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OBJECTIVE: This study sought to determine if ambulance service users differ in their health behaviours to "walk-in" patients attending an emergency department (ED) with acute asthma. METHOD: Retrospective cross-sectional study of people with acute asthma stratified by ambulance use attending two ED. The health-promoting lifestyle profile and health risk appraisal tools assessed health and risk-taking behaviours, and the clinical variables assessed include: forced expiratory volume in 1 s, admission rates, severity, asthma medications, anxiety and depression. RESULTS: Of the 142 patients, 26% used the ambulance service as transport to the ED. Ambulance users were significantly older than walk-in patients (40 vs 32 years, p0.05) and were less likely to return to follow-up appointments (odds ratio (OR) 2.93, 95% CI 1.16 to 7.37). Walk-in patients were more likely to report higher levels of education (OR 4.36, 95% CI 1.11 to 17.09). There was no difference between the groups for health-promoting behaviours. In reducing risks to their health and after adjusting for age and gender, there was a trend towards ambulance users undertaking preventive health measures more often than walk-in patients. CONCLUSIONS: Ambulance users with acute asthma are more likely to be older, married and less educated. There is no evidence that this group is less responsible in managing their health; however, fewer ambulance users attended their follow-up appointment and the implication for ongoing care requires further investigation.