title: Asthma Exacerbations in a Tertiary Hospital: Clinical Features, Triggers, and Risk Factors for Hospitalization.
abstract: BACKGROUND
  The risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients who experience asthma exacerbations. We also assessed potential triggers of exacerbations and possible predictors of hospitalization.
  
  
  METHODS
  A retrospective, noninterventional cohort study was conducted in adult patients who attended the emergency department of a tertiary hospital with an asthma exacerbation during 2014.
  
  
  RESULTS
  The study population comprised 831 patients (888 events). Most episodes occurred in January and May. Respiratory infection was the trigger in 523 events. In 34.21% of cases, the eosinophil count was ≥260/mm3 (≥400/mm3 in 20.7%), which was significantly associated with allergic asthma (P<.0001). The risk factors for hospitalization were older age (OR, 1.58; 95%CI, 1.46-1.71), no previous diagnosis of asthma (OR, 1.40; 95%CI, 1.06-1.86), poorly controlled asthma (OR, 1.78; 95%CI, 1.10-2.88), respiratory infection (OR, 2.65; 95%CI, 1.95-3.62), and severe exacerbation with more treatment requirements. The rate of hospitalization was significantly lower in patients with ≥400 eosinophils/mm3 (P<.001).
  
  
  CONCLUSIONS
  Older age, absence of a previous asthma diagnosis, uncontrolled disease, and concomitant chronic obstructive pulmonary disease are frequent among patients presenting at the emergency department with asthma exacerbations. Various features were associated with a higher risk of admission. Blood eosinophilia should be considered a marker of asthma, but not a predictor of hospitalization.
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pola-Bibian
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.|CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Dominguez-Ortega
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Vilà-Nadal
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Entrala
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: González-Cavero
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.|CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Barranco
authors.affiliation: Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Cancelliere
authors.affiliation: Department of Biostatistics, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Díaz-Almirón
authors.affiliation: Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.|CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Quirce
mesh_terms: D006801:Humans; D001249:Asthma / Q000453:epidemiology / Q000175:diagnosis; D008297:Male; D005260:Female; D062606:Tertiary Care Centers; D006760:Hospitalization / Q000706:statistics & numerical data; D008875:Middle Aged; D012307:Risk Factors; D012189:Retrospective Studies; D000328:Adult; D000368:Aged; D018450:Disease Progression; D004804:Eosinophils / Q000276:immunology; D012141:Respiratory Tract Infections / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D007958:Leukocyte Count
keywords: Asthma; Eosinophilia; Exacerbation; Risk of hospital admission