Reassessment of asthma management in an accident and emergency department

To determine if shortcomings in asthma management in the Accident and Emergency (A & E) department identified in a previous (1983) study (Reed et al. Thorax 1985; 40: 897-902) had been corrected, we retrospectively reviewed the case records of patients attending with asthma between December 1987 and November 1988. There was an increase in the number of patients attending with asthma; 0.73 per 1000 in 1988 versus 0.57 per 1000 in 1983. Sixty-seven percent of patients were self-referred and 80% presented between 1600 h and 0800 h. There was inadequate recording of the asthma history and examination findings. Peak expiratory flow (PEF) was recorded in 86% before treatment (compared to 11% in 1983) and 70% after treatment. In addition, a prospective study of 40 patients responding to a questionnaire 2 weeks after discharge, revealed persistent symptoms of unstable asthma in 50%. Although there has been a marked improvement in the use of PEF measurements since the 1983 study, the standards of management of asthma patients may still be inadequate as evidence by the presence of unstable asthma symptoms in many of those discharged. A standardized management protocol which provides guidelines for treatment based on PEF has been introduced to the A & E department.