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<td><h1><a name="h1" id="h1"></a>Clinical Decisionmaking </h1>
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<h2><a name="head3">Corticosteroid treatment, environmental controls, and other actions can reduce risk of relapse after an acute asthma episode </a></h2>
<p>Each year, between 5 and 10 percent of asthmatics will suffer an episode severe enough to warrant a visit to the emergency department (ED). Despite significant advances made in the management of asthma, many asthmatics maintain a poor quality of life (allergen exposure and inadequate use of medication) and are prone to relapse from their asthma for weeks after treatment for an acute asthma attack. </p>
<p>In a recent review of asthma studies, Yvonne M. Coyle, M.D., of the University of Texas Southwestern Medical Center at Dallas, identified several risk factors that can be modified to prevent acute asthma relapse among high-risk individuals. A 3- to 10-day course of systemic corticosteroids helps reduce the risk of acute asthma relapse after ED treatment. However, many asthmatics relapse in spite of treatment with corticosteroids and other antiinflammatory agents. These individuals may require intensive asthma treatment in an inpatient setting or perhaps in an ED treatment unit, followup to assess the need for counseling regarding behavioral issues that may affect their asthma (for example, anxiety), smoking cessation therapy for those living with asthmatic children, or asthma self-management education.</p>
<p>Behavioral counseling would target those who appear to be overly anxious or complacent about their asthma care. Asthma education may include instruction on how to maintain complex medication regimens, institute environmental control strategies such as the avoidance of indoor allergens (for example, smoke, dust, mold, and animal dander), detect and self-treat asthma exacerbations (for example, using symptom identification and a peak flow meter), and communicate effectively with health care providers. Referral to an asthma specialist to evaluate the need for immunotherapy for indoor allergens may also be needed for some asthmatics. Finally, there is convincing evidence that an asthma care followup visit with a doctor within a month after acute asthma care prevents relapse.</p>
<p>See "Predictors of acute asthma relapse: Strategies for its prevention," by Dr. Coyle, in the <em>Journal of Asthma</em> 40(3), pp. 217-224, 2003. </p>
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