+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Increasing the use of anti-inflammatory agents for acute asthma in the emergency department: experience with an asthma care map



Increasing the use of anti-inflammatory agents for acute asthma in the emergency department: experience with an asthma care map



Canadian Respiratory Journal 15(1): 20-26



Acute asthma is a common emergency department (ED) presentation and variation in its management is well recognized. The present study examined the use of an asthma care map (ACM) in one Canadian ED to improve adherence to acute asthma guidelines, emphasizing the use of systemic corticosteroids (SCSs) and inhaled corticosteroids (ICSs). Three time periods were studied: the 15 months before ACM introduction (PRE), the 15 months following a three-month introduction of the ACM (POST(1)) and the 18 months after POST(1) (POST(2)). Randomly selected patient charts from each period were included from patients who were 18 to 60 years of age and presented with a primary diagnosis of acute asthma. A priori criteria were established to determine the degree of completion and success of the ACM. Primary outcomes included documentation, use of SCSs in the ED, and prescription of SCSs and ICSs at ED discharge. A total of 387 patient charts were included (PRE, n=150; POST(1), n=150; POST(2), n=87). Patient characteristics in the three groups were similar; however, patients in POST(1) and POST(2) showed higher use of newer agents than those in the PRE group. Overall, more women (n=209; 54%) than men were seen; the mean age was 32.4 years. The care map was used in 67% of cases during POST(1) and 70% during POST(2). The use of peak expiratory flow (PEF) was high during the PRE, POST(1) and POST(2) periods (91%, 89% and 91%, respectively); however, documentation of other markers of severity increased in the POST periods. Use of SCSs occurred earlier (P<0.01) and more often (57% PRE, 68% POST(1) and 75% POST(2); P<0.01) in the POST(1,2) periods than the PRE period. There was a significant increase in use of SCSs on discharge (55% PRE, 66% POST(1) and 69% POST(2); P<0.05), and prescription of ICSs significantly increased (24% PRE, 45% POST(1) and 61% POST(2); P<0.001) in the POST(1,2) periods. Discharge without any corticosteroids decreased over the three periods (32% PRE, 21% POST(1) and 17% POST(2); P<0.05). The length of stay in the ED increased over the study periods (181 min PRE, 209 min POST(1) and 265 min POST(2); P<0.01) and admissions were infrequent (9% PRE, 13% POST(1) and 6% POST(2); P=0.50). The present study provides evidence that the standardized ED ACM was widely accepted, improved chart documentation, improved some aspects of ED care and increased prescribing of discharge preventive medications.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 053809727

Download citation: RISBibTeXText

PMID: 18292849

DOI: 10.1155/2008/431390


Related references

Changing the process of care and practice in acute asthma in the emergency department: experience with an asthma care map in a regional hospital. Cjem 9(5): 353-365, 2007

Evaluation of a program aimed at increasing referrals for asthma education of patients consulting at the emergency department for acute asthma. Chest 126(5): 1495-1501, 2004

Evaluation of a Program Aimed at Increasing Referrals for Asthma Education of Patients Consulting at the Emergency Department for Acute Asthma. Yearbook of Pulmonary Disease 2006: 37-38, 2006

Anti-inflammatory treatment after discharge home from the emergency department in adults with acute asthma. Journal of Emergency Medicine 37(2 Suppl.): S35-S41, 2009

Anti-inflammatory treatment after discharge home from the emergency department in adults with acute asthma. Proceedings of the American Thoracic Society 6(4): 380-385, 2009

Effect of an emergency department asthma program on acute asthma care. Annals of Emergency Medicine 34(3): 321-325, 1999

Asthma control and prior medical care of patients presenting with acute asthma at the emergency department. Medical Journal of Malaysia 58(4): 482-489, 2003

Asthma Patients Presenting for Emergency Department Care Had High Levels of Morbidity That Continued at 30 Days: Results from the Illinois Emergency Department Asthma Collaborative. Annals of Emergency Medicine 46(3-Supp-S): 102-0, 2005

Emergency department revisits for pediatric acute asthma exacerbations: association of factors identified in an emergency department asthma tracking system. Pediatric Emergency Care 24(8): 505-510, 2008

Adequacy of medical chart review to characterize emergency care for asthma: findings from the Illinois Emergency Department Asthma Collaborative. Academic Emergency Medicine 13(3): 345-348, 2006

Asthma specialist care preferences among parents of children receiving emergency department care for asthma. Journal of Asthma 2019: 1-8, 2019

Puerto Rican families' experiences of asthma and use of the emergency department for asthma care. Journal of Pediatric Health Care 26(5): 356-363, 2013

Do asthma integrated care pathways improve asthma management in an accident and emergency department?. European Respiratory Journal 12(Suppl. 28): 261S, 1998

Recurrent emergency department visits for asthma in children: an opportunity for asthma care improvement?. Allergologia et Immunopathologia 36(2): 57-58, 2008

Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma. Journal of Asthma 56(8): 816-822, 2019