistic about urgent care, but says it's part of a larger whole.

"As systems and networks grow, and the availability of urgent care and the sophistication that continues beyond typical business hours, that improves the ability for management throughout the 24-hour cycle for individuals with this illness," she said.

Kolka and Martell agree that proper management of asthma is key, so triggers can be minimized, and when there is a crisis, patients know exactly what to do.