Multicenter study of cigarette smoking among adults with asthma exacerbations in the emergency department, 2011–2012

Introduction Previous studies demonstrated a high prevalence of cigarette smoking in patients presenting to the emergency department (ED) with acute asthma. Despite the clinical and public health importance, there have been no recent multicenter efforts to characterize this patient population. We aimed to update the prevalence of cigarette smoking among ED patients with asthma exacerbations. Methods Multicenter chart review study of 48 EDs across 23 US states. We identified ED patients aged 18–54 years with asthma exacerbations during 2011–2012. We classified patients into three groups based on smoking status: never smoker, former smoker, and current smoker. We fit multivariable logistic regression models to examine independent predictors of being a current smoker. Results Of 1801 enrolled patients, never smokers accounted for 51% (95%CI, 49%–54%), former smokers 13% (95%CI, 11%–14%), and current smokers 36% (95%CI, 34%–38%). The multivariable model demonstrated several independent predictors for current smoking: older age (age 30–39 and 40–54 years), non-Hispanic white or black, having public or no insurance, and not having an asthma specialist (all P < 0.05). Conclusion This large multicenter study of ED patients with asthma exacerbations demonstrated that one in three patients were current smokers. This burden of current smokers has not changed from multicenter findings in the late 1990s. The persistently high burden suggests the inadequacy of current measures to manage tobacco use in these high-risk patients.