S T U D Y ACUTE EXACERBATION OF

BROCHIAL ASTHMA:
EVALUATION AND
MANAGEMENT IN AN
EMERGENCY DEPARTMENT

Abu Rish K. & Mousa A, H.

Emergency Department, King Hussein Medical Center
Amman, Jordan

Abstract measurement of Peak Flow Expiratory Rate (PEFR). The

severity of the bronchial asthma attack was classified according
Two hundred patients presenting at the Emergency
to the PEFR with >75% being mild, 50-75% moderate and <33%
Department (ED) with signs and symptoms of acute asthma
and requiring emergency management were studied to being severe.
determine their response to repeated nebulization with B- Patients with complications such as pneumonia, diabetes
2 agonist. This was effective in 83% while a further 14% mellitus, ischaemic heart disease and life threatening conditions
needed the addition of intravenous hydrocortisone. The needing intensive care were excluded from the study.
remaining 3% did not improve and were admitted.
We concluded that the assessment of the severity of
Results
asthma is easy for a primary care doctor and that B-2 The 200 patients included 114 males and 86 females, (Male
agonist nebulization is an effective, safe and easily applied to Female ratio of 1.3:1) all at least 15 years of age (Figure 1)
method of treatment. and all having been diagnosed previously with bronchial asthma
according to the criteria of the American Thoracic Society1 n .
Introduction Further demographic information is in (Table 1).
Acute exacerbation of bronchial asthma is one of the
conditions which causes stress to patients, families and Demographic Distribution
emergency department physicians. It is generally accepted that
B2-agonists (salbutamol nebulizer) are effective and safe, with Figure 1: Male to Female Ratio: 1.3 :1
a rapid effect that reduces the severity of an acute attack and
lowers the rate of hospital admission. Bolus nebulization of B2-
agonist is easily applied and well tolerated by patients.
We thought to study the safety and efficiency of the B2-
agonists by bolus nebulization (BN) in the initial management
of acute asthma cases in an emergency department.

Materials and Methods

This prospective study involved 200 patients presenting to
the Emergency Department with acute exacerbation of bronchial
asthma. The protocol used in the evaluation and management
consisted of repeated bolus nebulization (BN) at intervals of
0,30,60 minutes with intravenous hydrocortisone being
Table 1: Sex and age group distribution.
administered if indicated. For each patient this protocol was
evaluated over a period of two hours Age Group Male Female Total No. Pt's
The patient was assessed by a detailed history, physical 15-35 25 20 45
examination, basic diagnostic laboratory tests and an immediate
35-55 30 23 53
55-75 49 34 83
Address for correspondence:
Dr. Kamal Abu Rish 75-95 10 0 19
Emergency Department, King Hussein Medical Center Total No. 114 86 200
P. O. Box 520818, Amman, Jordan

36 QATAR MEDICAL JOURNAL VOL. 7 / NO. 2 / NOVEMBER 1998

Acute Exacerbation of Bronchial Asthma.
Of the 200 patients, 115 (57.5%) responded to the first
nebulization, 69 (34.5%) improved after the second dose and
10 (5%) improved after three doses. Six (3%) did not improve
and were admitted to hospital. (Table 2).
Table 2: Response to Bolus Nebulization with B2~agonist
Dose frequency No. of Patients Percentage %
First dose 115 57.5
Second dose 69 34.5
Third dose 10 5 effective bronchodilators in current clinical use and that, in
No response 6 3
Total 200 100
Discussion
The use of a B2-agonist nebulizer is a standard method for
the management of an acute attack of bronchial asthma. In this
study we used the schedule of bolus nebulization in use at the
King Hussein Medical Center E.D.(8) and we found that the use
°f a B2-agonist nebulizer is effective, safe and easily applied.
References:
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Afilalo. et al. Continuous Nebulization of Albuterol (Salbutamol) in
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QATAR MEDICAL JOURNAL VOL. I / NO. 2 / NOVEMBER 1998
Abu Risk K., et. al.
Most of th^ patients (97%) showed a good response and
improved with BN (plus intravenous hydrocortisone when
indicated). Only 3% of patients did not respond and needed
admission to hospital.
In similar studies Antoinette Colacone et. al.(1) compared
the continous B2-agonist infusion and bolus nebulization in the
initial management of bronchial asthma and concluded that both
methods were effective in their bronchodilation activity but bolus
nebulization achieved a more rapid response. Win Castle et al
(3)
suggested that B2-agonist inhalers are accepted as the most
patients requiring stabilization of their asthma with appropriate
doses of B2-agonists, nebulization and intravenous steroid
administration are the principal therapy in an emergency
department.
Conclusion
Assessment of the severity of asthma is easy for a primary
care doctor. A B2-agonist nebulizer is effective, safe and easily
applied. Most patients will show a good response although a
few will need intravenous hydrocortisone in addition. Only a
small number will require hospital admission.
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