Acute Asthma In Emergency Department Research Articles

Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis

Asthma exacerbations are a common and important cause of attendance at emergency departments (ED) and subsequent hospital admissions. Despite previous reviews reporting that in acute settings the risk of hospital admission is reduced with the use of high doses of inhaled corticosteroids (ICS), this evidence has not changed clinical practice. To estimate the efficacy of ICS in the treatment of acute asthma in ED. Randomized controlled trials were identified using PubMed, The Cochrane Library, and EMBASE. The primary outcome was hospital admission rates. The primary comparison was between administration of ICS in addition to systemic corticosteroids (SCS) and to SCS alone. Secondary comparisons were ICS alone compared with SCS alone and ICS compared with placebo. There were 25 studies involving 2733 participants. For the primary comparison, ICS in addition to SCS reduced the risk of hospital admission compared with SCS; fixed-effects odds ratio (95% confidence interval) 0.73 (0.57-0.94). Lung function was poorly reported. There was moderate evidence of an improvement in clinical scores and vital signs with ICS in addition to SCS. Relatively few studies reported adverse events. There is moderate evidence that high doses of ICS, in addition to SCS, reduce the risk of hospital admission in ED treatment of moderate-to-severe asthma exacerbations. Further research is required to determine their optimal role in both ED and outpatient settings.

Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study.

Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub-study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in-hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. Five hundred and eighty-four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co-morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients - inhaled beta-agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. The data suggests that compliance with guideline-recommended therapy in both regions, particularly corticosteroid administration, is sub-optimal. It also suggests over-use of antibiotics.

What Is the Role for Magnesium to Treat Severe Pediatric Asthma Exacerbations?

In this review, we explore the role for intravenous magnesium sulfate (IVMg) to treat children with acute exacerbations of asthma. Children who receive care for severe acute asthma in emergency departments are often hospitalized after inadequate response to standard asthma treatment. IVMg may have a role to decrease hospitalization of children with severe acute asthma, but is in need of further research. Future exploration of IVMg should include larger randomized controlled trials of IVMg versus standard treatment, administration of IVMg with enough time to have effect on hospitalization, exploration of the pharmacology of IVMg so that the most effective dosage regimens can be selected, and use of measures and criteria to select research participants reflective of the children likely to benefit from more effective asthma treatment in clinical practice.

Acute asthma in emergency department, prevalence of respiratory and non-respiratory symptoms

BackgroundAlthough asthma is a well identified presentation to the emergency department, little is known about the frequency and percentage of respiratory and non-respiratory symptoms in patients with acute asthma in the emergency department (ED). ObjectiveThe aim of this study is to identify the relationship between acute asthma exacerbation and different respiratory and non-respiratory symptoms including chest pain encountered by patients visiting the emergency department. Subjects and methodsProspective study included 169 (97 females and 72 males) asthmatic patients who were admitted to emergency department of two tertiary care facility hospitals for asthma exacerbation from the period of September 2010 to August 2013, an anonyms questionnaire was used to collect symptoms and analysis of symptoms. Results97 (57%) of the patients were females , mean age was 35.6years; dyspnea on exertion was the commonest symptom accounting for 161 (95.2%) of patients, followed by dyspnea at rest in 155 (91.7%), wheezing in 152 (89.9%), chest pain was present in 82 patients (48.5%), burning pain was experienced in 36 (43.9%) of the total patients with chest pain. Non-respiratory symptoms were seen frequently in acute asthma in ED. ConclusionsDyspnea was the commonest chest symptom encountered in patients with acute asthma followed by wheezing. Chest pain in acute asthma is a common symptom and should be fully studied to exclude misdiagnosis as of cardiac origin; there is a need for a better dissemination of knowledge about this disease association with chest pain. It was also noted that other non-respiratory symptoms are frequently encountered with acute asthma in emergency department.

