ABSTRACT
This study prospectively examined the pharmacologic treatment of all wheezing children presenting to a pediatric emergency department from December 1987 to September 1991 (10,091 cases). There were increasing trends in rate of hospitalization, use of oxygen saturation measurements, use of corticosteroids and beta agents at discharge, and use of aerosolized bronchodilators administered in the emergency department. This cohort shows decreasing trends in use of theophylline and the use of subcutaneous bronchodilators administered in the emergency department. Increasing patient severity could not be confirmed in this cohort. The increase in use of corticosteroids in wheezing children is well supported in the literature. The use of theophylline appears to have significantly declined while there is still some controversy over its recommendations in the literature.
Subject(s)
Respiratory Sounds , Respiratory Tract Diseases/drug therapy , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-Agonists/administration & dosage , Bronchodilator Agents/administration & dosage , Child , Child, Preschool , Cohort Studies , Drug Therapy/trends , Emergency Service, Hospital , Female , Hospitalization/trends , Humans , Infant , Infant, Newborn , Male , Nebulizers and Vaporizers , Prospective Studies , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/physiopathology , Theophylline/administration & dosageABSTRACT
This study examined the oxygen saturation (OSAT) changes measured by pulse oximetry during emergency department (ED) bronchodilator treatment of wheezing patients. Data were collected prospectively on two cohorts (November 1987 to November 1988, 2,468 patients; and December 1988 to October 1990, 4,913 patients) presenting to a pediatric ED with wheezing-associated respiratory illnesses. Initial, posttreatment, and discharge OSAT was recorded in many of these patients. Improvement in OSAT following ED bronchodilator administration was noted in most patient groups. Initial OSAT was indicative of severity as measured by the need for hospitalization and the number of bronchodilator treatments administered in the ED. Subcutaneous epinephrine and aerosolized albuterol were compared in OSAT improvement and side effects. Aerosolized albuterol was not shown to be superior to epinephrine. Improvements in OSAT following bronchodilator administration documents the presence of relative preexisting hypoxemia which is reversed to some degree with bronchodilators. Pulse oximetry is an objective means of assessing asthma severity.
