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Improved Management of Acute Asthma among Pregnant Women Presenting to the Emergency Department.

Chest. 2014 Oct 30;

Authors: Hasegawa K, Cydulka RK, Sullivan AF, Langdorf MI, Nonas SA, Nowak RM, Wang NE, Camargo CA

Abstract
Abstract: Background:A multicenter study in the late 1990s demonstrated suboptimal emergency asthma care for pregnant women in US emergency departments (EDs). After a decade, follow-up data are lacking. We aimed to examine changes in emergency asthma care of pregnant women since the 1990s. Methods:We combined data from four multicenter observational studies of ED patients with acute asthma performed in 1996-2001 (three studies), and 2011-2012 (one study). We restricted the data so that comparisons were based on the same 48 EDs in both time periods. We identified all pregnant patients aged 18 to 44 years with acute asthma. Primary outcomes were treatment with systemic corticosteroids in the ED, and, among those sent home, at ED discharge. Results:Of 4895 ED patients with acute asthma, the analytic cohort comprised 125 pregnant women. Over the two time periods, there were no significant changes in patient demographics, chronic asthma severity, or initial peak expiratory flow. In contrast, ED systemic corticosteroids treatment increased significantly from 51% to 78% across the time periods (OR 3.11; 95%CI 1.27-7.60; P=0.01); systemic corticosteroids at discharge increased from 42% to 63% (OR 2.49; 95%CI 0.97-6.37; P=0.054). In the adjusted analyses, pregnant women in recent years were more likely to receive systemic corticosteroids, both in ED (OR 4.76; 95%CI 1.63-13.9; P=0.004) and at discharge (OR 3.18; 95%CI 1.05-9.61; P=0.04). Conclusions:Over the two time periods, emergency asthma care in pregnant women has significantly improved. However, with one in three pregnant women being discharged home without systemic corticosteroids, further improvement is warranted.
Background: A multicenter study in the late 1990s demonstrated suboptimal emergency asthma care for pregnant women in US emergency departments (EDs). After a decade, follow-up data are lacking. We aimed to examine changes in emergency asthma care of pregnant women since the 1990s.
Methods: We combined data from four multicenter observational studies of ED patients with acute asthma performed in 1996-2001 (three studies), and 2011-2012 (one study). We restricted the data so that comparisons were based on the same 48 EDs in both time periods. We identified all pregnant patients aged 18 to 44 years with acute asthma. Primary outcomes were treatment with systemic corticosteroids in the ED, and, among those sent home, at ED discharge.
Results: Of 4895 ED patients with acute asthma, the analytic cohort comprised 125 pregnant women. Over the two time periods, there were no significant changes in patient demographics, chronic asthma severity, or initial peak expiratory flow. In contrast, ED systemic corticosteroids treatment increased significantly from 51% to 78% across the time periods (OR 3.11; 95%CI 1.27-7.60; P=0.01); systemic corticosteroids at discharge increased from 42% to 63% (OR 2.49; 95%CI 0.97-6.37; P=0.054). In the adjusted analyses, pregnant women in recent years were more likely to receive systemic corticosteroids, both in ED (OR 4.76; 95%CI 1.63-13.9; P=0.004) and at discharge (OR 3.18; 95%CI 1.05-9.61; P=0.04).
Conclusions: Over the two time periods, emergency asthma care in pregnant women has significantly improved. However, with one in three pregnant women being discharged home without systemic corticosteroids, further improvement is warranted.

PMID: 25358070 [PubMed – as supplied by publisher]

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