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EDs Improve on Meeting Some Acute Asthma Guidelines, Fall Short on Other

BOSTON – How well are EDs doing in meeting nationally established treatment guidelines for acute asthma attacks? While use of appropriate medications improved over the study period, timeliness of care and other issues remained significant problems.

That’s according to a new study from Massachusetts General Hospital, which was published online recently by the Journal of Allergy and Clinical Immunology. The authors blame some of the lapses on continuing ED overcrowding.

"Asthma continues to be a significant health problem in the U.S., and while the improved ability of hospitals and other facilities to meet health quality guidelines for conditions such as heart attacks and pneumonia has been documented, changes in the quality of emergency asthma care have attracted less attention," said corresponding author Kohei Hasegawa, MD, MPH, MGH of Massachusetts General’s Department of Emergency Medicine. "We found that while emergency asthma care has become highly concordant with those guideline recommendations that are supported by strong scientific evidence, concordance with guideline-recommended care supported by weaker evidence declined. Our observations should encourage studies building more robust evidence for the latter."

For the current report, researchers analyzed data from three studies conducted by the Multicenter Airway Research Collaboration, a project of the Emergency Medicine Network, an international research consortium.

Data from two studies involving patients treated for acute asthma in the EDs of 48 U.S. hospitals between 1997 and 2001 were compared with similar data from patients seen in the same EDs in 2011-12. Treatment delivery was compared to guidelines established by the National Institutes of Health in 2007, with specific recommendations ranked according to their evidence-basis.

Overall, the researchers found that EDs did better with delivery of specific medications to patients at certain severity levels, which were considered level A guidelines.

On the other hand, the decline in adherence to level B and unranked guidelines – especially those relating to the assessment of pulmonary function and the timeliness with which care was delivered – actually appeared to outweigh improvement in the level-A recommendations, according to study authors.