Pulmonary function testing in the emergency department and medications prescribed at discharge: results of the Multinational Acute asthma Management, Burden, and Outcomes (MAMBO) study.
OBJECTIVE
To evaluate asthma care in the emergency department (ED), including use of pulmonary function testing (PFT) and how patients are treated when discharged.


METHODS
Internet-based surveys were completed by 298 healthcare practitioners in seven countries on 1078 patients 15-70 years old with an acute asthma exacerbation.


RESULTS
Less than 60% of patients received guideline-recommended therapy with a bronchodilator, corticosteroid, and supplemental oxygen. Patients undergoing PFT had significantly more courses of asthma therapy (2.3 vs 1.7; p < 0.001), and received more medications (5.7 vs 3.9; p < 0.001). At discharge, 17.9% of patients did not receive a prescription asthma medication and 12.8% did not receive a physician referral. Men (p<0.022), patients with more severe disease (p<0.0001), and those seen by a pulmonologist (p<0.0001), were more likely to be treated.


CONCLUSIONS
Management of patients with acute asthma exacerbations diverged from guideline recommendations. Enhanced adherence to guidelines could lead to improved outcomes.
Fitzgerald
J Mark
JM
University of British Columbia, Vancouver General Hospital Division of Respiratory Medicine, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada. markf@interchange.ubc.ca
O'Byrne
Paul M
PM
McFetridge
Jeffrey T
JT
Demuth
Dirk
D
Allen-Ramey
Felicia C
FC
D000293:Adolescent; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012129:Respiratory Function Tests / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
D018927:Anti-Asthmatic Agents