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Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism


The objective of this study was to investigate the management of patients with asthma attack admitted to the emergency department (ED) in terms of compliance with international guidelines. The records of patients with asthma who were admitted to a university-based ED between December 2001 and December 2002 were evaluated. A total of 72 cases with available data were evaluated retrospectively. Twenty-six patients (36.1%) were admitted more than once during the study period. The number of multiple admissions ranged from 2 (15 patients, 20.0%) to 11 (2 patients, 2.8%). Peak expiratory flow (PEF) measurements were recorded in 17 patients (23.6%) on presentation. Pulse and respiratory rates were recorded in 70 (97.0%) and 67 patients (93.0%), respectively. Thirty-four patients (47.2%) underwent chest x-ray; results were normal in most patients. Salbutamol was the most commonly used drug as first-line therapy. Ipratropium bromide (inhaled) and systemic corticosteroids were added to the salbutamol in 47 (65.2%), 42 (58.4%), and 32 patients (44%), respectively. Pulmonologists were consulted in only 7 cases (9.7%). Thirty patients (43.4%) were prescribed corticosteroids on discharge. The role of functional parameters in determining asthma severity and monitoring treatment effects should be emphasized in clinical practice. Finally, more prevalent use of management guidelines will help determine their usefulness.

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  1. Global Strategy for Asthma Management and Prevention. Revised April 2002. Global Initiative for Asthma web site. Washington, DC: National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No. 02-3659. Available at: workshop.pdf. Accessed September 11, 2004.

  2. Ulahannan T, Hardern RD, Hamer DW. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?Postgrad Med J. 1996;72:162–163.

    PubMed  CAS  Article  Google Scholar 

  3. Stanford R, McLaughlin T, Okamoto LJ. The cost of asthma in the emergency department and hospital.Am J Respir Crit Care Med. 1999;160: 211–215.

    PubMed  CAS  Google Scholar 

  4. Ulusal Astim Tani ve Tedavi Rehberi. Toraks Dergisi 2000;1(EK1). Available at: http://www.toraks. Accessed June 1, 2003.

  5. Town I, Kwong T, Holst P, Beasley R. Use of a management plan for treating asthma in an emergency department.Thorax. 1990;45:702–706.

    PubMed  CAS  Google Scholar 

  6. Chidley KE, Wood-Baker R, Town GI, Sleet RA, Holgate ST. Reassessment of asthma management in an accident and emergency department.Respir Med. 1991;85:373–377.

    PubMed  Article  CAS  Google Scholar 

  7. Pinnock H, Johnson A, Young P, Martin N. Are doctors still failing to assess and treat asthma attacks? An audit of the management of acute attacks in a health district.Respir Med. 1999;93: 397–401.

    PubMed  Article  CAS  Google Scholar 

  8. Hart SR, Davidson AC. Acute adult asthma-assessment of severity and management and comparison with British Thoracic Society Guidelines.Respir Med. 1999, 93;8–10.

    PubMed  Article  CAS  Google Scholar 

  9. Salmeron S, Liard R, Elkharrat D, Muir J, Neukirch F, Ellrodt A. Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study.Lancet. 2001;358:629–635.

    PubMed  Article  CAS  Google Scholar 

  10. Rodrigo GJ, Rodrigo C. The role of anticholinergics in acute asthma treatment: an evidencebased evaluation.Chest. 2002;121:1977–1987.

    PubMed  Article  CAS  Google Scholar 

  11. Edmonds ML, Camarga CA Jr, Pollack CV Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis.Ann Emerg Med. 2002; 40:145–154.

    PubMed  Article  Google Scholar 

  12. Littenberg B, Gluck EH. A controlled trial of methylprednisolone in the emergency treatment of acute asthma.N Engl J Med. 1986;314:150–152.

    PubMed  CAS  Article  Google Scholar 

  13. Storr J, Barrell E, Barry W, Lenney W, Hatcher G. Effect of a single oral dose of prednisolone in acute childhood asthma.Lancet. 1987;1:879–882.

    PubMed  Article  CAS  Google Scholar 

  14. Rodrigo G, Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation.Chest. 1999;116:285–295.

    PubMed  Article  CAS  Google Scholar 

  15. Rowe BH, Keller JL, Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis.Am J Emerg Med. 1992;10:301–310.

    PubMed  Article  CAS  Google Scholar 

  16. Becker JM, Arora A, Scarfone RJ, et al. Oral versus intravenous corticosteroids in children hospitalized with asthma.J Allerg Clin Immunol. 1999;103:586–590.

    Article  CAS  Google Scholar 

  17. Jonsson S, Kjartansson G, Gislason D, Helgason H. Comparison of the oral and intravenous routes for treating asthma with methylprednisolone and theophylline.Chest. 1998;94:723–726.

    Article  Google Scholar 

  18. Thomas JA, Potter MW, Counselman FL, Smith DG. Emergency physician practice and steroid use in the management of acute exacerbations of asthma.Am J Emerg Med. 2001;19:465–468.

    PubMed  Article  CAS  Google Scholar 

  19. Grunfeld A, Beveridge RC, Berkowitz J, FitzGerald JM. Management of acute asthma in Canada: an assessment of emergency physician behaviour.J Emerg Med. 1997;15:547–556.

    PubMed  Article  CAS  Google Scholar 

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Akoglu, S., Topacoglu, H., Karcioglu, O. et al. Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism. Adv Therapy 21, 348–356 (2004).

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  • asthma
  • acute attack
  • management
  • emergency medicine
  • residents in emergency medicine