Background: Recent surveys in emergency medicine departments show inadequacies in many aspects of acute asthma management.Objective: The objective of this study was to evaluate the adherence to management algorithm for acute asthma in the emergency department which focused on evidence-based treatment steps rather than documentation and patient classification. Methods: A retrospective audit of consecutive adult patients with acute exacerbations of asthma in the emergency medicine department of a university hospital managed in the context of a clinical algorithm. Results: We collated information from 344 episodes of acute asthma (94% of total) over a 4-month period. The first-line treatment was nebulised bronchodilators in 97%, combination of salbutamol and ipratropium bromide in 93% and the combination in recommended dosages in 87%. Systemic corticosteroid treatment was administered to 82% of patients. A further course of systemic corticosteroid was prescribed at discharge for 94% of patients. Overall, 93% of patients received some form of systemic corticosteroid treatment. The admission rate was 35.2%, and was significantly higher in women and the elderly. Of those who were admitted, 46.2% received >3 nebulised treatments and 69% received intravenous hydrocortisone. Conclusions: In the management of acute asthma, we found excellent compliance with specific treatment steps based upon clinical evidence. However, adherence to second-line treatment was less satisfactory. Nevertheless, whenever second-line treatment was complied with, reasonable outcomes were achieved. It may be more appropriate to emphasise evidence-based treatment rather than extensive documentation.
Attendance at the emergency medicine department (EMD) for acute exacerbation is an important milestone in the natural history of patients with asthma. It is an indication of clinically severe disease, inadequate preventive treatment and failure of self-medication for acute symptoms.
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