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Original Research: Asthma |

Rates and Correlates of Relapse Following ED Discharge for Acute AsthmaAsthma Relapses: A Canadian 20-Site Prospective Cohort Study

Brian H. Rowe, MD, FCCP; Cristina Villa-Roel, MD; Sumit R. Majumdar, MD, MPH; Riyad B. Abu-Laban, MD, MHSc; Shawn D. Aaron, MD; Ian G. Stiell, MD; Jeffrey Johnson, PhD; Ambikaipakan Senthilselvan, PhD; for the AIR Investigators
Author and Funding Information

From the Department of Emergency Medicine (Drs Rowe and Villa-Roel), the Department of Medicine (Dr Majumdar), and the School of Public Health (Drs Rowe, Villa-Roel, Johnson, and Senthilselvan), University of Alberta, Edmonton, AB; the Department of Emergency Medicine (Dr Abu-Laban), University of British Columbia, Vancouver, BC; and the Department of Medicine (Dr Aaron) and the Department of Emergency Medicine (Dr Stiell), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.

CORRESPONDENCE TO: Brian H. Rowe, MD, FCCP, Department of Emergency Medicine, University of Alberta, 1G1.43 Walter C. Mackenzie Health Sciences Center, 8440-112 St, Edmonton, AB T6G 2B7, Canada; e-mail: brian.rowe@ualberta.ca


FUNDING/SUPPORT: This study was supported by the Canadian Institutes of Health Research (CIHR), Ottawa, Ontario, and the Medical Services Incorporated Foundation (MSI), Edmonton, Alberta.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):140-149. doi:10.1378/chest.14-0843
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BACKGROUND:  Acute asthma is a common ED presentation. In a prospective, multicenter cohort study, we determined the frequency and factors associated with asthma relapse following discharge from the ED.

METHODS:  Adults aged 18 to 55 years who were treated for acute asthma and discharged from 20 Canadian EDs underwent a structured ED interview and a follow-up telephone interview 4 weeks later. Standardized antiinflammatory treatment was offered at discharge. Multivariable analyses were performed.

RESULTS:  Of 807 enrolled patients, 58% were women, and the median age was 30 years. Relapse occurred in 144 patients (18%) within 4 weeks of ED discharge. Factors independently associated with relapse occurrence were female sex (women, 22% vs men, 12%; adjusted OR [aOR], 1.9; 95% CI, 1.2-3.0); symptom duration of ≥ 24 h prior to ED visit (long duration, 19% vs short duration, 13%; aOR, 1.7; 95% CI, 1.3-2.3); ever using oral corticosteroids (ever use, 21% vs never use, 12%; aOR, 1.5; 95% CI, 1.1- 2.0); current use of an inhaled corticosteroid ([ICS]/long-acting β-agonist combination product (combination product, 25% vs ICS monotherapy,15%; aOR, 1.9; 95% CI, 1.1-3.2); and owning a spacer device (owning one, 24% vs not owning one, 15%; aOR, 1.6; 95% CI, 1.3-1.9).

CONCLUSIONS:  Despite receiving guideline-concordant antiinflammatory treatments at ED discharge, almost one in five patients relapsed within 4 weeks. Female sex, prolonged symptoms, treatment-related factors, and markers of prior asthma severity were significantly associated with relapse. These results may help physicians target more aggressive interventions for patients at high risk of relapse.

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