Chest
Clinical Investigations: AsthmaSurvey of Asthma Practice Among Emergency Physicians
Section snippets
Materials and Methods
A survey instrument was designed containing questions covering the respondent's training background, nature of clinical practice, use of medications for acute asthma, and use of PFT. Most of the questions were multiple choice and covered pertinent aspects of the guidelines for ED management of asthma. In addition, questions were included covering the sources of information physicians used to guide asthma management. A pilot study of the survey was performed with a mailing to a random sample of
Results
Of 800 (52%) surveys, 416 were returned; 298 (72%) respondents were board certified in emergency medicine (EM) and 56 (13%) were board prepared in EM (Table 2). In addition, 133 (32%) were board certified and 21 (5%) were board prepared in another specialty; 199 (48%) respondents had completed a residency in EM.
Fifty-five (13%) of those surveyed practice in a university or governmental teaching hospital, 79 (19%) practice in other teaching hospitals, 258 (62%) practice in community hospitals,
Discussion
Recommendations for changes in asthma management have been widely reported. There has, however, been little work undertaken to assess the effect of these published guidelines on actual practice. This study demonstrates that most emergency physicians follow the treatment but not the assessment guidelines as published.
Some work has been performed to assess the success of guidelines in influencing management in other countries. The British Thoracic Society has published a stepwise approach to
Conclusion
Emergency physicians report use of corticosteroids and inhaled β-agonists at least as often as recommended by the guidelines. There is less concordance with the NAEPP recommendations for measurement of PFTs. Educational efforts and research efforts should highlight the importance of PFT, in light of information that demonstrates its effect on the management of acute asthma.
References (19)
- et al.
International trends in asthma mortality: 1970 to 1985
Chest
(1988) Asthma guidelines and evidence-based medicine
Lancet
(1993)- et al.
Reassessment of asthma management in accident and emergency department
Respir Med
(1991) - et al.
Physician estimation of FEV1 in acute exacerbation of COPD
Chest
(1994) - et al.
Evaluation of the severity of asthma: patients versus physicians
Am J Med
(1980) - et al.
Spirometric evaluation of acute bronchial asthma
J Am Coll Emerg Phys
(1979) - et al.
The National Asthma Education Program: expert panel report guidelines for the diagnosis and management of asthma
Med Care
(1993) - Medical news and perspectives: international consensus report urges sweeping reform in asthma treatment. JAMA 1992;...
- NIH asthma treatment guidelines not being utilized in patient care. W Va Med J 1993;...
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Repeated dyspnea score and percent FEV<inf>1</inf> are modest predictors of hospitalization/relapse in patients with acute asthma exacerbation
2014, Respiratory MedicineCitation Excerpt :These are relatively simple to perform, are an objective assessment of airflow, and have been extensively studied. However, the exact cut-off value for these tests to optimize sensitivity and specificity for the need for hospitalization has been debated [2,14,27] and ranges from <50% predicted to <25% predicted. Perhaps as a result of this wide variation in a “safe for discharge” %FEV1 its use for disposition decision making is not widespread.
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2005, Annals of Emergency MedicineCitation Excerpt :Although Stempel et al11 investigated prescription patterns for 2 months after an ED visit and demonstrated that the increase in prescriptions for inhaled corticosteroids after an ED visit reverted to baseline rates in the second month after the index visit, we demonstrate that prescriptions rates remain low for at least a year after the visit. Possible reasons for this include failure of many patients to follow up after an ED visit, lack of physician familiarity with the guidelines, lack of agreement with guidelines, complexity of the guidelines, and failure to apply them correctly.25-33 Although a visit to the ED represents a failure of the NAEPP EPR-2 goals, it also represents an opportunity to improve asthma care.
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2004, Chest
revision accepted October 18.