title: Multicenter study of cigarette smoking among adults with asthma exacerbations in the emergency department, 2011-2012.
abstract: Previous studies demonstrated a high prevalence of cigarette smoking in patients presenting to the emergency department (ED) with acute asthma. Despite the clinical and public health importance, there have been no recent multicenter efforts to characterize this patient population. We aimed to update the prevalence of cigarette smoking among ED patients with asthma exacerbations.
  
  
  
  Multicenter chart review study of 48 EDs across 23 US states. We identified ED patients aged 18-54 years with asthma exacerbations during 2011-2012. We classified patients into three groups based on smoking status: never smoker, former smoker, and current smoker. We fit multivariable logistic regression models to examine independent predictors of being a current smoker.
  
  
  
  Of 1801 enrolled patients, never smokers accounted for 51% (95%CI, 49%-54%), former smokers 13% (95%CI, 11%-14%), and current smokers 36% (95%CI, 34%-38%). The multivariable model demonstrated several independent predictors for current smoking: older age (age 30-39 and 40-54 years), non-Hispanic white or black, having public or no insurance, and not having an asthma specialist (all P < 0.05).
  
  
  
  This large multicenter study of ED patients with asthma exacerbations demonstrated that one in three patients were current smokers. This burden of current smokers has not changed from multicenter findings in the late 1990s. The persistently high burden suggests the inadequacy of current measures to manage tobacco use in these high-risk patients.
authors.affiliation: Department of Emergency Medicine, Northwell Health System, New Hyde Park, NY, United States. Electronic address: rsilverman@northwell.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Silverman
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Emergency Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, New York, NY, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Egan
authors.affiliation: Department of Emergency Medicine, Akron City Hospital, Akron, OH, United States.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Stiffler
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000150:complications* / Q000453:epidemiology; D000073865:Cigarette Smoking / Q000009:adverse effects* / Q000453:epidemiology* / Q000208:ethnology; D017281:Cost of Illness; D019468:Disease Management; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D064424:Tobacco Use / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
keywords: Asthma exacerbation; Cigarette smoking; Emergency department; Tobacco