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(Chest. 1999;116:1638-1645.)
© 1999 American College of Chest Physicians

Current Outpatient Management of Asthma Shows Poor Compliance With International Consensus Guidelines*

David McD Taylor, MD; Thomas E. Auble, PhD; William J. Calhoun, MD, FCCP and Vincent N. Mosesso, Jr., MD

* From the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Correspondence to: Vincent N. Mosesso Jr., MD, 230 McKee Place, Suite 400, Pittsburgh, PA 15213; e-mail: vnm{at}med.pitt.edu

Study objective: This study aimed to establish whether the outpatient management of patients presenting with an asthma exacerbation to the emergency department (ED) was in compliance with the 1992 guidelines of the "International Consensus Report on the Diagnosis and Management of Asthma."

Design: Prospective, observational study using a researcher-administered questionnaire.

Setting: University tertiary referral ED.

Patients: Convenience sample of asthmatics (aged 18 to 54 years) presenting for asthma treatment between July 1, 1997, and June 30, 1998.

Results: Eighty-five asthmatic patients were enrolled. Of these, 34 patients (40%) smoked, 53 patients (62%) were undertreated with medication when compared to the consensus guidelines, and 74 patients (87%) had no written "plan of action." During an asthma attack, 9 patients (11%) did not use a bronchodilator as first-line action and 76 patients (89%) did not commence or increase the use of an inhaled steroid. Forty-nine patients (58%) did not know that bronchospasm occurred in asthma, and 53 patients (62%) did not know that bronchial swelling occurred. Twenty-six patients (31%) thought short-acting bronchodilator drugs were asthma preventers. Sixty-two patients (73%) could not adequately define peak expiratory flow (PF), 41 patients (48%) did not own a PF meter, and only 8 patients (9%) determined their PF daily. Fifty-three patients (62%) were reviewed by a physician once a year or less, and 18 patients (21%) noted family and friends as their only source of asthma education.

Conclusions: The outpatient management of most asthma patients presenting to the ED did not comply with the consensus guidelines, and asthma knowledge was poor.

Key Words: asthma • emergency department • guidelines • management




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