The patient was in no apparent distress. Examination revealed the following: oropharynx, moist mucosa and no lesions; chest, bilateral loud high pitched wheezing diffusely, with prolonged expiratory phase; cardiac, S1 S2, diminished, no murmur, regular rate and rhythm, and tachycardia; abdomen, soft, nontender, normal bowel sounds, and no hepatospleno-megaly; and extremities, no clubbing, cyanosis, or edema. The neurologic examination was unremarkable.

Laboratory Findings

Laboratory findings are as follows: WBC count, 9.8 X 103/^L with 94% polymorphonuclear neutrophils and 2% band neutrophils; hematocrit, 45%; and platelet count, 276 X 103/^L. Calcium measurement, liver function test results, and electrolyte levels were normal. No infiltrates were evident on chest radiograph, and ECG revealed no acute changes.

Clinical Course

The patient was admitted to the hospital with a diagnosis of asthma exacerbation. She improved with IV steroids, bronchodilators, and antibiotics Pharmacy. Prednisone online was tapered to 60 mg/d. Ten days after admission, she developed neck swelling and hoarseness with pronounced subcutaneous emphysema. Her chest was clear on examination, and the rest of her physical examination was otherwise unremarkable. Her chest radiograph revealed subcutaneous emphysema, pneumomediastinum, and no pneumothorax. On the 11th hospital day, the patient complained of abdominal pain. Examination showed diffuse abdominal tenderness; however, the abdomen was soft with no signs of peritoneal irritation. The patient’s WBC count increased to 23 X 103/^L, with 4% band neutrophils. CT of the abdomen with iodinated contrast medium (Gastrografin; Schering Diagnostics; Berlin, Germany) was nonrevealing. No intraperitoneal air was identified.

A surgeon was consulted on the 12th hospital day; the abdominal pain was attributed to pneumatosis coli. The patient continued to complain of increasing abdominal pain, although her abdominal examination remained unimpressive. The next day, the WBC count increased to 27 X 103/^L, with 8% band neutrophils. On the 14th hospital day, a second abdominal CT with gastrografin was nonrevealing. A chest radiograph and CT image at the level of mediastinum are shown below.

Prospective cohort studies performed during 1996 to 1998 by the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers provided 24-h coverage for a median duration of 2 weeks per year. Adults with acute asthma were interviewed in the ED and by telephone 2 weeks after hospital discharge.

In the United States, asthma does not affect all racial/ethnic groups equally. Population studies have repeatedly found higher asthma prevalence among blacks compared to whites. Black patients with asthma also experience greater morbidity and mortality. Hispanic patients, especially those of Puerto Rican descent, likewise bear a greater asthma burden than whites.

The reasons for racial/ethnic differences in asthma prevalence, morbidity, and mortality remain unclear.

While evidence for the genetic basis of asthma is clear, information about the contribution of genetic factors to race/ethnicity differences in asthma is lacking. Rather, other nongenetic factors have been implicated, such as lower socioeconomic status (SES) and its correlates, including greater allergen and irritant exposure and poor access to and compliance with state of the art management.

Most published studies on emergency department (ED) utilization by asthmatic adults of different racial/ethnic backgrounds have used retrospective reviews of archived or billing data. This restricts the range of variables that can be examined and leads to an incomplete picture of what actually happens to patients while they are in the ED Viagra in Canada. To further examine the role of race/ethnicity in asthma among adults presenting to the ED, we examined prospective data from the Multicenter Airway Research Collaboration (MARC). Based on previous research, we hypothesized that black and Hispanic asthma patients would be (1) in more severe respiratory distress on arrival to the ED, (2) more likely to receive substandard care while in the ED, (3) hospitalized more often during their index ED visit, and (4) more likely to relapse or have continued symptoms during the 2 weeks after hospital discharge. We further hypothesized that, after statistically controlling for factors thought to be confounders of the relation between race/ethnicity and illness severity (ie, education level, income, insurance status, and access to a primary care provider [PCP]), the observed racial/ethnic differences either would disappear or be dramatically reduced.