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Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study
Author(s) -
Craig Simon,
Kuan Win Sen,
Kelly AnneMaree,
Van Meer Oene,
Motiejunaite Justina,
Keijzers Gerben,
Jones Peter,
Body Richard,
Karamercan Mehmet A,
Klim Sharon,
Harjola VeliPekka,
Verschuren Franck,
Holdgate Anna,
Christ Michael,
Golea Adela,
Graham Colin A,
Capsec Jean,
Barletta Cinzia,
GarciaCastrillo Luis,
Laribi Said
Publication year - 2019
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13242
Subject(s) - medicine , guideline , asthma , demographics , emergency department , cohort , antibiotics , oxygen therapy , prospective cohort study , emergency medicine , pediatrics , demography , pathology , psychiatry , sociology , microbiology and biotechnology , biology
Objective Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. Methods In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub‐study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in‐hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. Results Five hundred and eighty‐four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co‐morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients – inhaled beta‐agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. Conclusion The data suggests that compliance with guideline‐recommended therapy in both regions, particularly corticosteroid administration, is sub‐optimal. It also suggests over‐use of antibiotics.