title: Patient and physician evaluation of the severity of acute asthma exacerbations.
abstract: We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (+/- SD) age of 37.3 +/- 14.5 years and 24.0 +/- 17.9 years of asthma symptoms) with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV1) were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV1 correlated significantly with the physician score (rho = 0.42, P = 0.001), but not with patient score (rho = 0.03; P = 0.77). Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV1). Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity) persisted as explanatory variables in physician score and FEV1 regression models, and should be emphasized in medical schools and emergency settings.
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: J A
authors.initials: JA
authors.lastname: Atta
authors.forename: M P T
authors.initials: MP
authors.lastname: Nunes
authors.forename: C H F
authors.initials: CH
authors.lastname: Fonseca-Guedes
authors.forename: L A
authors.initials: LA
authors.lastname: Avena
authors.forename: M T
authors.initials: MT
authors.lastname: Borgiani
authors.forename: R F
authors.initials: RF
authors.lastname: Fiorenza
authors.forename: M A
authors.initials: MA
authors.lastname: Martins
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010366:Peak Expiratory Flow Rate; D012044:Regression Analysis; D012720:Severity of Illness Index