Abstract

LEBLANC, Ana; SILVA, Rui  and  CASTRO, Eunice Dias de. Asthmatic admissions in a central hospital emergency department. Rev Port Imunoalergologia [online]. 2013, vol.21, n.4, pp.275-282. ISSN 0871-9721.

Background and methods: Asthma, a chronic disease with variable severity and frequent exacerbations, may lead to the emergency department (ED). In order to characterize asthmatics that, in 2008, were admitted in ED due to disease exacerbation, retrospective analysis of ED episodes records (“asthma” as main discharge’s diagnosis) was performed. Results : We analyzed 306 episodes, corresponding to 260 patients (60% female; 41.1 ± 20.1 years). According to Manchester triage, 53.3% were yellow, 43.5% orange, 2.3% red. Twenty four percent were previously followed by specialties, Allergology/Pneumology. Analyzing previous medication, 12.4% hadn’t any, 16.7% only β 2 SOS, 3% aminophylline, 3% long-acting β 2 (β2LA), 5.6% inhaled corticosteroids (ICS) and 21.2% β2LA/ICS, 9.2% antileukotrienes + others, 6% nebulizations with β2 ± anticholinergics; 7% aminophylline + β2LA/ICS, 4% systemic corticosteroids (CCS) and 2 under treatment with anti -IgE. In ED, 27 patients did nebulizations (β2 -agonist ± anticolinergic drug), 256 nebulizations + CCS (18 also required aminophylline and 15 MgSO4), 8 epinephrine and 3 non -invasive ventilation. Allergology/Pneumology specialist collaboration was requested in only 28 (9.2%) episodes. At discharge, medication was maintained in 61 cases and increased in 136 (49% with CCS). Ninety six patients had respiratory infection (antibiotic was prescribed in 86%). About 70% was discharged to the family doctor, 11% to a specialist and 18% admitted. Five patients were pregnant (2 already followed in Allergology), none of the others was referred to a specialist. Conclusions: During 2008, a significant number of asthmatics used ED for exacerbations, some in several and severe episodes. Note that only a quarter of patients were previously followed by a specialist and many had inappropriate chronic medication. Specialties collaboration is advised to establish an adequate therapeutic plan, particularly in severe cases and pregnant women and to increase patient adhesion.

Keywords : Asthma; exacerbation; emergency department.

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