Chidley K E, Wood-Baker R, Town G I, Sleet R A, Holgate S T
Department of Medicine I, Southampton General Hospital, U.K.
Respir Med. 1991 Sep;85(5):373-7. doi: 10.1016/s0954-6111(06)80180-0.
To determine if shortcomings in asthma management in the Accident and Emergency (A & E) department identified in a previous (1983) study (Reed et al. Thorax 1985; 40: 897-902) had been corrected, we retrospectively reviewed the case records of patients attending with asthma between December 1987 and November 1988. There was an increase in the number of patients attending with asthma; 0.73 per 1000 in 1988 versus 0.57 per 1000 in 1983. Sixty-seven percent of patients were self-referred and 80% presented between 1600 h and 0800 h. There was inadequate recording of the asthma history and examination findings. Peak expiratory flow (PEF) was recorded in 86% before treatment (compared to 11% in 1983) and 70% after treatment. In addition, a prospective study of 40 patients responding to a questionnaire 2 weeks after discharge, revealed persistent symptoms of unstable asthma in 50%. Although there has been a marked improvement in the use of PEF measurements since the 1983 study, the standards of management of asthma patients may still be inadequate as evidence by the presence of unstable asthma symptoms in many of those discharged. A standardized management protocol which provides guidelines for treatment based on PEF has been introduced to the A & E department.
为了确定在之前（1983年）一项研究（Reed等人，《胸腔》1985年；40: 897 - 902）中发现的急诊（A&E）部门哮喘管理缺陷是否已得到纠正，我们回顾性地查阅了1987年12月至1988年11月期间因哮喘就诊患者的病历。因哮喘就诊的患者数量有所增加；1988年每1000人中有0.73人，而1983年为每1000人中有0.57人。67%的患者是自行前来就诊的，80%的患者在16:00至08:00之间前来就诊。哮喘病史和检查结果的记录不充分。治疗前86%的患者记录了呼气峰值流速（PEF）（1983年为11%），治疗后为70%。此外，一项对40名出院两周后回复问卷的患者进行的前瞻性研究显示，50%的患者有不稳定哮喘的持续症状。尽管自1983年研究以来，PEF测量的使用有了显著改善，但从许多出院患者存在不稳定哮喘症状这一证据来看，哮喘患者的管理标准可能仍然不足。一项基于PEF提供治疗指南的标准化管理方案已引入急诊部门。
