Asthma crisis in emergency departments in Spain: what is our usual practice?

• Published in: Anales de pediatría (Barcelona, Spain : 2003) Vol. 78; no. 4; pp. 216 - 226
• Main Authors: Claret Teruel, G, Bilbao Meseguer, N, Valverde-Molina, J, Korta Murua, J, Sotoca Fernández, J V, Sánchez Echániz, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-04-2013
• Subjects: Asthma - therapy; Child; Emergency Service, Hospital; Emergency Treatment; Humans; Practice Patterns, Physicians; Spain; Surveys and Questionnaires; Spain
• ISSN: 1695-9531
• DOI: 10.1016/j.anpedi.2012.07.008

Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED).
To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management.
A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011.
A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled β2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=.017).
Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified.