Evaluation of relapse cases in asthma attack patients treated at the allergy department and emergency service

Asthma patients presenting with an acute attack to the emergency service treated and released then revisit the emergency service due to the same symptoms is a major problem in clinical practice. In this study we aimed to determine the factors affecting early and late stage relapses and frequency of relapse within the first 72 hours and 4-7 days after asthma patients who presented to the hospital with acute attack were fully treated and sent home. Patients who presented with an acute asthma attack to the pediatric emergency service and pediatric allergy asthma clinic between March 2011 and September 2012 treated and sent home were taken into the study. The parents were given a telephone call on the 3rd and 7th day. The persistence of symptoms like cough, wheezing and shortness of breath, use of drugs and a revisit a doctor were inquired. A total of 816 patients diagnosed with acute asthma attack presented to the pediatric emergency service and pediatric allergy asthma clinic during the study. A total of 662 patients who met the study criteria and could be reached for follow up were included in the study. 446 (67.4%) of the cases taken into the study were seen at the pediatric allergy asthma clinic and 216 (32.6%) of them at the pediatric emergency service. When we take a look at the treatments given to the patients who presented to the hospital with acute attack, there was no difference in treatment of patients with a mild attack between the departments whereas it was determined that the rate of administration of systemic steroids to patients with moderate attack was higher in the pediatric allergy asthma clinic (p=0.026). Furthermore it was determined that patients with moderate attack treated at the pediatic allergy asthma clinic, in addition to short acting beta 2 agonists were also priscribed systemic and inhaler steroids and both this rate of drug prescription and rate of giving out a written instuction plan was higher (p<0.05). It was found that patients with acute attack treated at the emergency service and evaluated on the third day after being sent home had a higher rate of respiratory symptoms and relapse than those evaluated at the pediatric allergy asthma clinic (p=0.001). Whereas there was no difference in the rate of respiratory symptoms and relapse between the patients evaluated on the 7th day in the two departments. Our study showed that patients evaluated and treated by fellows at the pediatric allergy asthma clinic had a less relapse rate experienced than patients evaluated, treated and sent home by pediatric residents at the emergency service. For this reason to be able to reduce relapse to the lowest: it is necessary that before the doctors start treatment at the emergency service where patients are generally seen first, should learn well the prognosis of asthma cases in the previous year, accurately determine the severity of the attack, inquire in detail the drugs taken at home before coming to the emergency service and determine the treatment of the attack by taking into considerations these parameters. It was also showed that it is important to choose the right drug dose especially for the control of respiratory tract inflamations. Doctors who treat acute attack should be tought the importance of giving the parents of patients whose treatment will continue at home a written instructional plan on how to use the drugs.