The present analysis identified several historical risk factors for acute asthma relapse. These results are similar to those obtained from three, single-center studies. McCarren et al observed 284 adult asthmatics for up to 8 weeks and found a 48% relapse rate. They found that patients with three or more ED visits within the prior 5 months, impairment in performing work or activities within the prior 4 weeks, or failure to achieve a PEFR of 50% at time of 24-h discharge from the hospital had a higher incidence of relapse. In Cleveland, we followed up 91 patients discharged after ED treatment in Canadian sildenafil Pharmacy for acute asthma, and found that patients who suffered relapse within 21 days of their ED visit tended to be younger and were more likely to have a history of ED visits in the previous 3 months.The results were the same whether we used 3 days or 21 days for our definition of relapse. Similarly, Ducharme and Kramer in Montreal followed up 314 children after ED treatment for acute asthma.
In their study, 30% of children had a relapse within 10 days, most (68%) within 1 day. Although a number of variables were significantly associated with relapse, only two were retained in the final multivariate model: four or more ED visits in the past year and use of an oral short-acting theophylline preparation during the course of ED treatment. The authors speculate that the latter finding may have been due to prescription of theophylline at ED discharge, but they were unable to test this hypothesis. In both studies, the strongest predictor of relapse was frequency of ED visits before the index visit. Although the relapse rate among patients with symptoms 7 days was not significantly different from the reference group, this finding may reflect a different type of “relapse” among patients with chronic asthma symptoms.
In all of these observational studies, including our own, there has been no apparent relationship between ED treatment with systemic steroids and risk for relapse. Observational studies are quite susceptible to confounding by indication, however, with physicians tending to prescribe steroids to patients with more complex conditions with higher risk of relapse. Further steroid use prior to or during the ED visit Health&Care Pharmacy may alter the postdischarge effect. Consequently, patients who receive systemic steroids may suffer more relapse events than otherwise expected, an excess that may not be completely reversed by the salutary effects of the prescribed steroids. The role of pharmacologic interventions is much better examined in randomized, double-blinded trials. In the case of systemic steroids, several trials in both adults and children with acute asthma have clearly documented decreases in risk of both hospital admission and acute asthma relapse.
