title: Emergency department asthma: compliance with an evidence-based management algorithm.
abstract: BACKGROUND
  Recent surveys in emergency medicine departments show inadequacies in many aspects of acute asthma management.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the adherence to management algorithm for acute asthma in the emergency department which focused on evidence-based treatment steps rather than documentation and patient classification.
  
  
  METHODS
  A retrospective audit of consecutive adult patients with acute exacerbations of asthma in the emergency medicine department of a university hospital managed in the context of a clinical algorithm.
  
  
  RESULTS
  We collated information from 344 episodes of acute asthma (94% of total) over a 4-month period. The first-line treatment was nebulised bronchodilators in 97%, combination of salbutamol and ipratropium bromide in 93% and the combination in recommended dosages in 87%. Systemic corticosteroid treatment was administered to 82% of patients. A further course of systemic corticosteroid was prescribed at discharge for 94% of patients. Overall, 93% of patients received some form of systemic corticosteroid treatment. The admission rate was 35.2%, and was significantly higher in women and the elderly. Of those who were admitted, 46.2% received > or = 3 nebulised treatments and 69% received intravenous hydrocortisone.
  
  
  CONCLUSIONS
  In the management of acute asthma, we found excellent compliance with specific treatment steps based upon clinical evidence. However, adherence to second-line treatment was less satisfactory. Nevertheless, whenever second-line treatment was complied with, reasonable outcomes were achieved. It may be more appropriate to emphasise evidence-based treatment rather than extensive documentation.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119704.
authors.forename: M
authors.initials: M
authors.lastname: Mahadevan
authors.forename: A
authors.initials: A
authors.lastname: Jin
authors.forename: P
authors.initials: P
authors.lastname: Manning
authors.forename: T K
authors.initials: TK
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001249:Asthma / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards; D015397:Program Evaluation / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index