Asthma Rescue and Controller Meds Underused in Emergency Department: Presented at ATS

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Title: Asthma Rescue and Controller Meds Underused in Emergency Department: Presented at ATS
URL: http://www.pslgroup.com/dg/221B56.htm
Doctor's Guide
May 21, 2008

By Marvin Ross

TORONTO -- May 21, 2008 -- Controller medications are being underused by patients seeking relief of acute asthma at emergency departments (ED). However, at discharge, ED physicians are prescribing rescue and controller medications only to a small percentage of these patients, according to results of a multinational study.

The study examined medications prescribed to adult asthma patients at discharge from the ED. The rationale was that the initiation of asthma controller therapy by ED physicians might prevent future asthma relapses.

Results from this study were presented here at the 104th International Conference of the American Thoracic Society (ATS) on May 18 by Paul O'Byrne, MD, E. J. Moran Campbell Professor in Respirology Medicine and Chair, Department of Medicine, McMaster University; and Executive Director, Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario.

For the Internet-based survey, Dr. O'Byrne and colleagues recruited physicians and nurses who provided acute asthma care to patients aged 15 to 70 years in the ED or its equivalent between January and December 2006. Participants were recruited in Australia, Canada, Mexico, France, Italy, Spain, and the United Kingdom.

Researchers gathered data on patient demographics, pulmonary function and blood saturation tests, staff involved in providing treatment, patients' duration of time in the ED, drug use before admission and during the hospital stay, medications prescribed at discharge, discharge destination, physician demographics, and hospital details.

The analysis excluded patients without a primary diagnosis of asthma were excluded from the study; patients with comorbid chronic obstructive pulmonary disease; and those who had been in the ED for more than 12 hours.

Surveys were completed for 1,078 patients by 298 doctors and 6 nurses. The highest proportion of patients was in the 15- to 29-year age range (44.5%): 46.2% were male and 39% were smokers. Of the patients surveyed 50.9% had used an asthma medication in the 24 hours before entering the ED; 74% used short-acting beta-agonists (SABA); 30% used inhaled corticosteroids (ICS); 22% used ICS/long-acting beta-agonist (LABA) combination products; and 18% used anticholinergics.

At discharge, 563 (52%) of patients were prescribed medications. The majority received SABA (51%) and systemic corticosteroids (45%). ICS/LABA and ICS alone were prescribed to 37% and 28%, respectively. Anticholinergics were prescribed to 18%. Only 20% of those prescribed ICS/LABA and 22% prescribed ICS at discharge reported having used these medications in the 24 hours prior to their exacerbation.

The study authors concluded that ED physicians are prescribing both rescue and controller medications to a subset of the patients who should get them at discharge.

The ED setting may serve as an opportunity to educate both medical staff and patients on improving asthma care, the researchers noted.

[Presentation title: Multi-National Study of Asthma Medications Prescribed at Discharge From the Emergency Department. Poster A37]

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