Acute asthma: treatment and outcome of 2000 consecutive pediatric emergency room visits in Doha, Qatar

Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

Introduction

Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department.

Materials & Methods

All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines.

Results

After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group.

Conclusions

The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

Young inner-city children visiting the emergency room (ER) for asthma: risk factors and chronic care behaviors

Inner-city children visiting emergency rooms (ER) for asthma often rely on the ER as their primary source of care. To evaluate chronic asthma control, structured interviews were conducted with the adult accompanying a sample of 46 children, 2-6 years old, presenting to an inner-city pediatric ER for asthma. Fifty-one percent had 10 or more prior ER visits and 46% had 2 or more previous hospitalizations. Seventy-two percent had functional severity scores in the moderate to severe range. Only 11% used daily inhaled anti-inflammatory medication. Not one patient had a written self-management plan. Most young children visiting an inner-city ER for asthma have poorly controlled and poorly managed chronic asthma.