Effect of a Short Course of Prednisone in the Prevention of Early Relapse after the Emergency Room Treatment of Acute Asthma

Chapman, KR; Verbeek, P. Richard; White, Jeff; Rebuck, A. S.

doi:10.1056/nejm199103213241202

Cited by 183 publications

(71 citation statements)

References 16 publications

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“…Among six such trials, in which all patients were randomly assigned treatment, the average percentage of female subjects was 56.9% (19)(20)(21)(22)(23)(24); the number of patients and the percentages of females enrolled in these trials are given in Table 2. The proportion of women was greater in every trial and was statistically significant when aggregated over all trials (weighted average method; p = 0.00001).…”

Section: Discussionmentioning

confidence: 99%

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Goodman¹,

Israel²,

Rosenberg³

et al. 1994

Am J Respir Crit Care Med

192

110

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Metered dose inhalers (MOls) are widely used in clinical practice for administering pharmaceuticals targeted to the lung. It is well known that the inhalation technique used with MOls can substantially influence the clinical response to inhaled medications. Todetermine the acceptability of MOl maneuvers, we studied 59 subjects (26 females and 33 males; age, 20 to 81 yr; mean age, 38 yr) to determine whether the MOl technique used by these individuals complied with published recommendations for acceptable inhalation technique. Measurements were made with an MOl adapter that contained an unobtrusive, lightweight, miniature sensing system. Inspiratory flow at the moment of MOl actuation (Va), the volume (integrated from airflow) at actuation as a fraction of total inspiratory volume 0/aM), breath-holding time (tBH), and inspiratory volume as a fraction of FVC 0/I/FVC) were determined from 59 uncoached inhalations. We defined an acceptable maneuver, based on published data, by four components: (1) inspiratory flow at actuation (Va) between 25 and 90 Umin; (2) actuation during early inspiration (0 < VaM~0.20); (3) adequate breathholding time (tBH >4 s), and (4) a deep inhalation (VIIFVC >0.50). For all subjects, only 25% of inhalation maneuvers met all four criteria for acceptability. We found that a significantly higher proportion of male than female subjects performed an acceptable MOl maneuver (43% versus 4%, p < 0.001). There were no significant differences in technique between younger and older subjects or between patients with a diagnosis of asthma or chronic obstructive pulmonary disease (COPO). We conclude that most patients use their MOls incorrectly; females of all ages are much more likely to have improper MOl technique than are males. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med 1994;150:1256-61.

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Section: Discussionmentioning

confidence: 99%

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Goodman¹,

Israel²,

Rosenberg³

et al. 1994

Am J Respir Crit Care Med

192

110

View full text Add to dashboard Cite

show abstract

“…Objective measurements such as spirometry or peak expiratory flow rate (PEFR) provide a better measure of a patient's status than do history or clinical examination (3)(4)(5). Furthermore, the benefit of corticosteroids in controlling the inflammatory component of asthmatic exacerbations has been demonstrated and is well accepted (6)(7)(8)(9).…”

Section: Traitement De L'asthme à L'urgence Objectifsmentioning

confidence: 99%

Asthma Management in the Emergency Department

Reid¹,

Marciniuk²,

Cockcroft³

2000

Canadian Respiratory Journal

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OBJECTIVES:To evaluate various aspects of the management of adult patients who present to the emergency department with acute exacerbations of asthma and who are discharged from the emergency department without hospital admission. Further, to compare the results with accepted management guidelines for the emergency department treatment of asthma.DESIGN:A retrospective chart collection and review until each site contributed 50 patients to the survey.SETTING:Three tertiary care hospitals in the Saskatoon Health District, Saskatoon, Saskatchewan. The study period was from July 1, 1997 to November 18, 1997.POPULATION:Patients aged 17 years or older, who were discharged from the emergency department with the diagnosis of asthma.METHODS:Data were collected on 130 patients from 147 emergency department visits.RESULTS:A number of important physical examination findings were frequently not documented. In contrast to management guidelines, peak expiratory flow rates (44%) and spirometry (1%) were not commonly used in patient assessments. Only 59% of patients received treatment in the emergency departments with inhaled or systemic corticosteroids. Furthermore, specific follow-up plans were infrequently documented in the emergency department charts (37%).CONCLUSIONS:Adherence with published Canadian guidelines for the emergency department management of acute asthma exacerbations was suboptimal. Corticosteroid use in the emergency department was significantly less than recommended. Increased emphasis on education and implementation of accepted asthma management guidelines is necessary.

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“…A short course of oral steroids after emergency room treatment of acute asthma has been shown to be effective in the prevention of early relapse. 18 Inhaled steroids were not available for physicians in the emergency department during the study period but were readily available in all the out-patient clinics that provided the follow-up care of the patients. We did not conduct a follow-up study of these patients to find out whether the early relapse rate has been reduced as a result of a short course of oral steroids.…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

Tsui¹,

Sham²,

Chan‐Yeung

et al. 2002

Hong Kong Journal of Emergency Medicine

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Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

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Effect of a Short Course of Prednisone in the Prevention of Early Relapse after the Emergency Room Treatment of Acute Asthma

Abstract: A short course of prednisone reduced early relapse rates after the treatment of acute asthma in the emergency room, an effect limited to the period of steroid administration.

Cited by 183 publications

References 16 publications

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Asthma Management in the Emergency Department

Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

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