Quality of Care for Acute Asthma in Emergency Departments in Japan: A Multicenter Observational Study

Little is known about the quality of acute asthma care in emergency departments (EDs) outside of North America. We evaluated concordance of acute asthma management in Japanese EDs with recommendations in the 2007 National Institutes of Health asthma guidelines and investigated whether guideline concordance was associated with risk of hospital admission. We conducted a multicenter chart review study in 23 EDs across Japan. We identified ED patients aged 18 to 54 years with acute asthma between 2009 and 2011. Concordance with evidence-based guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores both at patient and ED levels. These scores ranged from 0 to 100. Among 1380 patients, the median age was 35 years and 11% were hospitalized. Overall guideline concordance score was suboptimal both at the patient level (mean ± SD, 72 ± 14) and ED level (mean ± SD, 72 ± 6). Specifically, asthma care at the patient level was suboptimal in several areas: inhaled anticholinergics in ED (2%), systemic corticosteroid in ED (56%) and at discharge (36%), and peak flow assessment (9%). A multivariable model that adjusted for severity at presentation and several ED characteristics showed that higher guideline concordance was associated with significantly lower risk of hospital admission (odds ratio, 0.70 per 10-unit increase in composite score; 95% CI, 0.62-0.79 per 10-unit increase in composite score). The management of acute asthma in Japanese EDs is suboptimal. Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations. Knowledge translation initiatives are warranted to increase adherence with best practice in acute asthma management.

Direct Economic Cost of Acute Asthma in Emergency Department

Direct Economic Cost of Acute Asthma in Emergency Department

Noninvasive end-tidal carbon dioxide measurements in children with acute asthma

Objective To investigate the clinical significance of noninvasive detection of end-tidal carbon dioxide partial pressure (PetCO2) in the management of children with acute asthma, and to evaluate the association between PetCO2 and artery blood gas carbon dioxide partial pressure ( PaCO2 ). Methods This was a prospective,double blinded study of children aged 5 ～ 14 years old treated for acute asthma in a pediatric emergency department. PetCO2 and PaCO2 measurements were taken before therapy and after each nebulization treatment ( maximum of three). Various clinical parametesr were recorded. Patients with PaCO2 and PetCO2 measurements within 8 minutes of each other were eligible for inclusion. Patients with cardiac disease,chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded. Results Sixty five children were enrolled. The initial PetCO2 value was (34. 8 ±8. 6) mm Hg (95% confidence interval =34. 0 to 36. 1). The PetCO2 value of post-treatment was (33.2 ±8.2) mm Hg (95% confidence interval =32. 5 to 34. 4) ,which was decreased significantly than that before treatment(P ＜ 0. 01 ). Fifty seven PetCO2-PaCO2 paired values were available from 57 patients. The values of PetCO2 and PaCO2 were ( 34. 8 ±7. 6) mm Hg and (40. 6 ± 8. 3 ) mm Hg, respectively. PetCO2 and PaCO2 values were highly positively correlated ( r = 0. 92,P ＜ 0. 000 1 ). Conclusion Noninvasive bedside measurement of PetCO2 in children with acute asthma in emergency department is feasible. Continuous PetCO2 monitoring can provide a reliable assessment of pulmonary status. PetCO2 can serve as an important adjunct index in the clinical management of pediatric patients with acute asthma. Key words: End-tidal carbon dioxide partial pressure; Asthma; Artery blood gas carbon dioxide partial pressure; Children

Discharge Considerations for Adult Asthmatic Patients Treated in Emergency Departments

OBJECTIVE:To review the medical literature on outcome of treatment of acute asthma in the emergency department and issue recommendations regarding patient admission or discharge.DATA SOURCES:A MEDLINE search was done for articles in the English language on acute asthma and treatment in the emergency department for the years 1975 to 1993. In addition, references in pertinent review articles were reviewed.STUDY SELECTION:Studies addressing treatment of acute asthma in emergency departments were selected by consensus.DATA SYNTHESIS:Three major areas have been shown to affect outcome and the decision to admit or discharge a patient following treatment in the emergency department: first, the severity of the attack and the response to therapy; second, historical risk factors; and third, care following discharge from the emergency department. This paper reviews the literature on outcome of acute asthma attacks and issues recommendations regarding objective airflow measurements and co-existing risk factors to be assessed before discharging patients. The role of anti-inflammatory therapy in emergency department treatment and in postdischarge treatment of these patients is also reviewed.CONCLUSION:Evaluation for discharge following treatment of acute asthma should integrate objective measures of airflow obstruction with historical high risk factors. The use of systemic corticosteroids in the emergency department and following discharge, with careful follow-up, may help control the attack and reduce relapse of asthma.