Abstract
Aims:
To evaluate asthma care in the emergency department (ED), including use of pulmonary function testing (PFT) and how patients are treated when discharged.
Methods:
Internet-based surveys were completed by 298 healthcare practitioners in seven countries on 1078 patients 15–70 years old with an acute asthma exacerbation.
Results:
Less than 60% of patients received guideline-recommended therapy with a bronchodilator, corticosteroid, and supplemental oxygen. Patients undergoing PFT had significantly more courses of asthma therapy (2.3 vs 1.7; p < 0.001), and received more medications (5.7 vs 3.9; p < 0.001). At discharge, 17.9% of patients did not receive a prescription asthma medication and 12.8% did not receive a physician referral. Men (p<0.022), patients with more severe disease (p<0.0001), and those seen by a pulmonologist (p<0.0001), were more likely to be treated.
Conclusions:
Management of patients with acute asthma exacerbations diverged from guideline recommendations. Enhanced adherence to guidelines could lead to improved outcomes.
Keywords: asthma, exacerbation, guidelines, disease severity, treatment outcomes, assessment, drug therapy, emergency department, lung function
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Footnotes
Dr. O'Byrne discloses that, within the past 3 years, he has served on advisory boards for AstraZeneca, Biolipox, GlaxoSmithKline (GSK), Merck, Nycomed, Topigen, Resestentia, and Wyeth; has received lecture fees form AstraZeneca, Chiesi, GSK, Nycomed, and Ono Pharma, and has been a recipient (or is a pending recipient) of grants sponsored by AstraZeneca, Altana, Boehringer, Genentech, GSK, Medimmune, Merck, Pfizer, and Wyeth.
Dr. Fitzgerald discloses that he has received fees for advisory board attendance and membership of CME lecture panels sponsored by a number of companies, including Astra Zeneca, GSK, Nycomed, Merck, and Novartis, that market drugs used in the treatment of asthma. He has also received travel assistance from GSK to attend the European Respiratory Society meeting in September 2008. He has also received research funding, for asthma-related research, from these and other pharmaceutical companies, which has been paid directly to his institution (University of British Columbia).
Mr. McFetridge was a research fellow employed by the study sponsor at the time the study was completed.
Dr. Demuth discloses that his organisation (Adelphi Real World) was supported by the study sponsor to oversee the study, as well as to acquire data and conduct statistical analyses.
Dr. Allen-Ramey discloses that she is an employee of (and shareholder in) the study sponsor.