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* From the Department of Emergency Medicine (Dr. Silverman), Long Island Jewish Medical Center, New Hyde Park, NY; Department of Emergency Medicine (Dr. Boudreaux), Earl K. Long Medical Center, Baton Rouge, LA; Division of Pulmonary and Critical Care Medicine (Dr. Woodruff), Department of Medicine, University of California, San Francisco, CA; and the Department of Emergency Medicine (Ms. Clark and Dr. Camargo), Massachusetts General Hospital, Boston, MA.
A list of MARC investigators is located in the Appendix.
Correspondence to: Robert Silverman, MD, Department of Emergency Medicine, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040-1596; e-mail: aresilv{at}aol.com
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.
Key Words: acute disease • asthma • emergency medicine • smoking
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