FACTORS ASSOCIATED WITH RELAPSE AFTER EMERGENCY DEPARTMENT TREATMENT FOR ACUTE ASTHMA

Study objective: The rate of relapse after emergency department treatment for acute asthma is high. Most studies on this subject were performed before the recent recommendations for routine use of corticosteroids and followed the patients for 10 or fewer days. We sought to evaluate relapse following ED treatment for acute asthma over a longer period, focusing particularly on the relationship between steroid use and outpatient followup visits. Design: A prospective study in which we followed patients for 21 days after discharge to determine their relapse rate (unscheduled return for asthma treatment) and compliance with scheduled outpatient appointments. Setting: University-affiliated county hospital ED. Participants: One hundred four adult asthmatic patients discharged from our ED after treatment under a standardized protocol. Results: Follow-up was performed for 91 patients(88%). There was no difference in the posttreatment forced expiratory volume at 1 second between those who relapsed (55.2%) and those who did not (57.8%; NS). Twenty-three patients (25.3%) relapsed within 3 weeks of discharge. Ninety-one percent of relapses occurred before the patients saw their primary care physician. Those who relapsed had a history of previous ED visits and hospitalizations. There was no difference in theophylline levels or history of cigarette use. Patients who relapsed within 3 days had higher eosinophil counts. Conclusion: Even with routine use of oral corticosteroids, a high percentage of patients relapse after ED treatment for acute asthma. Patients who relapse have a greater number of recent ED visits and so should be targeted for more aggressive management of their asthma.