Multicenter study of cigarette smoking among patients presenting to the emergency department with acute asthma.
BACKGROUND
Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse.


OBJECTIVE
To determine the smoking prevalence among emergency department (ED) patients with acute asthma and to investigate the relationships between smoking and acute asthma severity.


METHODS
A 63-site medical record review study of ED patients, ages 14 to 54 years, with a principal diagnosis of acute asthma was performed. Patients with chronic obstructive pulmonary disease were excluded. Measurements for acute asthma severity included sociodemographic factors, asthma medical history, ED presentation, clinical course, medications administered, and return visit within 48 hours.


RESULTS
A total of 4,052 patient medical records were reviewed. A total of 1,332 patients (33%; 95% confidence interval, 31%-34%) were documented as smokers. No statistically significant differences were found between smokers and nonsmokers in vital signs, oxygen saturation, peak expiratory flow, and administration of asthma medications. By contrast, smokers were more likely than nonsmokers to receive antibiotics in the ED (12% vs 9%, P < .001) or at discharge (23% vs 14%, P < .001). A multivariate analysis confirmed that smoking status was independently associated with antibiotic administration (odds ratio, 1.6; 95% confidence interval, 1.3-1.8).


CONCLUSIONS
One-third of ED patients with acute asthma smoked cigarettes. Smokers and nonsmokers did not differ in their acute asthma severity. Asthmatic smokers, however, were more likely to receive antibiotics, even when adjusting for other possible confounders.
Patel
Sundip N
SN
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Cooper University Hospital, Camden 08103, USA. patel-sundip@cooperhealth.edu
Tsai
Chu-Lin
CL
Boudreaux
Edwin D
ED
Kilgannon
J Hope
JH
Sullivan
Ashley F
AF
Blumenthal
David
D
Camargo
Carlos A
CA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D016017:Odds Ratio; D012143:Respiratory Physiological Phenomena; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents