Emergency department treatment of asthma with systemic corticosteroids is not always timely
Research Activities, May 2010, No. 357
Each year, there are 2 million visits to emergency departments (EDs) for acute asthma attacks. Use of systemic corticosteroids (SCs) within 1 hour of ED arrival significantly improves pulmonary function and reduces the odds of hospital admission by 60 percent. However, not all asthma patients receive this treatment and, if they do, the medication may be given late in the course of the ED visit. The researchers identified 3,798 patients with acute asthma in 62 urban EDs located in 23 States. They analyzed clinical data to determine if patients had received SCs in a timely manner, specifically within 1 hour or less.
The majority of patients (67.4 percent) received SC treatment in the ED. However, more than half of treated patients (51.5 percent) got SCs more than an hour after their arrival time, with a median door-to-SC time of 62 minutes. ED physicians appropriately administered SCs to patients with more severe episodes (i.e., history of intubation for asthma, higher respiratory rate, and lower oxygen saturation). However, nonmedical factors associated with delayed SC treatment concerned the researchers. For example, patients with delayed SC treatment were more likely to be women, 40 years of age and older, and have a longer duration of symptoms.
Delayed patients also had longer ED stays and the likelihood of a delay in treatment was increased during peak ED hours. Patients who did not receive SCs were more likely to be discharged from the ED. The study was supported in part by the Agency for Healthcare Research and Quality (HS13099).
See "Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma," by Chu-Lin Tsai, M.D., Sc.D., Brian H. Rowe, M.D., MSc., Ashley F. Sullivan, M.S., M.P.H., and Carlos A. Camargo Jr., M.D., Dr.P.H., in the October 2009 Annals of Allergy, Asthma & Immunology 103, pp. 318-324.