Adequacy of outpatient management of asthma patients admitted to a state hospital in Argentina.
OBJECTIVE
The aim of this study was to assess chronic outpatient management of adult patients admitted with asthma.


METHODS
A cross-sectional survey was conducted of 98 consecutive asthma admissions to a specialized pulmonary State Hospital in Buenos Aires, Argentina, over a 12-month period. Patients were surveyed, within 48 h of admission, with a previously validated questionnaire which deals with chronic outpatient management and measures taken by patients or physicians to treat symptoms during asthma exacerbations.


RESULTS
FEV1% predicted was 30.2 +/- 10.7. Mean admission rate and emergency department (ED) visits in the previous year were 0.7 +/- 1.2 and 4.6 +/- 5.1, respectively. A total of 96, 65 and 9% of the patients had been treated previously in the ED, admitted to hospital or mechanically ventilated, respectively. Only 62% had been prescribed inhaled corticosteroids (IC) by their physician; 38% had been prescribed nebulized beta agonists (Nbeta2) and 68% a metered dose inhaler (MDIbeta2). Inhaled beta2-agonist usage during acute exacerbations over the 24 h prior to admission was 14.4 +/- 7.4 puffs for MDIbeta2 and 8.6 +/- 5.4 occasions for Nbeta2. Only 11% of the patients were able to perform all the steps of the MDI inhalation technique correctly. An action plan had been provided by their physicians to 43% of patients, while 58% changed their medication on their own. Only three patients had a peak flow meter (PFM) prescribed. ED was used by 26% for their routine care. No health insurance coverage was available to 75.5% of the patients.


CONCLUSIONS
Underuse of IC, poor MDI inhalation technique, and low prescription of an action plan was common and a PFM was seldom prescribed. During exacerbations, many patients changed their medication spontaneously and MDIbeta2 underuse was observed.
Raimondi
Guillermo A
GA
Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina. raimondi@fleni.org.ar
Menga
Guillermo
G
Rizzo
Oscar
O
Mercurio
Sandra
S
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D001118:Argentina; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006783:Hospitals, State; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists