Relation of measures of asthma severity and response to treatment to outcome in acute severe asthma.

Abstract

Background It would be helpful if patients with asthma who require admission to hospital for an acute attack could be identified. Methods The relation between the severity of an attack of asthma as determined by admission assessment and the eventual outcome was studied in 52 asthmatic patients aged 14 to 44 years and admitted to an asthma emergency room. The patient's history, including medication and previous admissions to hospital, was recorded and a clinical assessment, including a full inspiratory and expiratory flow-volume loop, was performed on four occasions: on admission, at two hours and at 12-18 hours after the start of a standardised treatment, and two weeks later on an outpatient basis. Patients who were discharged and who had an uneventful follow up at the two week assessment were defined as good responders. Patients who had to be admitted to hospital after 12 to 18 hours or were readmitted during the two weeks, or both, were defined as poor responders. Results Thirty eight patients were good responders and 14 were poor responders (seven admitted at 12 to 18 hours, seven returned to hospital). All four patients with a raised arterial carbon dioxide tension (Paco2) ( > 6 kPa) and the three with cyanosis were in the poor responder group, and this group had lower peak expiratory flow (PEF) values (21% v 30% predicted) on admission. There was, however, considerable overlap in PEF between the two groups and no clinical measure was able to distinguish between the good and the poor responders reliably. Poor

Early prediction of poor outcome in patients with acute asthma in the emergency room

“…In agreement with previous studies (3,(12)(13)(14), we found that no single clinical or pul- monary functional factor assessed during the first hour of management in the ER could adequately predict the outcome of acute episodes. Previous studies have suggested that a multifactorial assessment of patients with acute asthma may provide the key to achieving this goal (8).…”

“…These findings are in accordance with most earlier studies that failed to reliably identify poor outcome by measurements of single risk factors or by multifactorial predictor indices applied to acute asthmatic patients during their ER stay (12).…”

Oxygen saturation as a predictor of prolonged, frequent bronchodilator therapy in children with acute asthma

“…Studies assessing the value of baseline oximetry as a predictor of hospitalization in asthma have yielded variable results, with some detecting benefit 10,11 and others not. [12][13][14][15][16][17] Only three studies have examined SaO 2 as an independent predictor. 10,13,17 However, these studies did not use a clinical asthma score; therefore the association between the severity of the index episode and the SaO 2 could not be determined.…”

The British Guidelines on Asthma Management * 1995 Review and Position Statement

“…48 The 50% figure is arbitrary but widely accepted 49 and supported empirically by the BTS audit. 50 The guidelines do not take into account the patient's previous history but previous hospital admissions or attendance at Accident and Emergency departments are important risk factors for readmissions [51][52][53] and death. 54 Similarly, there is a diVerence between a patient with a PEF of 50% who has been on prednisolone for a week and a patient who has a short history and has not yet started oral steroids.…”