SESSION TYPE: Asthma Predictors and Outcomes
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Relapse, defined as the need for emergent or urgent care following an emergency department (ED) visit, is common in subjects with asthma even following a course of systemic corticosteroids. Although 25% of adults relapse within 4 weeks, it is not clear whether this represents relapse of the acute episode or chronic recidivism from persistently uncontrolled asthma. To better define the clinical course following an asthma exacerbation resulting in an ED visit, we measured lung function and the frequency of exacerbations during the subsequent 12 weeks.
METHODS: Data were analyzed from the standard care group of a multicenter study of adult subjects presenting to the ED with an asthma exacerbation, having an FEV1 <70% predicted following bronchodilator therapy, and having ≥1 exacerbation within the previous year. Subjects were treated with a 7-day course of systemic corticosteroids and provided with a prescription for 12 weeks of inhaled corticosteroids at discharge. Subjects returned at weeks 1, 6, and 12 for evaluation.
RESULTS: Baseline characteristics of 36 subjects were an average age of 36 years; 28 (78%) were women, and 25 (69%) were African American. The number of ED visits in the prior year averaged 5.9 (median 3.0), and 9 subjects (25%) had a lifetime history of endotracheal intubation for asthma. The baseline percent-predicted FEV1 was 57% after initial ED bronchodilator therapy, 66% at week 1, and remained unchanged (67%) at week 12. A total of 31 exacerbations were observed in 14 (39%) of 36 subjects by week 12. Of those, 6% occurred at week 1, 45% between weeks 2 to 6, and 48% between weeks 7 to 12. The weighted exacerbation rate through week 12 was 3.59 exacerbations/subject/year (95% CI 2.44, 5.10).
CONCLUSIONS: Twelve weeks following an ED visit, asthma remained poorly controlled and exacerbations were common, despite prescription of controller therapy.
CLINICAL IMPLICATIONS: This study identifies a population that requires better management strategies to achieve long-term asthma control and prevent emergent visits following an ED visit.
DISCLOSURE: Robert Silverman: Other: Prinicipal investigator in a clinical trial sponsored by MedImmune LLC
Keunpyo Kim: Employee: Employee of MedImmune LLC
Joseph Parker: Employee: Employee of MedImmune LLC
Kimmie McLaurin: Employee: Employee of MedImmune LLC
Xiao Tu: Employee: Employee of MedImmune LLC
Nestor Molfino: Employee: Employee of MedImmune LLC
The data from this trial was obtained from a randomized controlled clinical trial of an investigation product. No information regarding the investigational product is contained in this abstract.MedImmune LLC, Gaithersberg, MD