[Impact of inhaled corticosteroid prescription at discharge from the emergency room on exacerbations of asthma in Japanese hospital].

BACKGROUND: Inhaled corticosteroid (ICS) therapy has been reported to improve relapses of asthma following emergency room (ER) discharge, but the benefits of ICS prescription at discharge from the ER are unclear. OBJECTIVE: To assess background of the patients who visit ER, and determine whether the prescription of ICS at ER reduces relapses in the patients with asthma. METHODS: A prospective multi-center cohort study was conducted at 32 Japanese ERs. Patients aged two to 82 years who visited ER with moderate to severe exacerbation of asthma underwent questionnaire and follow-up three and six months later. The primary observations were of the asthma-related hospitalizations, ER visits, and unscheduled visits. RESULTS: Among 343 asthma patients (Children: 120, Adults: 223), 33% of children and 12% of adult patients were classified as intermittent asthma, retrospectively. The patients with intermittent had the same rates of hospitalization (29.6%) and ER visits (46.2%) as those with persistent (hospitalization rate: 24.7%, ER visits: 53.1%, ns) before enrolled. The odds ratio for hospitalization in the patients received ICS at the discharge from the ER, compared with the patients who did not received ICS, yielded 0.256 (95% confidence interval, 0.069 to 0.942; p=0.040) by multinomial logistic regression model. CONCLUSION: Prescribing ICS at discharge from the ER to asthma patients is associated with the reduction of risk for asthma-related hospitalization. For patients discharged from the ER, including mild intermittent asthma, ICS might be prescribed.