Factors associated with relapse after emergency department treatment for acute asthma.
OBJECTIVE
The rate of relapse after emergency department treatment for acute asthma is high. Most studies on this subject were performed before the recent recommendations for routine use of corticosteroids and followed the patients for 10 or fewer days. We sought to evaluate relapse following ED treatment for acute asthma over a longer period, focusing particularly on the relationship between steroid use and outpatient follow-up visits.


METHODS
A prospective study in which we followed patients for 21 days after discharge to determine their relapse rate (unscheduled return for asthma treatment) and compliance with scheduled outpatient appointments.


METHODS
University-affiliated county hospital ED.


METHODS
One hundred four adult asthmatic patients discharged from our ED after treatment under a standardized protocol.


RESULTS
Follow-up was performed for 91 patients (88%). There was no difference in the posttreatment forced expiratory volume at 1 second between those who relapsed (55.2%) and those who did not (57.8%; NS). Twenty-three patients (25.3%) relapsed within 3 weeks of discharge. Ninety-one percent of relapses occurred before the patients saw their primary care physician. Those who relapsed had a history of previous ED visits and hospitalizations. There was no difference in theophylline levels or history of cigarette use. Patients who relapsed within 3 days had higher eosinophil counts.


CONCLUSIONS
Even with routine use of oral corticosteroids, a high percentage of patients relapse after ED treatment for acute asthma. Patients who relapse have a greater number of recent ED visits and so should be targeted for more aggressive management of their asthma.
Emerman
C L
CL
Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
Cydulka
R K
RK
D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006766:Hospitals, County; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009820:Ohio; D012307:Risk Factors
D008775:Methylprednisolone