Multicenter study of cigarette smoking among patients presenting to the emergency department with acute asthma

Background: Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse. Objectives: To determine the smoking prevalence among emergency department (ED) patients with acute asthma and to investigate the relationships between smoking and acute asthma severity. Methods: A 63-site medical record review study of ED patients, ages 14 to 54 years, with a principal diagnosis of acute asthma was performed. Patients with chronic obstructive pulmonary disease were excluded. Measurements for acute asthma severity included sociodemographic factors, asthma medical history, ED presentation, clinical Course, medications administered, and return visit within 48 hours. Results: A total of 4,052 patient medical records were reviewed. A total of 1,332 patients (33%; 95% confidence interval, 31%-34%) were documented as smokers. No statistically significant differences were found between smokers and nonsmokers in vital signs, oxygen saturation, peak expiratory flow, and administration of asthma medications. By contrast, smokers were more likely than nonsmokers to receive antibiotics in the ED (12% vs 9%, P < .001) or at discharge (23% vs 14%, P < .001). A multivariate analysis confirmed that smoking status was independently associated with antibiotic administration (odds ratio, 1.6; 95% confidence interval, 1.3-1.8). Conclusions: One-third of ED patients with acute asthma smoked cigarette. Smokers and nonsmokers did not differ in their acute asthma severity. Asthmatic smokers, however, were more likely to receive antibiotics, even when adjusting for other possible confounders. Ann Allergy Asthma Immunol. 2009;103:121-127.