Asthma severity and adequacy of management in accident and emergency departments in France: a prospective study

Background Recent guidelines have enabled doctors to establish accident and emergency department management strategies for acute asthma on the basis o f severity of exacerbations at presentation. However, there is no available information on acute asthma patients classified according to severity of d isease. Our aim was to describe the severity of such exacerbations at prese ntation, and the adequacy of treatment and management. Methods We did a 12-month multicentre cross-sectional observational cohort study in adult patients with acute asthma who attended one of 37 accident a nd emergency departments in France. The doctors who examined the patients o btained information using a formatted chart. We classified exacerbations ac cording to severity (life-threatening, severe, or mild to moderate), on the basis of clinical findings and peak expiratory flour value, as defined by currently used guidelines. Findings Of 3772 patients with acute asthma, 975 (26%) had life-threatening attacks, 1834 (49%) had severe exacerbations without life-threatening feat ures, and 963 (26%) had mild to moderate exacerbations. Initial treatment i ncluded nebulised beta2 agonists, anticholinergics, and systemic corticoste roids in 3492 (93%), 1841 (49%), and 2252 (60%), respectively. According to severity classification, anticholinergics were used in 494 (51%), 913 (50% ), and 434 (45%) of patients in life-threatening, severe, and mild to moder ate exacerbations groups, respectively; corticosteroids were given in 666 ( 68%), 1117 (61%), and 468 (49%), respectively. The overall admission rate w as 54.2%, and mean stay was 6.1 (SD 6.0) days. Patients were admitted in 74 7 (77%), 1018 (55%), and 278 (29%) of cases in life-threatening, severe, an d mild to moderate groups, respectively. Three patients died in hospital. Interpretation Acute asthma exacerbations are often life-threatening in pat ients who attend accident and emergency departments, and management of pati ents is not ideal, mainly because of underuse of corticosteroids and inappr opriate admission rates according to severity.