Current outpatient management of asthma shows poor compliance with international consensus guidelines

Study objective: This study aimed to establish whether the outpatient manag ement of patients presenting with an asthma exacerbation to the emergency d epartment (ED) was in compliance with the 1992 guidelines of the "Internati onal Consensus Report on the Diagnosis and Management of Asthma." Design: Prospective, observational study using a researcher-administered qu estionnaire, Setting: University tertiary referral ED. Patients: Convenience sample of asthmatics (aged 18 to 54 years) presenting for asthma treatment between July 1, 1997, and June 30, 1998. Results: Eighty-five asthmatic patients were enrolled. Of these, 34 patient s (40%) smoked, 53 patients (62%) were undertreated with medication when co mpared to the consensus guidelines, and 74 patients (87%) had no written "p lan of action." During an asthma attack, 9 patients (11%) did not use a bro nchodilator as first-line action and 76 patients (89%) did not commence or increase the use of an inhaled steroid. Forty-nine patients (58%) did not k now that bronchospasm occurred in asthma, and 53 patients (62%) did not kno w that bronchial swelling occurred. Twenty-six patients (31%) thought short -acting bronchodilator drugs were asthma preventers. Sixty-two patients (73 %) could not adequately, define peak expiratory flow (PF), 41 patients (48% ) did not own a PF meter, and only 8 patients (9%) determined their PF dail y. Fifty-three patients (62%) were reviewed by a physician once a year of l ess, and 18 patients (21%) noted family and friends as their only source of asthma education. Conclusions: The outpatient management of most asthma patients presenting t o the ED did not comply with the consensus guidelines, and asthma knowledge was poor.