Factors Associated With Relapse After Emergency Department Treatment for Acute Asthma☆,☆☆,★
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INTRODUCTION
Patients who experience relief of dyspnea after emergency department treatment may relapse after discharge. Several investigators have devised criteria to distinguish patients who can be discharged safely from those who are likely to continue to have symptoms of asthma. Early studies focused on changes in pulmonary function during ED treatment for asthma, specifying the degree of improvement in pulmonary function needed to discharge the patient successfully.1, 2 Some investigators have failed
MATERIALS AND METHODS
Our study was conducted in the ED of MetroHealth Medical Center— a large, urban, county-owned, university-affiliated ED—from February 1992 through June 1993. Patients were included in the study if they presented to the ED with acute asthma manifested as dyspnea, cough, or wheezing and a 1-second initial forced expiratory volume (FEV1) less than 70% of the predicted normal value. Adult patients between the ages of 18 and 50 years were eligible for the study if they had history of asthma.
RESULTS
One hundred forty-five patients were enrolled initially in the study; 104 were discharged from the ED, and 41 were admitted to the hospital. Follow-up data were available for 91 patients (88%). There was no significant difference between patients who were followed and those who were lost to follow-up in age, pretreatment and posttreatment FEV1, gender, or medication use. The 27 male and 64 female patients had a mean age of 35.7±13.1 years. Of the 91 patients, 28.9% were cigarette smokers and
DISCUSSION
Identifying patients at risk for relapse and devising methods for minimizing the risk of relapse have been the subjects of many studies. Early investigators focused on using spirometric criteria to identify patients at risk for relapse. Nowak et al1 studied 59 patients discharged from the ED after standardized therapy that did not include corticosteroids and found that those discharged with subsequent persistent dyspnea had a lower FEV1 (1.19±.65 L) than patients discharged successfully
CONCLUSION
Despite oral corticosteroid therapy, 25% of patients treated in the ED for asthma relapsed within 3 weeks. Pulmonary function testing was not useful in identifying patients at risk for relapse. Those who relapsed were characterized by history of frequent ED visits. Patients who relapsed early were characterized by eosinophilia. The timing of relapse does not seem to correlate with the termination of corticosteroid therapy. The patients at highest risk of relapse may benefit from more aggressive
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Cited by (62)
Literature Review: Prediction Modeling of Emergency Department Disposition Decisions for Children with Acute Asthma Exacerbations
2018, Clinical Pediatric Emergency MedicineRates and correlates of relapse following ED discharge for acute asthma: A Canadian 20-site prospective cohort study
2015, ChestCitation Excerpt :It is likely that the use of these medications is confounded by severity; sicker patients with more severe chronic asthma are treated with more aggressive therapy. Finally, a failure to identify associations between relapse and several widely cited factors was important.9‐11 Most notably, the role of pulmonary flow measures has been a controversial area in the literature.19‐22
A randomized controlled trial of self-management education for asthma patients in the emergency department
2011, Annals of Emergency MedicineCitation Excerpt :This explanation is consistent with outcomes of other reports that showed better quality of life and fewer ED visits for patients who stopped smoking and decreased exposure to environmental smoke.41,42 Regarding the repeated ED outcome, our results confirm results of other studies that reported greater prevalence of ED visits among patients with previous ED visits and lack of medical follow-up; the latter issue was approximated in our study by self-reported difficult access to outpatient care.4,6,8,43,44 However, unlike other researchers we did not find that hospitalization for asthma was associated with more subsequent ED visits.
Pitfalls in the Evaluation of Shortness of Breath
2010, Emergency Medicine Clinics of North AmericaCitation Excerpt :The factors associated with asthma relapse were a history of frequent ED visits over the previous year, use of a home nebulizer, multiple asthma triggers, and symptoms lasting for more than a day. Lack of a regular primary-care physician was also associated with a higher incidence of relapse.41 In the treatment and assessment of the asthmatic, it is crucial to be aware of the criteria for severe asthma, and screening patients for predictors of near-fatal and fatal asthma attacks should be part of the discharge planning for every patient who presents to the ED with asthma.
Cessation of dexamethasone exacerbates airway responses to methacholine in asthmatic mice
2007, European Journal of Pharmacology
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From the Department of Emergency Medicine, MetroHealth Medical Center, Department of Surgery, Case Western Researve University, Cleveland, Ohio.
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Address for reprints: Charles L Emerman, MD, FACEP, Department of Emergency Medicine, S1-203, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109
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Reprint no. 47/1/65119