Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital

Abstract

Objective: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms. Methods: This prospective, observational study investigated a sample of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis. Results: Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2. Conclusion: Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.

The health behaviour and clinical characteristics of ambulance users with acute asthma

“…However, the use of combination therapy and more frequent use of oral steroids could suggest poorly controlled and/or difficult-to-manage asthma. Baseline symptoms have been found to be poor predictors for admission to hospital; in contrast the failure of medical treatment to resolve asthma symptoms after 6 h may be a more useful indicator 39. In the ambulance service group a quarter had a peak flow meter, used it more often in a week and reported more oral steroid use and inhaled combination therapy.…”

Wheezing

“…Longer duration of symptoms before health care presentation is associated with an increased risk of hospital admission. 38 Intensification of therapy with increased short-acting beta agonists and, in some cases, a short course of oral corticosteroids, may avoid hospitalization in some patients with mild exacerbations. 36 Doubling the dose of inhaled corticosteroids (ICS) in patients already receiving this therapy has not been shown to be effective for preventing the progression of an exacerbation.…”

Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations

“…Response to treatment in the ED is a better predictor of the need for hospitalization than the severity of an exacerbation at the time of presentation. 3,5,7,9,[29][30][31][32][33][34][35] All repeat assessments should include the patient's subjective response to treatment, physical findings, and FEV 1 or PEF results (or arterial blood gas measurements or pulse oximetry in patients with suspected hypoventilation, those who are in severe distress, and those with FEV 1 or PEF results 25% of predicted value; see earlier discussion of laboratory studies in the section entitled, ''Initial assessment of asthma exacerbations in the ED'').…”