Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1990 Feb;45(2):130–134. doi: 10.1136/thx.45.2.130

Changes in hospital management of acute severe asthma by thoracic and general physicians in Birmingham and Manchester during 1978 and 1985.

D R Baldwin 1, L P Ormerod 1, A D Mackay 1, D E Stableforth 1
PMCID: PMC462326  PMID: 2315876

Abstract

Hospital management of acute severe asthma in 14 large hospitals in Birmingham and Manchester was audited in a random 20% of 1196 patients aged 15-45 years admitted in 1985. Of the 239 admissions randomised, 192 were suitable for study. Results were compared with those from a study in the same hospitals using the same methods in 1978. The age and sex of the patients and their smoking history, duration of asthma, and hospital attendance were similar in 1978 and 1985. A much smaller proportion of patients presented with symptoms of over seven days' duration in 1985 (8.5%) than in 1978 (26%). The inpatient management of asthma appears to have improved in both thoracic and general units, with more thorough functional assessments, more frequent performance of relevant investigations (arterial blood gases and peak expiratory flow rates) and more frequent use of recommended treatment (nebulised bronchodilators, oral and intravenous corticosteroids). Less difference was found in 1985 between units with a specialist thoracic interest and those without, though some differences remained in 1985 in monitoring of peak expiratory flow rate and arterial blood gases, outpatient prescribing, and follow up arrangements. Inhaled preventive medication was prescribed more frequently than in 1978. In 1985 there was a 56% increase in admissions for asthma. The proportion of severely ill patients was similar to that in 1978, but in the most severe functional grade mean arterial carbon dioxide tension was higher in 1985 and more patients were ventilated. Our results suggest that hospital management by thoracic and general physicians has improved over the period 1978-85. Patients presented earlier in 1985, though there seems to have been an increase in asthma of all grades of severity.

Full text

PDF
130

Images in this article

131Image
on p.131

Selected References

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

  1. Arbab O. A., Wiggins J., Ayres J. G., Stableforth D. E. The use of parenteral aminophylline in patients taking slow release theophylline preparations: an observation of clinical practice. Br J Dis Chest. 1985 Apr;79(2):161–171. [PubMed] [Google Scholar]
  2. Arnold A. G., Lane D. J., Zapata E. Current therapeutic practice in the management of acute severe asthma. Br J Dis Chest. 1983 Apr;77(2):123–135. doi: 10.1016/0007-0971(83)90018-9. [DOI] [PubMed] [Google Scholar]
  3. Britton W. J., Woolcock A. J., Peat J. K., Sedgwick C. J., Lloyd D. M., Leeder S. R. Prevalence of bronchial hyperresponsiveness in children: the relationship between asthma and skin reactivity to allergens in two communities. Int J Epidemiol. 1986 Jun;15(2):202–209. doi: 10.1093/ije/15.2.202. [DOI] [PubMed] [Google Scholar]
  4. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Differences in hospital asthma management. Lancet. 1988 Apr 2;1(8588):748–750. doi: 10.1016/s0140-6736(88)91549-8. [DOI] [PubMed] [Google Scholar]
  5. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Management of asthma in hospital: a prospective audit. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1637–1639. doi: 10.1136/bmj.296.6637.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Burney P. G. Asthma mortality in England and Wales: evidence for a further increase, 1974-84. Lancet. 1986 Aug 9;2(8502):323–326. doi: 10.1016/s0140-6736(86)90012-7. [DOI] [PubMed] [Google Scholar]
  7. Davis B., Gett P. M., Jones E. S. A service for the adult asthmatic. Thorax. 1980 Feb;35(2):111–113. doi: 10.1136/thx.35.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fleming D. M., Crombie D. L. Prevalence of asthma and hay fever in England and Wales. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):279–283. doi: 10.1136/bmj.294.6567.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hay I. F., Higenbottam T. W. Has the management of asthma improved? Lancet. 1987 Sep 12;2(8559):609–611. doi: 10.1016/s0140-6736(87)92995-3. [DOI] [PubMed] [Google Scholar]
  10. Jackson R. T., Beaglehole R., Rea H. H., Sutherland D. C. Mortality from asthma: a new epidemic in New Zealand. Br Med J (Clin Res Ed) 1982 Sep 18;285(6344):771–774. doi: 10.1136/bmj.285.6344.771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Keating G., Mitchell E. A., Jackson R., Beaglehole R., Rea H. Trends in sales of drugs for asthma in New Zealand, Australia, and the United Kingdom, 1975-81. Br Med J (Clin Res Ed) 1984 Aug 11;289(6441):348–351. doi: 10.1136/bmj.289.6441.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mitchell E. A. Increasing prevalence of asthma in children. N Z Med J. 1983 Jun 22;96(734):463–464. [PubMed] [Google Scholar]
  13. Osman J., Ormerod P., Stableforth D. Management of acute asthma: a survey of hospital practice and comparison between thoracic and general physicians in Birmingham and Manchester. Br J Dis Chest. 1987 Jul;81(3):232–241. doi: 10.1016/0007-0971(87)90155-0. [DOI] [PubMed] [Google Scholar]
  14. Screening for congenital hypothyroidism. Br Med J. 1980 Jul 5;281(6232):1–2. [PMC free article] [PubMed] [Google Scholar]
  15. Sears M. R., Jones D. T., Holdaway M. D., Hewitt C. J., Flannery E. M., Herbison G. P., Silva P. A. Prevalence of bronchial reactivity to inhaled methacholine in New Zealand children. Thorax. 1986 Apr;41(4):283–289. doi: 10.1136/thx.41.4.283. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES