Randomised pragmatic comparison of UK and US treatment of acute asthma presenting to hospital.
نویسندگان
چکیده
BACKGROUND Systemic corticosteroids and inhaled beta(2) agonists are accepted first line treatments for acute severe asthma, but there is no consensus on their optimum dosage and frequency of administration. American regimens include higher initial dosages of beta(2) agonists and corticosteroids than UK regimens. METHODS In a prospective, pragmatic, randomised, parallel group study, 170 patients of mean (SD) age 37 (12) years with acute asthma (peak expiratory flow (PEF) 212 (80) l/min) presenting to hospital received treatment with either high dose prednisolone and continuous nebulised salbutamol as recommended in the US or lower dose prednisolone and bolus nebulised salbutamol as recommended in the UK by the BTS. RESULTS Outcome measures were: deltaPEF at 1 hour (BTS 89 l/min, US 106 l/min, p=0.2, CI -8 to 41) and at 2 hours (BTS 49 l/min, US 101 l/min, p<0.0001, CI 28 to 77); time to discharge if admitted (BTS 4 days, US 4 days); rates of achieving discharge PEF (>60%) at 2 hours (BTS 64%, US 78%, p=0.04); time to regain control of asthma as measured by PEF >/=80% best with </=20% variability (BTS 3 days, US 4 days, p=0.6); PEF at 24 hours in patients admitted (BTS 293 l/min, US 288 l/min, p=0.8); and control of asthma in the subsequent month (no significant differences). CONCLUSIONS Treatment with higher doses of continuous nebulised salbutamol leads to a greater immediate improvement in PEF but the degree of recovery at 24 hours and speed of recovery thereafter is achieved as effectively with lower corticosteroid doses as recommended in the British guidelines.
منابع مشابه
Asthma Control Level Assessment by Moving from the Current Reactive Care Models into a Preventive Approach based on Fuzzy Clustering and Classification Algorithms
Background and Aim: Asthma is a common and chronic disease of respiratory tracts. The best way to treat Asthma is to control it. Experts of this field suggest the continues monitoring on Asthma symptoms and adjustment of self-care plan with offering the preventive treatment program to have desired control over Asthma. Presenting these plans by the physician is set based on the control level in ...
متن کاملComparison of the Prevalence of Geographic Tongue in Asthmatic Patients and Healthy Subjects in Masih Daneshvari Hospital in 2014
Background and aim: Geographic tongue is a recurrent disorder with several associated etiologies. It is believed to be a common occurrence in the patients suffering from recurrent, acute inflammatory diseases. The purpose of this study was to compare the prevalence of geographic tongue between asthmatic patients and healthy subjects. Materials and Methods: This descriptive-analytic study was...
متن کاملComparison of Video-Assisted Thoracoscopic Surgery and Intrapleural Urokinase as an Initial Treatment for Parapneumonic Effusion and Thoracic Empyema
Introduction: The treatment of complicated parapneumonic effusion (PPE) and thoracic empyema (TE) is controversial; and the choice of treatment after confirming the failure of simple drainage remains unclear. The purpose of this study was to compare the outcomes of intrapleural urokinase (UK) administration and video-assisted thoracoscopic surgery (VATS) as initial treatment options for PPE and...
متن کاملتعیین و مقایسه میزان پایایی تأثیر درمانی دو روش Ultra Sound تحت استرچ و Hold-Relax بر کاهش کوتاهی عضله همسترینگ
Background & Objective: The effect of simultaneous US(Ultra-Sound) with stretching, however, has not been compared with other manual stretching techniques like PNF(Proprioceptive Nueromuscular Facilitation). Furthermore, the permanency of the two techniques has not been investigated, either. Method: This study was a randomised clinical trial on 20 non-athlete and healthy women. The subjects...
متن کاملDiagnostic Accuracy of Acute Appendicitis by Ultrasound in Hospital Emergency
Background Acute appendicitis is the most common medical condition requiring immediate abdominal surgery.Medical ultrasound is a non-intrusive, non-expensive and available diagnostic method. In this study, the accuracy of ultrasound in diagnosis of acute appendicitis in hospital emergency was evaluated. Materials and Methods This retrospective cohort study was performed at Ahvaz Imam Khomeini h...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Thorax
دوره 57 12 شماره
صفحات -
تاریخ انتشار 2002