Pulmonary function testing in the Emergency Department and medications prescribed at discharge: results of the Multinational Acute asthma Management, Burden, and Outcomes (MAMBO) study

Abstract

Aims: To evaluate asthma care in the emergency department (ED), including use of pulmonary function testing (PFT) and how patients are treated when discharged.Methods: Internet-based surveys were completed by 298 healthcare practitioners in seven countries on 1078 patients 15-70 years old with an acute asthma exacerbation.Results: Less than 60% of patients received guideline-recommended therapy with a bronchodilator, corticosteroid, and supplemental oxygen. Patients undergoing PFT had significantly more courses of asthma therapy (2.3 vs 1.7; p < 0.001), and received more medications (5.7 vs 3.9; p < 0.001). At discharge, 17.9% of patients did not receive a prescription asthma medication and 12.8% did not receive a physician referral. Men (p<0.022), patients with more severe disease (p<0.0001), and those seen by a pulmonologist (p<0.0001), were more likely to be treated.Conclusions: Management of patients with acute asthma exacerbations diverged from guideline recommendations. Enhanced adherence to guidelines could lead to improved outcomes.

Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit

“…A multi-national study on acute asthma management, burden, and outcomes also revealed that <60% of the patients received guideline-recommended therapy with a BD, CS, and supplemental oxygen 23. Oxygen administration is low in this study because there is a lack of assessment of the oximetry status and indication for acute oxygen administration during the initial assessment on admission.…”

“…Functional assessment components such as oxygen saturation and PEFR were measured in 5.9% and 5.0% of the cases, respectively; these indices are comparatively <93.0% and 20% in Spain24 and 96.1% and 81.0% in the UK,18 respectively. PEFR is less commonly assessed in Mexico and Italy and more commonly assessed in Australia and France 23. None of the cases had their post-BD PEFR and this is in contrast to 38.0% reported in the UK which is also a disappointing result 18.…”

“…The assessment of severity was poor as only 32.7% were documented; it is more than 3.3% in the audit of childhood asthma in Lagos,14 but it is less than 42.1–82.2% in other parts of the world 23. Functional assessment components such as oxygen saturation and PEFR were measured in 5.9% and 5.0% of the cases, respectively; these indices are comparatively <93.0% and 20% in Spain24 and 96.1% and 81.0% in the UK,18 respectively.…”

What Is the Role of PFTs in Monitoring Adverse Effects of Surgery, Drug Treatments, Radiation Therapy, and During Hospitalization?

“…However, in 2010 Fitzgerald and colleagues, using an Internet-based survey, evaluated the use of pulmonary function testing in the emergency departments of hospitals in 7 countries. 25 Based on the responses of 298 healthcare providers and 1,078 patients, ages 15 to 70, the authors found that among patients who underwent pulmonary function testing, only 11% had FEV 1 , 12% had both PEF and FEV 1 , and the rest had only PEF measured. Forty-four percent of patients with moderate or severe exacerbations did not have any spirometric testing performed.…”

Definitions of asthma exacerbations

“…However, these parameters have not been assessed systematically and are therefore just general guides [1,9]. It needs to be emphasized that adherence to guidelines on asthma management is poor [34 ]. Therefore, a suitable definition for clinical practice has to be prospective.…”