A prospective audit of asthma management following emergency asthma treatment at a teaching hospital

Abstract

Objective: To audit the assessment and treatment of acute asthma and the subsequent application of the Australian Asthma Management Plan.

Design: Prospective audit of case notes with follow-up telephone questionnaire and clinical assessment at 8-12 weeks after discharge.

Setting: Tertiary-level teaching hospital.

Main outcome measures: Comparison with published guidelines for acute and ongoing asthma management.

Results: Asthma severity was objectively assessed in the Primary and Emergency Care Department, with lung function performed in 95% of acute presentations. Clinical history and examination were documented completely in 28% of presentations. Corticosteroids were underused and there was inappropriate use of ipratropium bromide. At 8-12 weeks follow-up most patients were symptomatic with limited activity due to asthma (46%) and impaired lung function (66%). One-third of patients were undertreated. Asthma management skills were seriously inadequate: only 20% of patients were performing peak flow monitoring, and only 21% recalled receiving specific instructions for the management of future exacerbations. Inhaler technique was inadequate in one-third of patients and asthma knowledge was poor. These deficits were more frequent in patients not admitted to hospital.

Conclusion: This audit identified suboptimal assessment and treatment of acute asthma, and deficits in the implementation of the Australian Asthma Management Plan following discharge. Patients in this audit were undertreated and not provided with the skills to manage future attacks of asthma.