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

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Adolescent; Adult; Age Factors; Anti-Asthmatic Agents; Anti-Bacterial Agents; Asthma; Emergencies; *Emergency Service, Hospital; Female; Humans; Male; Medical Records; Odds Ratio; Respiratory Physiological Phenomena; Respiratory Tract Infections; Sex Factors; Smoking; United States; Young Adult


Emergency Medicine


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 cigarettes. 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.

DOI of Published Version



Ann Allergy Asthma Immunol. 2009 Aug;103(2):121-7. Link to article on publisher's site

Journal/Book/Conference Title

Annals of allergy, asthma and immunology : official publication of the American College of Allergy, Asthma, and Immunology


At the time of publication, Edwin Boudreaux was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID