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Title: Peak expiratory flow rate guided protocol did not improve outcome in emergency room asthma
Authors: Abisheganaden, J.
Ng, S.B.
Sin Fai Lam, K.N.
Lim, T.K. 
Keywords: Asthma exacerbation
Emergency room
Peak expiratory flow rate
Practice guidelines
Issue Date: Nov-1998
Citation: Abisheganaden, J., Ng, S.B., Sin Fai Lam, K.N., Lim, T.K. (1998-11). Peak expiratory flow rate guided protocol did not improve outcome in emergency room asthma. Singapore Medical Journal 39 (11) : 479-484. ScholarBank@NUS Repository.
Abstract: Background and Aims of Study: All current international practice guidelines recommend that treatment of acute asthma in the emergency room (ER) should be guided by the peak expiratory flow rate (PEFR). The aim of this study was to assess the efficacy of a PEFR guided protocol in treating ER asthma. Methods: We compared two different management protocols in adult asthmatics who presented to the ER with acute exacerbations. The routine protocol (RP) assessed and dispensed patients according to overall subjective and clinical response without pre-determined criteria. The peak protocol (PP) used serial measurements of PEFR to guide intensity of bronchodilator treatment and fitness for hospital discharge. On the PP, a threshold PEFR of ≥ 60% predicted had to be achieved before the patient could be discharged from the ER. Results: There were 79 patients in the RP group and 70 in the PP group. There was no significant difference between the two groups in baseline PEFR, PEFR after treatment and percentage increase in PEFR with treatment. The PP resulted in a higher hospital admission rate than RP. Conclusion: We conclude that in the management of acute asthma in the ER, a PEFR guided protocol neither improved overall PEFR response to treatment nor reduced admission rates when compared with current management as it is practised in Singapore.
Source Title: Singapore Medical Journal
ISSN: 00375675
Appears in Collections:Staff Publications

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