Prehospital management of exacerbations of asthma: relation to patient and disease characteristics.
OBJECTIVE
Admission to hospital due to an exacerbation of asthma may represent a failure of prehospital management to prevent an attack or bring about its remission. We aim to describe the steps taken prior to hospital attendance in patients with asthma and to identify patient or disease characteristics that were associated with failure to take appropriate actions.


METHODS
Patients aged over 15 years who were discharged from hospital or the Emergency Department with a primary diagnosis of asthma completed a questionnaire about the impact of asthma and its management prior to the onset of the recent exacerbation. The impact of asthma on quality of life was measured using our Asthma Quality of Life Questionnaire (AQLQ).


RESULTS
Seventy-eight subjects completed the questionnaire including 49 who had been inpatients and 29 who had been discharged from the Emergency Department. They included many subjects with severe asthma: 41% had nocturnal symptoms three or more times per week and 41% had been admitted to hospital with asthma in the 12 months prior to this episode. Their AQLQ scores were high (severe) (mean 4.5+/-2.2). Most subjects described their presenting exacerbation as slow in onset and moderate or severe in intensity. During this exacerbation and prior to hospital attendance, only 27% of subjects had measured their peak expiratory flow rate, 19% had commenced or increased the dose of inhaled steroids, and 22% had commenced oral steroids. These actions were not related to the self-perceived speed of onset of the attack. Patients with lower levels of asthma-related concerns for health and more severe mood disturbance associated with asthma were less likely to take these appropriate self-management steps.


CONCLUSIONS
This study shows that the failure of prehospital management to prevent the necessity of hospital attendance in most cases stems from a failure to implement currently recommended actions or treatments for exacerbations. Addressing this problem should result in a reduction in rates of hospitalization for asthma.
Marks
G B
GB
Asthma Clinic, Liverpool Health Service, New South Wales, Australia. g.marks@unsw.edu.au
Heslop
W
W
Yates
D H
DH
D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D001294:Attitude to Health; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires
D001993:Bronchodilator Agents; D005938:Glucocorticoids