Asthma management in the emergency department

To evaluate various aspects of the management of adult patients who present to the emergency department with acute exacerbations of asthma and who are discharged from the emergency department without hospital admission. Further, to compare the results with accepted management guidelines for the emergency department treatment of asthma.

A retrospective chart collection and review until each site contributed 50 patients to the survey.

Three tertiary care hospitals in the Saskatoon Health District, Saskatoon, Saskatchewan. The study period was from July 1, 1997 to November 18, 1997.

Patients aged 17 years or older, who were discharged from the emergency department with the diagnosis of asthma.

Data were collected on 130 patients from 147 emergency department visits.

A number of important physical examination findings were frequently not documented. In contrast to management guidelines, peak expiratory flow rates (44%) and spirometry (1%) were not commonly used in patient assessments. Only 59% of patients received treatment in the emergency departments with inhaled or systemic corticosteroids. Furthermore, specific follow-up plans were infrequently documented in the emergency department charts (37%).

Adherence with published Canadian guidelines for the emergency department management of acute asthma exacerbations was suboptimal. Corticosteroid use in the emergency department was significantly less than recommended. Increased emphasis on education and implementation of accepted asthma management guidelines is necessary.