Prospective multicenter study of relapse after treatment for acute asthma among children presenting to the emergency department

Objective: Single-center studies have reported varying relapse rates after treatment of patients with acute asthma, We determined the relapse rate after emergency department (ED) treatment in a cohort of children. Design: This was a prospective inception cohort study performed during 1997-1998. Setting: The study was performed in 44 EDs including both general and pediatric centers. Patients: Children (n = 1184) aged 2 to 17 years who had been admitted to EDs, with acute asthma restricted to 881 patients discharged from the ED. Main results: Two weeks after discharge, families were telephoned to determine relapse. Follow-up data were available for 762 (86%) of the children with a 10% incidence of relapse. On univariate analysis several factors were associated with relapse including current medications and markers of asthma severity. On multivariate analysis the factors associated with relapse were age (OR 1.4 per 5-year increase), use of second-line asthma medications (OR 3.7), exposure to cigarette smoke (OR 0.5), and ED visits within the past year (OR 1.2 per 5 ED visits). Conclusions: The incidence of relapse among children is lower than that observed among adults and varies with age. Other risk factors such as frequent ED visits are likely markers of chronic asthma severity. Further research should focus on ways to decrease the relapse rate among patients at high risk.