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Rationale: Asthma is a common reason for emergency department (ED) presentation. Few studies have explored the experiences of adults during asthma exacerbation, particularly those that necessitate ED care. Objectives: This study explored adults experiences during asthma exacerbation. Methods: A photovoice study was conducted. ED patients presenting for asthma care between the ages of 17-55 years were eligible for the study and recruited in the ED. Participants had 3-4 weeks to take photographs and subsequently completed a one-on-one photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed. Measurements and Main Results: Six patients agreed to participate; 2 were lost to follow-up. One primary theme emerged. Specifically, the role of hope and fear, including the tension between them, in their experience of their condition. Hope and fear permeated all aspects of experience, including the following subthemes: 1) participants adopting the roles of advocate and expert, 2) frustration with their health state, 3) loss of freedom and subsequent feelings of failure, 4) barriers to accessing health care, and 5) “good” and “bad” ED care. Asthma was an ever-present consideration in participants lives during times of “good asthma control” and times of exacerbation. Conclusions: Participants’ focus on the roles of hope and fear, both in the ED and beyond, suggests that openly acknowledging and addressing these emotional aspects as a part of the ED interaction could result in a better care experience for some patients. Seeing the whole person as more than their symptoms and sharing decision-making may help clinicians to provide care that supports hopefulness.

“Not just the asthma”: Understanding the acute asthma experiences of adult women with asthma presenting to the emergency department through photovoice