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J Asthma. 2019 Sep;56(9):985-994. doi: 10.1080/02770903.2018.1508472. Epub 2018 Oct 12.

Reasons and outcomes for patients receiving ICS/LABA agents prior to, and one month after, emergency department presentations for acute asthma.

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a Departments of Emergency Medicine, University of Alberta , Edmonton , AB , Canada.
e Department of Emergency Medicine, Mt. Sinai Hospital , Toronto , ON , Canada.
b Medicine, University of Alberta , Edmonton , AB , Canada.
f Division of Emergency Medicine, Laval University , Quebec City , PQ , Canada.
g Department of Emergency Medicine, Dalhousie University , Halifax , NS , Canada.
h Departments of Emergency Medicine and of Biomedical & Molecular Sciences, Queen's University , Kingston , ON , Canada.
i Department of Emergency Medicine, University of British Columbia , Vancouver , BC , Canada.
j Department of Emergency Medicine and Medicine, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , ON , Canada.
c School of Public Health, University of Alberta , Edmonton , AB , Canada.
d Alberta Health Services (AHS) all in Edmonton , Edmonton , AB , Canada.


Objective: Asthma is a common emergency department (ED) presentation. This study examined factors associated with inhaled corticosteroids/long-acting beta-agonist (ICS/LABA) use; and management and outcomes before and after ED presentation. Methods: Secondary analysis of a prospective cohort study; adults treated for acute asthma in Canadian EDs underwent a structured interview before discharge and were followed-up four weeks later. Patients received oral corticosteroids (OCS) at discharge and, at physician discretion, most received ICS or ICS/LABA inhaled agents. Analyses focused on ICS/LABA vs "other" treatment groups at ED presentation. Results: Of 807 enrolled patients, 33% reported receiving ICS/LABA at ED presentation; 62% were female, median age was 31 years. Factors independently associated with ICS/LABA treatment prior to ED presentation were: having an asthma action plan; using an asthma diary/peak flow meter; influenza immunization; not using the ED as usual site for prescriptions; ever using OCS and currently using ICS. Patients were treated similarly in the ED and at discharge; however, relapse was higher in the ICS/LABA group, even after adjustment. Conclusion: One-third of patients presenting to the ED with acute asthma were already receiving ICS/LABA agents; this treatment was independently associated with preventive measures. While ICS/LABA management improves control of chronic asthma, patients using these agents who develop acute asthma reflect higher severity and increased risk of future relapse.


Asthma; emergency department; management

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