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Research ArticleOriginal Contributions

Multicenter Study of Clinical Features of Sudden-Onset Versus Slower-Onset Asthma Exacerbations Requiring Hospitalization

Venktesh R Ramnath, Sunday Clark and Carlos A Camargo
Respiratory Care August 2007, 52 (8) 1013-1020;
Venktesh R Ramnath
Pulmonary and Critical Care Unit
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Sunday Clark
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts. She is now affiliated with the Department of Emergency Medicine, New York Presbyterian Hospital, New York, New York.
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Carlos A Camargo Jr
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Asthma exacerbations differ in their speed of symptom onset.

OBJECTIVE: To characterize and compare demographic factors, clinical risk factors, and clinical outcomes among hospitalized patients who presented with sudden-onset (≤ 3 h) versus slower-onset asthma exacerbations, across a wide age range.

METHODS: We reviewed the medical records of a random sample of 1,294 patients, ages 2–54 years, admitted in 30 United States hospitals, for acute asthma from January 1999 to May 2000.

RESULTS: Data on duration of symptoms were available for 1,260 (97%) of the patients. Seventy-two patients (6%) had sudden-onset exacerbations. Sudden-onset patients were older than slower-onset patients (30 y vs 19 y, p = 0.03) but did not differ by other sociodemographic characteristics. Markers of chronic asthma severity were similar between the groups. The sudden-onset patients were more likely to present to the emergency department between midnight and 8:00 AM, to require intubation, and to be admitted to the intensive care unit (all p < 0.01). The higher risk of intensive care unit admission remained significant even after adjustment for 6 potential confounders (odds ratio 2.5, 95% confidence interval 1.3–4.9). However, hospital stay was shorter in the sudden-onset patients (2.0 d vs 2.7 d, p = 0.01). There was no difference in peak expiratory flow at hospital discharge.

CONCLUSIONS: The sudden-onset patients were older and they more commonly presented to the emergency department between midnight and 8:00 AM with severe exacerbations that required intubation and intensive care unit admission. However, the sudden-onset group was discharged from the hospital earlier.

  • sudden-onset asthma
  • emergency department
  • intensive care unit
  • intubation

Footnotes

  • Correspondence: Carlos A Camargo MD DrPH, Emergency Medicine Network Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114. E-mail: ccamargo{at}partners.org.
  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2007 by Daedalus Enterprises Inc.
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Respiratory Care: 52 (8)
Respiratory Care
Vol. 52, Issue 8
1 Aug 2007
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Multicenter Study of Clinical Features of Sudden-Onset Versus Slower-Onset Asthma Exacerbations Requiring Hospitalization
Venktesh R Ramnath, Sunday Clark, Carlos A Camargo
Respiratory Care Aug 2007, 52 (8) 1013-1020;

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Multicenter Study of Clinical Features of Sudden-Onset Versus Slower-Onset Asthma Exacerbations Requiring Hospitalization
Venktesh R Ramnath, Sunday Clark, Carlos A Camargo
Respiratory Care Aug 2007, 52 (8) 1013-1020;
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Keywords

  • sudden-onset asthma
  • Emergency Department
  • intensive care unit
  • intubation

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