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A study of the management of asthma in a hospital emergency department.

We reviewed the medical assessment and treatment of 108 consecutive adult asthmatic patients who attended the Wellington Hospital emergency department for treatment of asthma. Almost 90% of these patients were self referred. Systemic corticosteroids were administered or increased in dose during this asthma attack in only 14% of the 93 patients in whom prior drug therapy was recorded. In the emergency department measurement of either peak expiratory flow or forced expiratory volume in one second was made before treatment in 89% of patients, and after treatment in 77%. About 50% received systemic corticosteroids during their attendance, and of the 66 who were subsequently discharged, 40% were prescribed oral prednisone. Communication with general practitioners concerning patients discharged was poor. We conclude that although the medical assessment and management of severe asthma in this emergency department was of a high standard, there were problems relating to the increased reliance by asthmatic patients on this hospital based service.