Open Access Research article

Long-term smoking increases the need for acute care among asthma patients: a case control study

Paula Kauppi1*, Henna Kupiainen2, Ari Lindqvist2, Tari Haahtela1 and Tarja Laitinen3

Author Affiliations

1 Skin and Allergy Hospital, Helsinki University Central Hospital, PO Box 160, FI-00029 HUS Helsinki, Finland

2 Research Unit of Pulmonary Diseases and Division of Pulmonology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS Helsinki, Finland

3 Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, PO BOX 52, FI-20521 Turku, Finland

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BMC Pulmonary Medicine 2014, 14:119  doi:10.1186/1471-2466-14-119

Published: 16 July 2014



To examine risk factors for asthma patients’ emergency room (ER) visits in a well organized asthma care setting.


A random sample of 344 asthma patients from a Pulmonary Clinic of a University Hospital were followed through medical records from 1995 to 2006. All the ER visits due to dyspnea, respiratory infections, chest pain, and discomfort were evaluated.


The mean age of the study population was 56 years (SD 13 years), 72% being women. 117 (34%) of the patients had had at least one ER visit during the follow-up (mean 0.5 emergency visits per patient year, range 0–7). Asthma exacerbation, lower and upper respiratory infections accounted for the 71% of the ER visits and 77% of the hospitalizations. The patients with ER visits were older, had suffered longer from asthma and more frequently from chronic sinusitis, were more often ex- or current smokers, and had lower lung function parameters compared to the patients without emergency visits. Previous (HR 1.9, CI 1.3-3.1) and current smoking (HR 3.6, CI 1.6-8.2), poor self-reported health related quality of life (HRQoL) (HR 2.5, CI 1.5-4), and poor lung function (FEV1 < 65%, HR 2.2, CI 1.3-3.7) remained independent risk factors for ER visits after adjustment for age and gender.


Asthma patients who are or have been long-term smokers are more likely to require ER care compared to never smokers.

Obstructive lung disease; Emergency visits; Hospitalizations; Smoking cessation