Asthma Care Practices in Chicago-Area Emergency Departments: Asthma Treatment
As seen in Table 2, use of arterial blood gases in the initial assessment of persons with asthma was reported infrequently (9.1 ± 1.8% of patients). However, arterial blood gases were much more likely to be obtained for persons presenting with a severe asthma exacerbation (72.3 ± 3.8% of patients). Chest radiography was a common assessment tool for selected indications. Specifically, when the diagnosis was in doubt, 85.0 ± 2.8% of patients had a chest radiograph; 79.2 ± 2.3% of patients received one if they were both wheezing and febrile; and 70.1 ± 3.8% of patients received one if they were presenting with wheezing for the first time.
The average estimated length of stay for an asthma-related ED visit was 3.0 ± 0.1 h (see Table 3). The average disposition time (ie, the decision to admit) for patients with asthma was estimated at 2.5 ± 0.2 h.
All of the respondents reported use of p-agonists as initial pharmacotherapy. All but one ED reported use of nebulizer-administered p-agonist as initial therapy. One ED reported administering p-agonist therapy via me-tered-dose inhaler. Theophylline was administered infrequently, to only 9.6 ± 1.6% of patients. Steroid use was also examined. Systemic steroids (either IV or po) were given to 62.3 ± 4.0% of asthma patients during the first hour of care, and to 73.2 ± 3.9% of patients at some time during their ED visit. Approximately 13% of the EDs reported low use of systemic steroids (administered to < 50% of asthma patients). canadian neighbor pharmacy viagra
The survey data indicate that supplemental oxygen was given to an average of 77.1 ± 3.4% of all persons treated for asthma.
Discharge and Follow-up Procedures
Table 4 describes several aspects of the discharge and follow-up procedures reported by the Chicago-area EDs. According to survey results, systemic steroids were prescribed at discharge for 55.9 ± 3.5% of patients with asthma (Fig 2). Inhaled steroids, cromolyn, and antibiotics were reportedly prescribed less frequently than systemic steroids; an average of 19.8 ± 2.9% of patients received inhaled steroids or cromolyn and 19.9 ± 1.7% received antibiotics. The respondents indicated that most asthma patients had a peak flow assessment at discharge (73.1 ± 4.1%). Only 25.0 ± 4.3% of patients were reported to have received a detailed follow-up appointment (with site and time specified) at discharge.
On average, the respondents estimated that 13.8 ± 1.1% of the persons with asthma seen in the ED had a relapse within 7 days.
Table 3—Reported Use of Selected Asthma Treatment Practices in Chicago-Area EDs (n = 64)
|Treatment Practices||Mean (SE)||Median (IQR)|
|Average time asthma patient spent in ED, h||3.0(0.1)||3 (2.3-3.5)|
|Average time asthma patient spent in ED before disposition, h||2.5 (0.2)||2 (2.0-3.0)|
|Percentage of patients receiving|
|IV or po steroids used within the first hour, %f||62.3 (4.0)||63 (45-85)|
|IV or po steroids used at any time during ED care, %|||73.2 (3.9)||80 (60-90)|
|Theophylline therapy at any time during ED care, %||9.6 (1.6)||5 (2-10)|
|Supplemental oxygen at any time during ED care, %||77.1 (3.4)||85 (60-100)|
|Treatment for > 4 h, %||17.5 (1.8)||10(10–20)|
|Percentage of EDs reporting|
|Availability of respiratory therapy, both day and night, %||93.7|
|The first medication given for asthma attack:|
|P-agonist by nebulizer, %||98.4|
|P-agonist by metered-dose inhaler, %||1.6|
Table 4—Reported Use of Selected Discharge/Follow-up Procedures in Chicago-Area EDs (n = 64)
|Discharge/Follow-up Procedures||Mean (SE)||Median (IQR)|
|Percentage of the patients given|
|Prescription for systemic steroids, %||55.9 (3.5)||60 (25-80)|
|Prescription for inhaled steroids/cromolyn, %||19.8 (2.9)||10 (5-25)|
|Prescription for antibiotics, %||19.9(1.7)||20(10-25)|
|Formal asthma education by physician or nurse, %||35.4(5.1)||10(0-75)|
|Written asthma educational material, %||57.0 (5.4)||75(10-100)|
|Formal training in use of metered-dose inhaler, spacer, %||31.4(4.2)||20 (5-50)|
|Specific follow-up appointment, %||25.0 (4.3)||10 (2-30)|
|Peak flow measurement at discharge (for patients old enough to comply), %||73.1 (4.1)||80 (50-100)|
|Percentage of asthma patients estimated to relapse within 7 d, %||13.8(1.1)||10 (9.5-20)|
Figure 2. Distribution of EDs reporting prescriptions for oral corticosteroids given to asthma patients at discharge (n = 64).