Hospital Admission an Opportunity to Evaluate, Educate about Asthma's Comorbidity Potential

Although asthma is not a top principal diagnosis in adults who have been admitted to the hospital, it is well documented that asthma can be a comorbidity in both children and adults admitted for other illnesses, such as heart disease, diabetes, pneumonia, or COPD.

Because asthma attacks occur episodically, asthma patients may have no breathing complaints or abnormal chest exam findings to trigger improved asthma care during their hospital stay. The absence of such noticeable symptoms, however, does not mean that patients are managing their asthma well on their own. Hospital admission for other conditions can provide an opening for physicians and pharmacists to discuss asthma as a comorbidity with their patients and attempt to optimize asthma care following discharge.

Considering the limited time available, clinicians may focus exclusively on the illness that prompted the admission, missing an opportunity to address ongoing asthma risks. Suboptimal management may lead to poor quality of life, more asthma attacks, and more visits to the emergency department and hospital admissions.

To illustrate these points, a team from the University of Tennessee Health Science Center in Memphis, TN, cited two examples of patients admitted to the hospital with asthma as a comorbidity in a commentary published in a recent issue of the Annals of Pharmacology and co-authored with its editor-in-chief.

In the first case, in which the patient was admitted for cellulitis, discussion of asthma revealed the need for daily therapy with an inhaled corticosteroid and occasional albuterol before exercise, as well as the need for patient education on minimizing exposure to asthma triggers. The UT team noted that “such brief interventions can improve the patient’s quality of life and reduce the risk of future exacerbations.” In another case, asthma as a potential comorbidity was recognized in a myocardial infarction patient, prompting a change in discharge medication from a non-cardioselective to a cardioselective beta blocker to reduce the possibility of drug-induced bronchospasm or fatal asthma.

These cases also spotlight the benefit of utilizing pharmacists to assess symptom control, ensure appropriate therapy, and educate patients about how to optimize asthma care. In addition, pharmacists may find the need to arrange for respiratory therapists to reinforce the use of correct inhaler technique.

The UTN team acknowledged that addressing asthma during a patient’s hospital stay for another illness can be challenging and recommended the autonomic care system as one approach to streamlining care in in complex cases with comorbidities. In some cases, the solution may be as simple as referral to an asthma specialist if a brief history indicates that this is needed.

The commentary suggests each inpatient encounter provides an opportunity to optimize medical management of comorbidities such as asthma through focused patient assessment and education, regardless of the illness that prompted admission.