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Emergency management of asthma in children: impact of NIH guidelines.

BACKGROUND
Asthma is the most common chronic disease of childhood. In 1991 the National Institutes of Health (NIH) published guidelines for the diagnosis and management of asthma, yet little is known about their impact on clinical practice.


OBJECTIVE
To examine the impact of the NIH guidelines on the emergency management of asthmatic children in the United States.


METHODS
A short anonymous survey concerning the emergency management of childhood asthma was mailed to 234 Directors of Pediatric Emergency Medicine in all Pediatric Residency Training Programs in the United States. The survey consisted of questions originally used in a similar study conducted in 1988 and an additional question relating to the impact of the NIH guidelines.


RESULTS
One hundred and thirty-seven (59%) completed surveys were returned. Compared with the results of the 1988 survey, more physicians routinely use pulmonary function testing (73% versus 47% in 1988, P < .001), inhaled beta-agonists as the initial drug of choice (98% versus 17%, P < .001), and early corticosteroid administration (82% vs 21%, P < .001) in their emergency management of asthmatic children. Fifty percent of survey participants believe that NIH guidelines changed their emergency management of childhood asthma.


CONCLUSIONS
Significant changes in the emergency management of asthmatic children have occurred since the publication of the NIH guidelines.