title: Emergency pre-hospital management of patients admitted with acute asthma.
abstract: BACKGROUND
  Little is known about the management of acute asthma prior to hospital admission. Pre-hospital treatment of patients referred to hospital with acute asthma was therefore studied in 150 patients divided into three groups: those in the Edinburgh Emergency Asthma Admission Service (EEAAS) who can contact an ambulance and present directly to respiratory services when symptoms arise (n = 38), those under continuing supervision at a hospital respiratory outpatient clinic (n = 54), and those managed solely in primary care (n = 58).
  
  
  METHODS
  Standardised admission forms detailing aspects of pre-hospital management, case records, GP referral letters, and ambulance patient transport forms were analysed.
  
  
  RESULTS
  In each group airflow obstruction had improved upon arrival at hospital, the effect being most marked in patients transported by ambulance (p<0. 001) and in those receiving nebulised beta(2) agonists prior to admission (p<0.005). However, 25% of patients arrived without having nebulised beta(2) agonists and 37% without having glucocorticoids. EEAAS patients were least likely to receive nebulised beta(2) agonists before arrival at hospital (p<0.05). This observation was attributable to a tendency for these patients to travel to hospital by car rather than by ambulance.
  
  
  CONCLUSIONS
  There is an important shortfall in administration of bronchodilators and glucocorticoids for acute asthma before arrival at hospital. Ambulances equipped with nebulised bronchodilators provide the optimal mode of transport to hospital for patients with acute asthma. In Edinburgh ambulances are not being used by a significant proportion of the population with asthma, possibly because of the mistaken belief that personal transport arrangements reduce journey time to hospital.
authors.affiliation: Respiratory Medicine Unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.forename: S P
authors.initials: SP
authors.lastname: Matusiewicz
authors.forename: P H
authors.initials: PH
authors.lastname: Brown
authors.forename: I A
authors.initials: IA
authors.lastname: McCall
authors.forename: J A
authors.initials: JA
authors.lastname: Innes
authors.forename: A P
authors.initials: AP
authors.lastname: Greening
authors.forename: G K
authors.initials: GK
authors.lastname: Crompton
mesh_terms: D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004632:Emergency Medical Services / Q000458:organization & administration*; D005194:Family Practice; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006753:Hospital Records; D006801:Humans; D008297:Male; D012606:Scotland
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids