Chest
Volume 123, Issue 5, May 2003, Pages 1472-1479
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Clinical Investigations
ASTHMA
Cigarette Smoking Among Asthmatic Adults Presenting to 64 Emergency Departments

https://doi.org/10.1378/chest.123.5.1472Get rights and content

Study objectives:

The emergency department (ED) is an important focal point for asthmatic individuals with uncontrolled illness. Anecdotally, many adults presenting to the ED with acute asthma are active cigarette smokers. The present study determined the prevalence of cigarette smoking among adults presenting to the ED with acute asthma and identified the factors associated with current smoking status.

Design:

A prospective cohort study conducted as part of the Multicenter Airway Research Collaboration.

Patients:

A structured interview was performed in 1,847 patients, ages 18 to 54 years, who presented to the ED with acute asthma.

Setting:

Sixty-four EDs in 21 US states and 4 Canadian provinces.

Results:

Thirty-five percent of the enrolled asthmatic patients were current smokers with a median of 10 pack-years (interquartile range, 4 to 20 pack-years), while 23% were former smokers, and 42% were never-smokers. Current smokers comprised 33% of asthmatic patients aged 18 to 29 years, 40% for ages 30 to 39 years, and 33% for ages 40 to 54 (p < 0.001). In a multivariate analysis, the factors independently associated with current smoking status (p < 0.05) were as follows: age 30 to 39 years; white race/ethnicity; non-high school graduate; lower household income; lack of private insurance; no recent inhaled steroid usage; and no history of systemic steroid usage. Although 50% of current smokers admitted that smoking worsens their asthma symptoms, only 4% stated that smoking was responsible for their current exacerbation.

Conclusions:

Although cigarette smoke is generally recognized as a respiratory irritant, cigarette smoking is common among adults presenting to the ED with acute asthma. The ED visit may provide an opportunity for patients to be targeted for smoking cessation efforts.

Section snippets

Materials and Methods

This study combines data from four prospective cohort studies performed during 1996 to 1998, as part of the Multicenter Airway Research Collaboration (MARC).7 Using a standardized protocol, investigators at 64 EDs in 21 US states and 4 Canadian provinces provided coverage 24 h per day for a median duration of 2 weeks. The inclusion criteria included physician diagnosis of acute asthma, age 18 to 54 years, and the ability to give informed consent. Of 2,496 eligible patients with acute asthma,

Results

A total of 1,847 patients with acute asthma were surveyed. Overall, 35% were current smokers, 23% were former smokers, and 42% had no prior smoking history (Fig 1). The median number of pack-years was 10 (IQR, 4 to 20 pack-years) for current smokers, and 8 pack-years (IQR, 2 to 18 pack-years) for former smokers. The average age of the cohort was 35 years, and the breakdown of smoking status by age group is shown in Figure 2. Current smoking was most common in individuals aged 30 to 39 years,

Discussion

Our results indicated that cigarette smoking was quite common among adults presenting to the ED with acute asthma. Overall, 35% of asthmatic patients between the ages of 18 and 54 years were current smokers with a median 10 pack-year history, and 23% were former smokers with a median 8 pack-year history. Only 42% of patients who presented to the ED with acute asthma did not have a history of smoking cigarettes or were currently smoking. Those patients who were more likely to be current smokers

Conclusions

Cigarette smoking is common among adults presenting to the ED with acute asthma. While certain factors such as socioeconomic status and race/ethnicity were associated with current smoking, even patients without the at-risk characteristics reported smoking at surprisingly high rates. More investigation needs to be done to understand why cigarette smoking is so common among patients presenting to the ED with acute asthma. In the meantime, the ED visit provides an opportunity for these patients to

EMNet Steering Committee

Edwin D. Boudreaux, PhD; Barry E. Brenner, MD, PhD; Carlos A. Camargo, Jr., MD (Chair); Rita K. Cydulka, MD, MS; Theodore J. Gaeta, DO, MPH; and Michael S. Radeos, MD, MPH.

EMNet Coordinating Center (at Massachusetts General Hospital, Boston, MA)

Keith Brinkley, MA; Carlos A. Camargo, Jr, MD (Director); Sunday Clark, MPH; Jennifer A. Emond, MS; Jessica L. Hohrmann, MPH; Sunghye Kim, MD.

Principal Investigators at the 64 Participating Sites

F.C. Baker, III (Maine Medical Center, Portland, ME); J.M. Basior (Buffalo General Hospital, Buffalo, NY); C.A. Bethel (Mercy Hospital, Philadelphia, PA); L. Bielory (University

ACKNOWLEDGMENT

We thank the MARC Investigators for their ongoing dedication to emergency airway research.

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    Dr. Camargo was supported by grant HL-03533 from the National Institutes of Health (Bethesda, MD). The Multicenter Airway Research Collaboration is supported by grant HL-63253

    from the National Institutes of Health and by unrestricted grants from Glaxo Wellcome Inc (Research Triangle Park, NC) and Monaghan Medical Corporation (Syracuse, NY).

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