Acute adult asthma - assessment of severity and management and comparison with British Thoracic Society Guidelines

To investigate the accuracy of clinical severity assessment of asthmatics a nd to compare emergency and subsequent ward management with British Thoraci c Society (BTS) Guidelines, the records of all patients admitted for severe asthma (46) over a 5-month period to a District General hospital were insp ected. Variations from recommended management were revealed. Appropriate oxygen ad ministration was often not provided in casualty and patients frequently lef t hospital before their discharge criteria were attained: recommended diurn al variations in peak Bow were exceeded in 26%. Eleven per cent of discharg es were against medical advice, making provision of adequate management log istically difficult. Adherence to BTS guidelines on the need for arterial b lood gas (ABG) analysis would have led to a failure to detect significant h ypoxaemia in 25% of cases. This study identified substantial variations from BTS management guidelines , It is suggested that oximetry is necessary on arrival to guide selection for arterial blood gas analysis.