Risk of relapse as the number of asthma triggers increases and Treatment ED

This study confirms previous findings that a substantial proportion of patients treated in the ED suffer a relapse within days to weeks after ED discharge. Although there is no common definition of an “acceptable” relapse rate, 17% certainly represents a high failure rate. In this study, we have confirmed that easily ascertainable historical features define patients at highest risk. Since the National Asthma Education and Prevention Program guidelines allow for physician discretion in the disposition of patients with moderate airflow limitation after treatment, these higher-risk patients may be appropriate for inpatient or observation unit care. erectile dysfunction

Patients with a number of recent ED or urgent clinic visits, multiple asthma triggers, longer duration of symptoms, or already using home nebulizers may be appropriate for admission, observation unit care, or close outpatient follow-up. There is not a consistent increase in risk of relapse as the number of asthma triggers increases, suggesting the lack of a linear dose response relationship. We cannot, however, quantify the exposure to each of these triggers so that it is difficult to make such a conclusion. Further, patients with symptoms for 7 days have a lower risk of relapse, suggesting that patients with chronic symptoms respond differently following acute therapy with Kamagra Australia. Possibly the chronic nature of their symptoms makes them less likely to return for acute care.

Recent evidence indicates that ED visits can be reduced by educational intervention. Over the longer term, some clinicians have found that intensive management programs may prevent ED visits for acute asthma. Irwin et all developed a systematic management protocol based in a pulmonary outpatient clinic. Patients underwent intensive investigation to validate the diagnosis of asthma and also were evaluated for gastroesophageal reflux disease. Patients had medication adjustments, including initiation of treatment with inhaled steroids, appropriate use of inhaled 3-agonists, and consideration of the use of other anti-inflammatory medications and Generic viagra online.

Using this comprehensive management scheme, the authors report that they were able to control “difficult” asthma 74% of the time. Similarly, Mayo et al found that a focused management program with easy access to medical providers and medication adjustments significantly decreased asthma hospitalizations. It has not been demonstrated conclusively that an intensive ED-based asthma management program similar to these two models could prevent relapse following acute asthma treatment in the ED, but such programs seem worthy of further investigation.

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