title: Relapse after emergency department discharge for acute asthma.
abstract: OBJECTIVE
  The objectives were to determine patient and treatment-response factors associated with relapse after emergency department (ED) treatment for acute asthma.
  
  
  METHODS
  Subjects aged 18-55 years who were treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview and telephone contact 2 weeks later.
  
  
  RESULTS
  Of 695 enrolled patients, 604 (86.9%) were discharged from the ED; follow-up was available in 529 (87.5%); 63% were female and the median age was 29 years. Most patients were discharged on oral (70.8%) and inhaled (60.1%) corticosteroids (CS); 2-week treatment adherences were 93.3 and 80.9%, respectively. Relapse occurred in 9.2% at 1 week (95% confidence interval [CI] = 7.1% to 12.0%) and 13.9% (95% CI = 11% to 17%) at 2 weeks. In multivariable modeling, factors associated with relapse were ethnicity (risk ratio [RR] white = 0.66; 95% CI = 0.52 to 0.83); female gender (RR = 1.57; 95% CI = 1.14 to 2.09); any ED visits in the past 2 years (RR = 1.47; 95% CI = 1.18 to 1.80); ever admitted for asthma treatment (RR = 1.83; 95% CI = 1.09 to 2.84); use of combined inhaled CS plus long-acting beta(2)-agonists (RR = 1.39; 95% CI = 1.07 to 1.78) and of oral CS (RR = 1.35; 95% CI = 1.12 to 1.59) at the time of ED presentation.
  
  
  CONCLUSIONS
  Ethnicity (white), female gender, prior ED visits and admissions for asthma, and recent treatments (especially oral CS) were associated with asthma relapse, which remains relatively common. Future research is required to target this high-risk group.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada. brian.rowe@ualberta.ca
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.forename: Allan
authors.initials: A
authors.lastname: Walker
authors.forename: Scott
authors.initials: S
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult