title: Rates and correlates of relapse following ED discharge for acute asthma: a Canadian 20-site prospective cohort study.
abstract: BACKGROUND
  Acute asthma is a common ED presentation. In a prospective, multicenter cohort study, we determined the frequency and factors associated with asthma relapse following discharge from the ED.
  
  
  METHODS
  Adults aged 18 to 55 years who were treated for acute asthma and discharged from 20 Canadian EDs underwent a structured ED interview and a follow-up telephone interview 4 weeks later. Standardized antiinflammatory treatment was offered at discharge. Multivariable analyses were performed.
  
  
  RESULTS
  Of 807 enrolled patients, 58% were women, and the median age was 30 years. Relapse occurred in 144 patients (18%) within 4 weeks of ED discharge. Factors independently associated with relapse occurrence were female sex (women, 22% vs men, 12%; adjusted OR [aOR], 1.9; 95% CI, 1.2-3.0); symptom duration of ≥ 24 h prior to ED visit (long duration, 19% vs short duration, 13%; aOR, 1.7; 95% CI, 1.3-2.3); ever using oral corticosteroids (ever use, 21% vs never use, 12%; aOR, 1.5; 95% CI, 1.1- 2.0); current use of an inhaled corticosteroid ([ICS]/long-acting β-agonist combination product (combination product, 25% vs ICS monotherapy,15%; aOR, 1.9; 95% CI, 1.1-3.2); and owning a spacer device (owning one, 24% vs not owning one, 15%; aOR, 1.6; 95% CI, 1.3-1.9).
  
  
  CONCLUSIONS
  Despite receiving guideline-concordant antiinflammatory treatments at ED discharge, almost one in five patients relapsed within 4 weeks. Female sex, prolonged symptoms, treatment-related factors, and markers of prior asthma severity were significantly associated with relapse. These results may help physicians target more aggressive interventions for patients at high risk of relapse.
authors.affiliation: Department of Emergency Medicine; School of Public Health. Electronic address: brian.rowe@ualberta.ca.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: Department of Emergency Medicine; School of Public Health.
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.affiliation: Department of Medicine.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: University of Alberta, Edmonton, AB; the Department of Emergency Medicine.
authors.forename: Riyad B
authors.initials: RB
authors.lastname: Abu-Laban
authors.affiliation: University of British Columbia, Vancouver, BC; and the Department of Medicine.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
authors.affiliation: Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: School of Public Health.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Johnson
authors.affiliation: School of Public Health.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult