Relapse following treatment of acute asthma in the emergency department

Abstract

Most patients presenting to the emergency department (ED) with acute asthma will have some, if not significant, relief of respiratory distress following treatment. The majority of patients are discharged to home; however, a significant portion of patients relapse and require urgent medical treatment. Many patients have continued respiratory symptoms and impairment in activities of daily living after ED treatment. In a large multicenter trial, we found that 17% of patients relapse within 2 weeks, requiring urgent medical treatment. The factors associated with asthma relapse were a history of numerous ED visits over the previous year, a history of urgent clinic visits over the previous year, use of a home nebulizer, multiple asthma triggers, and duration of symptoms between 1 and 7 days. In other studies, we found that many patients relapse before they can see their primary care physician, and that the lack of an identifiable primary care physician is associated with a higher incidence of relapse. Two interventions have been shown in studies to decrease the rate of relapse. The first, the administration of corticosteroids, has been adopted into general medical practice. Despite the routine use of corticosteroids following ED treatment, however, relapse remains a substantial problem. The second intervention involves focused long-term management by an asthma specialist. Several projects have demonstrated the efficacy of this approach in decreasing ED visits. Although it is time- and resource-intensive, this approach may be necessary for those patients who have frequent ED visits. Whether this approach is generalizable has yet to be demonstrated. In this article, we review the previous work on asthma relapse and suggest areas for further study.