A profile of acute asthma patients presenting to the emergency room

We conducted a three-month prospective study on the profile of 70 acute adult asthmatic patients presenting to the Accident and Emergency Unit of a general hospital. The overall background asthmatic activity, clinical features of current exacerbation, maintenance drug treatment, gross psycho-social problems, previous experience of near-fatal asthma, and admission and relapse rates were documented. Ninety percent of the presentations were within 24 hours of the initial attack, with an average pre-hospital therapy duration of 6.5 hours. Sixty-seven percent sought further treatment after failure to find relief from their salbutamol metered-dose inhalers. Sixteen percent did not receive any treatment before presentation. Ten percent gave a past history of mechanical ventilation for severe or near fatal asthma. The majority (94%) had asthmatic symptoms in the mild to moderate range. About half (46%) had attended the Emergency Room (ER) at least once in the previous six months. On average, patients were on two items of drugs and 23% were on maintenance inhaled steroids. One-third (33%) of the patients were found to have psycho-social problems relating to their condition. The admission rate was 37% with relapse rate following ER discharge of 13%. The study showed a high proportion of patients with psycho-social problems relating to asthma, and a subset of patients with frequent visits to the ER. It also revealed the infrequent use of prophylactic therapy.