Volume 19 Issue 2 June 2010Original Research
Pulmonary function testing in the Emergency Department
and medications prescribed at discharge: results of the
Multinational Acute asthma Management, Burden, and
Outcomes (MAMBO) study
Pages 155-162
*J Mark Fitzgeralda, Paul M O'Byrneb, Jeffrey T McFetridgec, Dirk Demuthd, Felicia C Allen-Rameye
a
Professor of Medicine, University of British Columbia (UBC), and Head, UBC and Vancouver General Hospital (VGH) Division of Respiratory Medicine, The Lung Centre, Gordon and Leslie Diamond Health Care Centre; and Director, Centre for Lung Health, University of British Columbia, Vancouver, BC, Canada
b
Firestone Institute for Respiratory Health, St. Josephs Hospital, and the Department of Medicine, McMaster University, Hamilton, Ontario, Canada
c
Department of Economics, Lehigh University, Bethlehem, PA, USA
d
Adelphi Real World, Bollington, UK
e
Global Outcomes Research, Merck & Co., Inc., Whitehouse Station, NJ, USA.
Received 6 May 2009 • Accepted 27 December 2009 • Online 26 January 2010
Abstract
AIMS: To evaluate asthma care in the emergency department (ED), including use of pulmonary function testing (PFT) and how patients
are treated when discharged.
METHODS: Internet-based surveys were completed by 298 healthcare practitioners in seven countries on 1078 patients 15-70 years old
with an acute asthma exacerbation.
RESULTS: Less than 60% of patients received guideline-recommended therapy with a bronchodilator, corticosteroid, and supplemental
oxygen. Patients undergoing PFT had significantly more courses of asthma therapy (2.3 vs 1.7; p < 0.001), and received more medications
(5.7 vs 3.9; p < 0.001). At discharge, 17.9% of patients did not receive a prescription asthma medication and 12.8% did not receive a
physician referral. Men (p<0.022), patients with more severe disease (p<0.0001), and those seen by a pulmonologist (p<0.0001), were
more likely to be treated.
CONCLUSIONS: Management of patients with acute asthma exacerbations diverged from guideline recommendations. Enhanced
adherence to guidelines could lead to improved outcomes.
Keywords
Asthma, exacerbation, guidelines, disease severity, treatment outcomes, assessment, drug therapy,
emergency department, lung function
* Corresponding author. J Mark Fitzgerald Tel: 604-875-4122 Fax: 604-875-4695 Email: markf@interchange.ubc.ca | |
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