OBJECTIVE: We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma. DESIGN AND SETTING: Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up. STUDY PARTICIPANTS: Three hundred and nine patients completed the study. MAIN MEASURES: We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2-3 weeks following acute asthma care. Potential risk factors were ozone exposure, indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence. RESULTS: Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r = 0.15, P = 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b = 32.76, 95% confidence interval (CI) = 3.98-61.53, P = 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2-3 weeks before follow-up was added as a potential patient risk factor. CONCLUSION: The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure, and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.
OBJECTIVE: We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma. DESIGN AND SETTING: Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up. STUDY PARTICIPANTS: Three hundred and nine patients completed the study. MAIN MEASURES: We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2-3 weeks following acute asthma care. Potential risk factors were ozone exposure, indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence. RESULTS: Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r = 0.15, P = 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b = 32.76, 95% confidence interval (CI) = 3.98-61.53, P = 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2-3 weeks before follow-up was added as a potential patient risk factor. CONCLUSION: The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure, and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.
Authors: Lisa G Wood; Heather Powell; Terry Grissell; Thuy T D Nguyen; Darren Shafren; Michael Hensley; Peter G Gibson Journal: Chest Date: 2007-02 Impact factor: 9.410