Implementation of the National Asthma Management Guidelines in the Emergency Department

OBJECTIVE: The national protocol for asthma management was released in 1995. There has been no national investigation to compare the actual care delivered at the Emergency Department to those recommended by these guidelines: To compare the documented management of acute bronchial asthma at the Emergency Room (ER) with the Saudi National Guidelines.

METHODS: Retrospective analyses of a total of 150 ER records, of patients with a diagnosis of asthma over a one year period (January through to December 2000), at King Abdul-Aziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Documentation of the history, indices of severity, treatment given, pre-discharge assessment and prescriptions were compared to the nationally recommended management.

RESULTS: History of the present attack, its duration, frequency of b-agonist use and nocturnal symptoms were documented in less than 50% of patients. Previous ER visits and hospitalization, peak flow rate and accessory muscle use were similarly recorded in less than 50% of patients whereas intensive care unit admission and intubation were documented in less than 15% of asthmatics. Steroids were given to only 46% of patients with acute asthma who visited the Emergency Department. Pre-discharge clinical assessment and peak flow readings were documented in 48% and 29%. Only 64% of patients were given a follow up appointment.

CONCLUSION: The documented treatment of patients with an acute asthmatic episode at the ER varies significantly from what is recommended by the National and International Asthma Management Guidelines. Failure to implement Asthma Guidelines probably results in an inadequate care of asthmatic patients and raises the urgent need for a National Physician Asthma Education Program.