Abstract：
OBJECTIVE: Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing.
METHODS: Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.
METHODS: Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI).
METHODS: Describe practice and variation in discharge advice, treatment recommendations and safety netting provision.
RESULTS: Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) \'nearly always\' assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided \'fixed\' bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).
CONCLUSIONS: There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
METHODS: Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers.
METHODS: Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI).
METHODS: Describe practice and variation in discharge advice, treatment recommendations and safety netting provision.
RESULTS: Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) \'nearly always\' assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided \'fixed\' bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%).
CONCLUSIONS: There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
摘要：
目的：急性喘息和哮喘发作的恢复应通过安全网支持，包括治疗建议。我们评估了急诊科（ED）针对儿童急性喘息/哮喘发作的出院做法，以描述安全网和恢复支气管扩张剂剂量的变化。
方法：2020年6月至2021年9月的两阶段研究，包括（1）部门出院实践调查，(2)对照顾者书面出院说明的分析。
方法：农村和城市环境中的二级和三级ED，来自英国和爱尔兰的儿科急诊研究（PERUKI）。
方法：描述出院建议的实践和变化，治疗建议和安全网规定。
结果：在66/71（93％）的参与站点中，62/66（93.9%）报告提供了书面安全网信息。52/66（78.8%）“几乎总是”评估吸入器/间隔器技术；常规药物审查（21/66；31.8%）和依从性（16/66；21.4%）频率较低。在第二阶段,61/66（92.4％）提交了出院文件；50/66（81.9％）包括支气管扩张剂计划。11/66(18.0%)提供个性化哮喘行动计划作为唯一的出院信息。45/50（90％）提供固定的支气管扩张剂给药方案；剂量逐渐减少是常见的（38/50；76.0％）。中位起始剂量为每4小时10次(27/50,54.0%);中位持续时间为4天(29/50,58.0%)。13/61（21.3％）未提供支气管扩张剂急性恶化的建议；如果提供，42/48（87.5％）建议立即抽吸10次。随后的剂量变化很大。常见的危险信号包括无法说话（52/61，85.2％），吸入器不持续4小时（51/61，83.6%）和呼吸窘迫（49/61，80.3%）。
结论：急性喘息和哮喘发作后，支气管扩张剂的给药剂量和安全网状物含量存在差异。这反映了缺乏证据，确认需要进一步开展有关支气管扩张剂恢复策略和最佳安全联网建议的多中心研究。
方法：2020年6月至2021年9月的两阶段研究，包括（1）部门出院实践调查，(2)对照顾者书面出院说明的分析。
方法：农村和城市环境中的二级和三级ED，来自英国和爱尔兰的儿科急诊研究（PERUKI）。
方法：描述出院建议的实践和变化，治疗建议和安全网规定。
结果：在66/71（93％）的参与站点中，62/66（93.9%）报告提供了书面安全网信息。52/66（78.8%）“几乎总是”评估吸入器/间隔器技术；常规药物审查（21/66；31.8%）和依从性（16/66；21.4%）频率较低。在第二阶段,61/66（92.4％）提交了出院文件；50/66（81.9％）包括支气管扩张剂计划。11/66(18.0%)提供个性化哮喘行动计划作为唯一的出院信息。45/50（90％）提供固定的支气管扩张剂给药方案；剂量逐渐减少是常见的（38/50；76.0％）。中位起始剂量为每4小时10次(27/50,54.0%);中位持续时间为4天(29/50,58.0%)。13/61（21.3％）未提供支气管扩张剂急性恶化的建议；如果提供，42/48（87.5％）建议立即抽吸10次。随后的剂量变化很大。常见的危险信号包括无法说话（52/61，85.2％），吸入器不持续4小时（51/61，83.6%）和呼吸窘迫（49/61，80.3%）。
结论：急性喘息和哮喘发作后，支气管扩张剂的给药剂量和安全网状物含量存在差异。这反映了缺乏证据，确认需要进一步开展有关支气管扩张剂恢复策略和最佳安全联网建议的多中心研究。
