Clinical study
Emergency room assessment and treatment of patients with acute asthma: Adequacy of the conventional approach

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Abstract

The adequacy of emergency room treatment of patients with acute severe asthma was assessed by analyzing the course of 127 visits to the emergency room by 102 patients. Using conventional clinical criteria as an end point (i.e., disappearance of dyspnea, elimination of labored breathing and reduction or elimination of wheezing) in 85.4 per cent of these episodes the patients responded sufficiently to emergency room treatment to allow their discharge. However, the relief of airway obstruction measured directly (1 second forced expiratory volume, FEV1) was modest (mean FEV1 on discharge was 57 per cent of the predicted normal value). Approximately one-quarter of those episodes that ended in the patient's discharge from the emergency room were followed by equally severe episodes within 10 days (relapse); 6 per cent of the patients initially discharged who returned to the emergency room required hospitalization. Subjects who had a relapse had significantly less improvement in FEV1 during treatment and lower FEV1 values at discharge than those who did not have a relapse (p < 0.05). Finally no clinical or conventional laboratory parameter (e.g., pulsus paradoxicus, sternomastoid muscle contraction, arterial carbon dioxide [PaCO2] or oxygen [PaO2] tension) was sufficiently reliable as an index of the degree of obstruction to substitute for the FEV1. We conclude that (1) the success of emergency room treatment depends on the degree of improvement in pulmonary function achieved; and (2) objective measures (e.g., FEV1) of the degree of airway obstruction are helpful in predicting the outcome of emergency room treatment of patients with acute asthma.

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This study was supported in part by U.S. Public Health Service Grant HL-08805.

Present address. 211 A Wearn Building, 2064 Abington Road, Case Western Reserve University, Cleveland, Ohio 44106.

1

From the Cardiovascular-Pulmonary Division, Hospital of the University of Pennsylvania, and the Pulmonary Section, Temple University Hospital, Philadelphia, Pennsylvania.

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