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Adequacy of outpatient management of asthma patients admitted to a state hospital in Argentina
Author(s) -
RAIMONDI Guillermo A.,
MENGA Guillermo,
RIZZO Oscar,
MERCURIO Sandra
Publication year - 2005
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2005.00663.x
Subject(s) - medicine , asthma , peak flow meter , emergency department , emergency medicine , inhaler , metered dose inhaler , bronchodilator , outpatient clinic , hospital admission , inhalation , copd , pediatrics , anesthesia , psychiatry
Objective: The aim of this study was to assess chronic outpatient management of adult patients admitted with asthma. Methodology: 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: FEV 1 % 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 (Nβ 2 ) and 68% a metered dose inhaler (MDIβ 2 ). Inhaled β 2 ‐agonist usage during acute exacerbations over the 24 h prior to admission was 14.4 ± 7.4 puffs for MDIβ 2 and 8.6 ± 5.4 occasions for Nβ 2 . 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 MDIβ 2 underuse was observed.