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Asthma in emergency department. Guidelines, physicians and patients.

BACKGROUND
Morbidity and mortality by bronchial asthma continues to be a serious public health problem all over the world. Bronchial asthma is considered the most common chronic disease among children and asthmatic crises are the most frequent cause for visits to the emergency room. Among adults, bronchial asthma has also a high rate of morbidity and repercussions in productivity as well as in the costs of the health systems that assist them. On the other hand, despite the development of the International Guidelines for the DIAGNOSIS and Treatment of Bronchial Asthma (IGDTBA), supported by the best scientific medical researches based on evidence, which recommend the prompt and regular use of inhaled corticosteroids in the treatment of the persistent clinical forms of bronchial asthma to reduce their morbidity and mortality, this has not yet been modified.


OBJECTIVE
To determine the causes of high morbidity and mortality due to bronchial asthma.


MATERIAL AND METHOD
We retrospectively studied a group of 152 asthmatic patients (a pediatric group of 88 patients and a adult group with 64) who visited NOVA Clinic in Monterrey, Mexico, emergency medical service 234 times during one year (January 1st to December 31st, 2004). Four variables were investigated: a) Number of patients who were diagnosed with bronchial asthma following the present guidelines (IGDTAB). b) Number of patients prescribed regular treatment with inhaled corticosteroids. c) Number of patients who had good acceptance of regular treatment with inhaled corticosteroids (compliance). d) The existence of some type of communication or cooperation among the different levels of medical attention (emergency service, outpatient service and asthma specialists) allowing them to work as a team in the treatment and education of the asthmatic patient.


RESULTS
a)


DIAGNOSIS
only one patient of the pediatric group and seven of the adult group had a diagnosis based on the IGDTBA. b) Only 42.7% of the patients were prescribed inhaled corticosteroids by their physicians as a regular preventive anti-inflammatory treatment. c) Only 47.6% of the patients who were prescribed inhaled corticosteroids as a regular treatment followed the same. When adding together the last two variables, it is observed that only 23 out of 88 patients in the pediatric group (26%) and 8 out of 64 adults (12.5%) followed regular treatment with inhaled corticosteroids as is recommended in the guidelines (IGDTAB). d) We found no communication or cooperation among the different levels of medical attention for the education and treatment of any of the patients studied.


CONCLUSIONS
The persistent morbidity from bronchial asthma in our study is due to: a) Most of physicians who care for asthmatic patients in emergency or outpatient services are not familiar with the International Guidelines for the DIAGNOSIS and Treatment of Bronchial Asthma (IGDTAB) and those who state that they do know about them have no interest in using them with their patients. b) Inhaled corticosteroids, recommended as the first line of anti-inflammatory medications for regular treatment of bronchial asthma, are not used by the majority of physicians. c) Asthmatic patients who follow regular treatment with inhaled corticosteroids account for lesser than 50%. d) There is no communication or cooperation among the different levels of medical attention for asthmatic patients (emergency medical service, outpatient service and specialists in asthma) for their education and treatment under the same parameters (IGDTBA), which partially explains the persistent morbidity and visit to emergency department.