EFFECT OF OUT-OF-HOSPITAL ALBUTEROL INHALATION TREATMENTS ON PATIENT COMFORT AND MORBIDITY

Study objective: To determine the effect of the institution of out-of- hospital albuterol treatments for acute asthma on out-of-hospital time intervals emergency department (ED) morbidity. Design: Retrospective chart and ambulance run report review. Participants: All patients who presented with a diagnosis of asthma on the ED record and ambulance ru n report during 1988 and 1990. Results: Ninety patients treated prior to the routine use of nebulized albuterol (in 1988) and 86 patients tr eated during the period after the institution of nebulized albuterol ( in 1990) were compared. Age, sex, scene and travel times, vital signs, peak expiratory flow rates, length of ED stay, hospitalizations, ED t reatment, and mortality were recorded for each patient. Changes over t ime were determined using a cohort of asthma patients in each year as controls. Severity was recorded as low (less than 3) or high (3 or mor e) on a modified Fischl index for asthma. Groups were compared by F te st, CHI2, or t test with P<.05 considered significant. Because there w ere differences for admission rates, first-hospital peak expiratory fl ow rates, and aminophylline use in control groups, the experimental gr oups could not be compared. No significant difference in travel interv al, steroid use, albuterol treatments, or length of ED stay was determ ined in either the experimental or control group. Scene time (9.7 minu tes versus 12.1 minutes) was significantly shorter in 1988 than in 199 0 (difference, 2.4 minutes; 95% confidence interval, 0.2 to 4.6; P<.01 ). The percentage of patients with high initial severity of disease (8 5% versus 66%; P<.001) and the percentage of patients with first postt reatment peak expiratory flow rates of less than 120 L/min (77% versus 58%; P<.001) were significantly higher in 1988 than in 1990. There wa s no significant difference in scene time, severity scores, or first p osttreatment peak expiratory flow rates in control groups. Conclusion: The institution of out-of-hospital use of nebulized albuterol increas ed scene time and increased first posttreatment peak expiratory flow r ates significantly. There was a significant decrease in initial patien t severity as measured on the modified Fischl index, although the vali dity of this index has not been established. It did not affect travel interval, length of stay in the ED, or medication use after ED present ation.