Behavioral and environmental factors associated with acute exacerbation of asthma

Background: The relapse rate following treatment for acute asthma is high. While previous studies have evaluated the utility of pulmonary function measurements to identify patients likely to relapse, the results are conflicting. The purpose of this study was to evaluate other correctable, risk factors that may be associated with relapse. Participants: Two hundred twenty-three patients treated in the emergency department during 1994, including those either admitted or discharged. Methods: Patient interviews to identify behavioral and environmental risk factors for asthma exacerbation. Telephone contact and medical record review to determine incidence of relapse. Results: Two hundred twenty-three patients were enrolled of whom follow-up data were available for 152 (68%). Twenty-one percent of the patients relapsed within 14 days. Relapse was associated with the lack of an identifiable primary care physician and inability to obtain discharge medications. There was no relationship between relapse and the use of a spacer, hypoallergenic pillow or mattress cover, cigarette smoking, the presence of pets in the home, or weekly carpet cleaning. Conclusion: Even following hospitalization for acute asthma, there is a significant relapse rate. Improving patients' access to primary care physicians and to appropriate medications may decrease the relapse rate. Although a significant portion of patients have behavioral and environmental risk factors for asthma exacerbation including cigarette smoking and failure to maintain a hypoallergenic environment, these factors are not associated with short-term relapse.