Prediction of Relapse within Eight Weeks after an Acute Asthma Exacerbation in Adults

• Published in: Journal of clinical epidemiology 1998-02, Vol.51 (2), p.107-118
• Main Authors: McCarren, Madeline, McDermott, Michael F, Zalenski, Robert J, Jovanovic, Borko, Marder, David, Murphy, Daniel G, Kampe, Linda M, Misiewicz, Virginia M, Rydman, Robert J
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Asthma; Asthma - diagnosis; Asthma - drug therapy; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Disease-Free Survival; emergency medicine; Female; Humans; Illinois; Male; Medical sciences; Middle Aged; Multivariate Analysis; outcomes; Pneumology; Prognosis; Prospective Studies; Recurrence; relapse; Risk Factors; Time Factors
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(97)00246-1

Associations between historical, presenting, and treatment-related characteristics and relapse within 8 weeks after a moderate to severe asthma exacerbation were studied in a cohort of 284 adult asthmatics. Data were collected prospectively, and a multivariate model was developed and internally validated. Within 10 days, only 8% had relapsed, increasing to 45% by 8 weeks. Three variables that could be identified at the time of discharge were independently associated with relapse. These included: having made three or more visits to an emergency department in the prior 6 months (hazard ratio (HR) = 2.3, 95% CI = 1.6–3.4); difficulty performing work or activities as a result of physical health in the 4 weeks prior (HR = 2.7, 95% CI = 1.6–4.3); discontinuing hospital-based treatment for the exacerbation within 24 hours without having achieved a peak expiratory flow rate of at least 50% of predicted (HR = 2.6, 95% CI = 1.6–4.1). These risk factors may help to identify patients with poorly controlled asthma in need of more intensive and comprehensive management.