[Clinical pathway for management of patients with acute asthma attack].
BACKGROUND
There have been few reports of clinical pathway (CP) for treatment of asthma attack, because patients with asthma always admit emergently and the severity varies. We introduced CP so that standard asthma treatment can be widely used, and investigated its clinical usefulness.


METHODS
We designed a new CP for treating asthma attack according to the guideline (Japanese guideline (JGL) and Global Initiative for Asthma (GINA)). 136 patients who admitted to our hospital due to asthma attack from January 1999 to November 2006, were enrolled our study. Excluding cases complicated with pneumonia, COPD or cardiac failure, we evaluated 46 cases treated with the CP comparing with 19 cases treated without the CP. The clinical evaluations include systemic and inhaled steroid use, FEV1.0%, history of asthma, and the duration of asthma attack. Furthermore, we investigated difference between cases with and without prolonged admission.


RESULTS
While the rates of systemic and inhaled steroid use in cases without the CP were 57.9% and 52.6% respectively, those in cases with the CP were approximately 100%. Employing the CP, FEV 1.0% at discharge time was elevated from 71.7% to 76.3% and the duration of hospitalization was shortened from 14.2 days to 11.5 days. Mean age of the cases with prolonged admission was higher than the rest.


CONCLUSIONS
The asthma CP is an effective way for the standard treatment according to the guideline to be used widely even by doctors who are not familiar with asthma treatment. It improves the efficacy of in-hospital treatment.
Azuma
Naoto
N
Division of Allergy and Clinical Immunology, National Hospital Organization Osaka-Minami Medical Center. naoazuuh@hyo-med.ac.jp
Katada
Yoshinori
Y
Kobayashi
Masaaki
M
Kojima
Makiko
M
Nakajima
Yumi
Y
Shibano
Miyo
M
Tomita
Hitomi
H
Yamanaka
Takao
T
Harada
Yoshinori
Y
Ishii
Taeko
T
Saeki
Yukihiko
Y
D000208:Acute Disease; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019091:Critical Pathways; D019468:Disease Management; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013224:Status Asthmaticus / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents