Emergency room assessment and adrenaline treatment of patients with acute asthma of different severity
Limthongkul, S.
Journal of the Medical Association of Thailand 72(6): 338-345
1989
ISSN/ISBN: 0125-2208 PMID: 2778423 Document Number: 330487
The adequacy of emergency room assessment and treatment of patients with acute severe asthmatic attacks was evaluated by analyzing the course of 451 visits of 348 patients to Chulalongkorn hospital's Emergency Room. Eighty-five per cent of the patients had an initial index score of .gtoreq. 4 and an average peak expiratory flow rate of 92.16 .+-. 46.3 L/min. The discharge index score was 85 per cent with a score of .ltoreq. 3 and an average peak expiratory flow rate of 192 .+-. 40.3 L/min. Our study indicated that the predictive index proposed by Fischl et al correlated with the severity of airway obstruction; however, the initial index did not help with emergency room decision-making in predicting which patients might be hospitalized, have a relapse or be discharged. In fact, in our emergency room department, the index score to determine airway obstruction and the pattern of response to treatment were better predictors of the outcome, which was classified into three categories: non-responsive or minimally responsive, responsive, and partially responsive. By using conventional clinical criteria (i.e. recumbent position with elimination of laboured breathing, disappearance of dyspnea and reduction of wheezing), there was a 93 per cent accurate determination in the episodes of patients who responded sufficiently to the emergency room treatment to allow their discharge. The remaining 7 per cent of those seeking emergency treatment were hospitalized, which is a lower incidence than that of others series. There was evidence which may explain that the higher incidence of hospital admission in the other series might have been due to practitioners admitting patients in whom a relapse was expected. Our study indicated that a relapsed patient should be evaluated and treated as a new case. There was no difference in the severity of airway obstruction and the outcome of treatment among the groups taking theophylline, corticosteroid, sympathomimetic amine inhaler and who were 45 or more years of age when compared with the overall group.