Acute Medicine and Medical Specialties, Western Infirmary, Glasgow.
Scott Med J. 2010 Feb;55(1):6-9. doi: 10.1258/RSMSMJ.55.1.6.
The U.K. has 75,000 hospital admissions and over 1500 deaths from asthma annually. The British Thoracic Society (BTS) guidelines represent the recognised standard for acute asthma management. We assessed the degree of conformity with these guidelines in an acute medical unit.
Data from consecutive admissions were collected prospectively. Practice was audited in October December 2005 and October 2006 - January 2007. Between cycles an educational programme was instigated,
Fifty-eight patients were included. Clinical parameters were well recorded in both cycles. Peak expiratory flow was consistently under-recorded (72% at admission; 67% in monitoring). in monitoring). Severity assessment was documented at 55% and 66% in cycle one and two respectively. Of these, the assessment was incorrect in 33% in cycle one and 21% in cycle two. All misclassifications of severity were underestimates. All life-threatening attacks were not identified. No improvement occurred between cycles. Overall, 60% of patients were inappropriately treated according to BTS guidelines, 40% due to under-treatment. Under-treatment occurred more frequently in cycle two compared with cycle one (57% vs. 24%, p = 0.007), predominantly due to inadequate treatment of life-threatening asthma.
Management of acute asthma in a large, urban teaching hospital is suboptimal. Educational intervention failed to improve care; more comprehensive strategies are required.
英国每年有 75000 例因哮喘住院和超过 1500 人死亡。英国胸科学会（BTS）指南是急性哮喘管理的公认标准。我们评估了在急性内科病房中这些指南的符合程度。
连续入院患者的数据均前瞻性收集。实践情况于 2005 年 10 月至 12 月和 2006 年 10 月至 2007 年 1 月期间进行审核。在两个周期之间，启动了一项教育计划。
共纳入 58 例患者。两个周期的临床参数均记录良好。呼气峰流速始终记录不足（入院时为 72%；监测时为 67%）。在监测时为 67%）。严重程度评估在第一个周期分别记录为 55%和第二个周期的 66%。其中，在第一个周期有 33%的评估错误，第二个周期有 21%的评估错误。所有严重程度的错误分类均为低估。所有危及生命的发作均未被识别。两个周期之间未出现改善。总体而言，根据 BTS 指南，60%的患者治疗不当，40%是由于治疗不足。与第一个周期相比，第二个周期的治疗不足更常见（57%对 24%，p = 0.007），主要是由于危及生命的哮喘治疗不足。
在大型城市教学医院中，急性哮喘的管理并不理想。教育干预未能改善护理；需要更全面的策略。
