Emergency pre-hospital management of patients admitted with acute asthma

Background-Little is known about the management of acute asthma prior to ho spital admission. Pre-hospital treatment of patients referred to hospital w ith acute asthma was therefore studied in 150 patients divided into three g roups: those in the Edinburgh Emergency Asthma Admission Service (EEAAS) wh o can contact an ambulance and present directly to respiratory services whe n symptoms arise (n = 38), those under continuing supervision at a hospital respiratory outpatient clinic (n = 54), and those managed solely in primar y care (n = 58). Methods-Standardised admission forms detailing aspects of pre-hospital mana gement, case records, GP referral letters, and ambulance patient transport forms were analysed. Results-In each group airflow obstruction had improved upon arrival at hosp ital, the effect being most marked in patients transported by ambulance (p< 0.001) and in those receiving nebulised beta(2) agonists prior to admission (p<0.005). However, 25% of patients arrived without having nebulised beta( 2) agonists and 37% without having glucocorticoids. EEAAS patients were lea st likely to receive nebulised beta(2) agonists before arrival at hospital (p<0.05). This observation was attributable to a tendency for these patient s to travel to hospital by car rather than by ambulance. Conclusions-There is an important shortfall in administration of bronchodil ators and glucocorticoids for acute asthma before arrival at hospital, Ambu lances equipped with nebulised bronchodilators provide the optimal mode of transport to hospital for patients with acute asthma. In Edinburgh ambulanc es are not being used by a significant proportion of the population with as thma, possibly because of the mistaken belief that personal transport arran gements reduce journey time to hospital.