Patient and physician evaluation of the severity of acute asthma exacerbations

Abstract

We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD) age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms) with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV 1 ) were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV 1 correlated significantly with the physician score (rho = 0.42, P = 0.001), but not with patient score (rho = 0.03; P = 0.77). Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV 1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV 1 ). Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity) persisted as explanatory variables in physician score and FEV 1 regression models, and should be emphasized in medical schools and emergency settings.

Global strategy for asthma management and prevention: GINA executive summary

“…Functional assessments such as PEF or FEV1 and arterial oxygen saturation measurements are strongly recommended, as physical examination alone may not fully indicate the severity of the exacerbation, particularly the degree of hypoxaemia [330,331]. Without unduly delaying treatment, a baseline PEF or FEV1 measurement should be made before treatment is initiated.…”

Asthma in Nigeria: Are the facilities and resources available to support internationally endorsed standards of care?

“…These results show that most hospitals were not adhering to this recommendation on oxygen therapy which is an important aspect of asthma therapy. In an acute care setting that is often involved in the management of asthma exacerbations, functional assessments such as measurement of PEFR or force expiratory volume in one second (FEV 1 ) and arterial oxygen saturation measurements by pulse oximetry are strongly recommended as physical examination alone may not fully indicate the severity of the exacerbation, particularly the degree of hypoxemia [1,20,21]. Furthermore, 41.2% of the selected hospital had access to a nebuliser and 20.6% to spacer.…”

Method for automatic detection of wheezing in lung sounds

“…The presence of wheezing in infants has also been used as a parameter to evaluate the predis-Methodology for detecting the presence of wheezing www.bjournal.com.br position to asthma (7). Other investigations have used wheezing, among other symptoms, to evaluate the physician's and patient's perception of acute asthma exacerbation, compared to objective measurements such as forced expiratory volume (8).…”