Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1985 Dec;40(12):897–902. doi: 10.1136/thx.40.12.897

Assessment and management of asthma in an accident and emergency department.

S Reed, S Diggle, M J Cushley, R A Sleet, A E Tattersfield
PMCID: PMC460221  PMID: 2869594

Abstract

Patients with asthma presenting to the accident and emergency department at Southampton General Hospital during 12 months were reviewed retrospectively to determine how many patients attended, when and how patients were assessed and treated, and what factors appeared to influence whether a patient was admitted to a medical ward or not. Thirty five visits were made by patients requesting a repeat prescription for a metered dose inhaler. A further 193 visits were made by 152 patients (93 male, 59 female); only data on the first visit of any individual were analysed in this study. Patients were more likely to visit in the autumn, at the weekend, and in the evenings. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--heart rate in 84% of examinations, pulsus paradoxus in 13%, and peak flow rate in 11%. Blood pressure was five times more likely to be recorded than peak flow rate. The drugs used to treat asthma were, in order of frequency, a beta agonist (120 patients), intravenous aminophylline (39), and intravenous corticosteroids (30). Sixty (39%) of the patients were admitted to a medical ward. Admission was more likely to occur when patients arrived during the week than at the weekend, when they had cyanosis or pulsus paradoxus, and after receiving parenteral treatment. There was no difference in mean heart rate between patients admitted to the ward and those discharged home. Although there was no specific evidence of inappropriate admission to or discharge from hospital in this retrospective study, the failure to record more objective measurements of the severity of asthma and, in particular, the extent of the airflow obstruction, is cause for concern.

Full text

PDF
897

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnold A. G., Lane D. J., Zapata E. Acute severe asthma: factors that influence hospital referral by the general practitioner and self-referral by the patient. Br J Dis Chest. 1983 Jan;77(1):51–59. [PubMed] [Google Scholar]
  2. Arnold A. G., Lane D. J., Zapata E. The speed of onset and severity of acute severe asthma. Br J Dis Chest. 1982 Apr;76(2):157–163. [PubMed] [Google Scholar]
  3. Ashley J. S. Seasonal trends in childhood asthma. Br Med J (Clin Res Ed) 1983 Dec 3;287(6406):1721–1721. doi: 10.1136/bmj.287.6406.1721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bellamy D., Collins J. V. "Acute" asthma in adults. Thorax. 1979 Feb;34(1):36–39. doi: 10.1136/thx.34.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burdon J. G., Juniper E. F., Killian K. J., Hargreave F. E., Campbell E. J. The perception of breathlessness in asthma. Am Rev Respir Dis. 1982 Nov;126(5):825–828. doi: 10.1164/arrd.1982.126.5.825. [DOI] [PubMed] [Google Scholar]
  6. Centor R. M., Yarbrough B., Wood J. P. Inability to predict relapse in acute asthma. N Engl J Med. 1984 Mar 1;310(9):577–580. doi: 10.1056/NEJM198403013100907. [DOI] [PubMed] [Google Scholar]
  7. Cochrane G. M., Clark J. H. A survey of asthma mortality in patients between ages 35 and 64 in the Greater London hospitals in 1971. Thorax. 1975 Jun;30(3):300–305. doi: 10.1136/thx.30.3.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cooke N. J., Crompton G. K., Grant I. W. Observations on the management of acute bronchial asthma. Br J Dis Chest. 1979 Apr;73(2):157–163. [PubMed] [Google Scholar]
  9. Fischl M. A., Pitchenik A., Gardner L. B. An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. N Engl J Med. 1981 Oct 1;305(14):783–789. doi: 10.1056/NEJM198110013051402. [DOI] [PubMed] [Google Scholar]
  10. Hetzel M. R., Clark T. J., Branthwaite M. A. Asthma: analysis of sudden deaths and ventilatory arrests in hospital. Br Med J. 1977 Mar 26;1(6064):808–811. doi: 10.1136/bmj.1.6064.808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Khot A., Burn R., Evans N., Lenney C., Lenney W. Seasonal variation and time trends in childhood asthma in England and Wales 1975-81. Br Med J (Clin Res Ed) 1984 Jul 28;289(6439):235–237. doi: 10.1136/bmj.289.6439.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Khot A., Burn R. Seasonal variation and time trends of deaths from asthma in England and Wales 1960-82. Br Med J (Clin Res Ed) 1984 Jul 28;289(6439):233–234. doi: 10.1136/bmj.289.6439.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Knowles G. K., Clark T. J. Pulsus paradoxus as a valuable sign indicating severity of asthma. Lancet. 1973 Dec 15;2(7842):1356–1359. doi: 10.1016/s0140-6736(73)93324-2. [DOI] [PubMed] [Google Scholar]
  14. MacDonald J. B., MacDonald E. T., Seaton A., Williams D. A. Asthma deaths in Cardiff 1963-74: 53 deaths in hospital. Br Med J. 1976 Sep 25;2(6038):721–723. doi: 10.1136/bmj.2.6038.721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Macdonald J. B., Seaton A., Williams D. A. Asthma deaths in Cardiff 1963-74: 90 deaths outside hospital. Br Med J. 1976 Jun 19;1(6024):1493–1495. doi: 10.1136/bmj.1.6024.1493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Med M. Prenatal development of lumbar intervertebral articulation. Folia Morphol (Praha) 1982;30(3):285–290. [PubMed] [Google Scholar]
  17. Ormerod L. P., Stableforth D. E. Asthma mortality in Birmingham 1975-7: 53 deaths. Br Med J. 1980 Mar 8;280(6215):687–690. doi: 10.1136/bmj.280.6215.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rebuck A. S., Read J. Assessment and management of severe asthma. Am J Med. 1971 Dec;51(6):788–798. doi: 10.1016/0002-9343(71)90307-x. [DOI] [PubMed] [Google Scholar]
  19. Rees H. A., Millar J. S., Donald K. W. A study of the clinical course and arterial blood gas tensions of patients in status asthmaticus. Q J Med. 1968 Oct;37(148):541–561. [PubMed] [Google Scholar]
  20. Rose C. C., Murphy J. G., Schwartz J. S. Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment. N Engl J Med. 1984 Mar 1;310(9):573–577. doi: 10.1056/NEJM198403013100906. [DOI] [PubMed] [Google Scholar]
  21. Rubinfeld A. R., Pain M. C. Perception of asthma. Lancet. 1976 Apr 24;1(7965):882–884. doi: 10.1016/s0140-6736(76)92097-3. [DOI] [PubMed] [Google Scholar]
  22. Shalley M. J., Cross A. B. Which patients are likely to die in an accident and emergency department? Br Med J (Clin Res Ed) 1984 Aug 18;289(6442):419–421. doi: 10.1136/bmj.289.6442.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Westerman D. E., Benatar S. R., Potgieter P. D., Ferguson A. D. Identification of the high-risk asthmatic patient. Experience with 39 patients undergoing ventilation for status asthmaticus. Am J Med. 1979 Apr;66(4):565–572. doi: 10.1016/0002-9343(79)91165-3. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES