Emergency room assessment and treatment of patients with acute asthma: Adequacy of the conventional approach

Abstract The adequacy of emergency room treatment of patients with acute severe asthma was assessed by analyzing the course of 127 visits to the emergency room by 102 patients. Using conventional clinical criteria as an end point (i.e., disappearance of dyspnea, elimination of labored breathing and reduction or elimination of wheezing) in 85.4 per cent of these episodes the patients responded sufficiently to emergency room treatment to allow their discharge. However, the relief of airway obstruction measured directly (1 second forced expiratory volume, FEV 1 ) was modest (mean FEV 1 on discharge was 57 per cent of the predicted normal value). Approximately one-quarter of those episodes that ended in the patient's discharge from the emergency room were followed by equally severe episodes within 10 days (relapse); 6 per cent of the patients initially discharged who returned to the emergency room required hospitalization. Subjects who had a relapse had significantly less improvement in FEV 1 during treatment and lower FEV 1 values at discharge than those who did not have a relapse (p 2 ] or oxygen [PaO 2 ] tension) was sufficiently reliable as an index of the degree of obstruction to substitute for the FEV 1 . We conclude that (1) the success of emergency room treatment depends on the degree of improvement in pulmonary function achieved; and (2) objective measures (e.g., FEV 1 ) of the degree of airway obstruction are helpful in predicting the outcome of emergency room treatment of patients with acute asthma.