Factors identify patients with asthma at risk for relapse after ED discharge
Nearly one in five patients treated for acute asthma at Canadian EDs relapsed within 4 weeks, despite receiving anti-inflammatory treatment at discharge, according to recent study results.
Researchers studied 807 patients (median age, 30 years; 58% females) who were treated for acute asthma and discharged from 20 EDs. All patients completed an ED interview and a follow-up telephone interview 4 weeks after discharge.
The patients were offered standardized anti-inflammatory treatment at discharge, which generally included inhaled beta-agonists, short-acting anticholinergics and a systemic corticosteroid.
Eighteen percent of patients (n=144) experienced a relapse within 4 weeks of discharge, with 79% of those patients seeking ED care. Females relapsed at a higher rate than males (P=.003).
In multivariable analysis, female sex (22% vs. 12% males; adjusted OR=1.9; 95% CI, 1.2-3), symptom duration of at least 24 hours before ED visit (19% vs. 13% shorter duration; aOR=1.7; 95% CI, 1.3-2.3); oral corticosteroid use (21% vs. 12% never use; aOR=1.5; 95% CI, 1.1-2); inhaled corticosteroids/long-acting beta agonist combination product current use with or without extra ICS (25% vs. 15% for ICS monotherapy; aOR=1.9; 95% CI, 1.1-3.2); and possession of a spacer device (24% vs. 15% who did not own one; aOR=1.6; 95% CI, 1.3-1.9) were independently associated with relapse.
“This study identified a practical set of factors which could be used by clinicians to identify patients at risk for relapse after discharge from an ED and guide health providers in the development of evidence-based clinical decision rules, educational strategies and optimal follow-up plans for the prevention of relapses,” the researchers concluded. “Although some further work is required to validate our specific findings, we believe that the presence of one or more of these risk factors identified patients at high risk of relapse who might benefit from more intensive ED management, disposition decisions (eg, early admissions) and discharge plans (eg, closer follow-up by a primary care provider or specialist after discharge).”
Disclosure: Brian H. Rowe, MD, MSc, has received funding from GSK and ElectroCore.