Effects of Pre-Hospital Dexamethasone Administration on Outcomes of Patients with COPD and Asthma Exacerbation; a Cross-Sectional Study
Archives of Academic Emergency Medicine,
Vol. 11 No. 1 (2023),
15 November 2022
,
Page e56
https://doi.org/10.22037/aaem.v11i1.2037
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) and asthma exacerbation are two common emergency situations. This study aimed to investigate the impact of pre-hospital dexamethasone initiation on treatment outcomes of these patients.
Methods: In this retrospective cross-sectional and comparative study, data from the emergency medical service (EMS) care report of patients with a final diagnosis of asthma or COPD, coded with Thailand's emergency medical triage protocol, collected between January 1, 2021, and October 31, 2022, were used. Data on baseline characteristics, emergency department length of stay (ED-LOS), and hospital admission rates were collected from electronic medical records and compared between cases with and without pre-hospital dexamethasone administration by EMS.
Results: 200 patients with COPD (n = 93) and asthma (n = 107) exacerbation were enrolled. The dexamethasone-treated group had a lower but statistically non-significant hospital admission rate (71.0% versus 81.0%, absolute difference: −10%, 95% confidence interval (CI): −21.76, 1.76; p = 0.100). In patients with asthma, the dexamethasone-treated had lower median ED-LOS time (235 (IQR: 165.5–349.5) versus 322 (IQR: 238–404) minutes; p = 0.003). Dexamethasone-treated asthma patients had lower but statistically non-significant hospital admission rates (60.4% versus 78.0%, absolute difference: −17.55%, 95% CI: −34.96, −0.14; p = 0.510). In COPD patients the dexamethasone-treated and untreated groups had non-significantly lower hospital admission rates (80.8% versus 85.40%, absolute difference: −4.60%, 95% CI: −19.82, 10.63; p = 0.561) and non-significantly lower ED-LOS (232 (IQR: 150 – 346) versus 296 (IQR: 212 – 330) minutes, absolute difference: −59 (−130.81, 12.81); p = 0.106).
Conclusion: The dexamethasone administration by EMS in pre-hospital setting for management of asthma and COPD patients is beneficial in reducing the ED-LOS and need for hospital admission but its effects are not statistically significant, except regarding the ED-LOS of asthma exacerbation cases.
- asthma
- chronic obstructive pulmonary disease
- dexamethasone
- emergency medical services
- hospital stay
- Pulmonary disease, chronic obstructive
- Dexamethasone
- Length of stay
How to Cite
References
WHO. Chronic respiratory diseases 2020 [cited 2021 10 Nov]. Available from: https://www.who.int/health-topics/chronic-respiratory-diseases#tab=tab_1.
Martins LC, de Oliveira MdRD, do Nascimento Saldiva PH, Braga ALF. Air pollution and emergency room visits due to chronic lower respiratory diseases in the elderly: an ecological time-series study in São Paulo, Brazil. J Occup Environ Med. 2002;44(7):622-7.
Long D, Bendal J, Bower A. Out-of-hospital administration of corticosteroids to patients with acute asthma: A case study and literature review. Australas J Paramed. 2008;6:1-11.
Stead L, Whiteside T. Evaluation of a new EMS asthma protocol in New York City: a preliminary report. Prehosp Emerg Care. 1999;3(4):338-42.
Phipps P, Garrard C. The pulmonary physician in critical care• 12: acute severe asthma in the intensive care unit. Thorax. 2003;58(1):81-8.
Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalised patients. Cochrane Database Syst Rev. 2001;2001(1):CD001740.
Barrios RJ, Kheradmand F, Batts LK, Corry DB. Asthma: pathology and pathophysiology. Arch Pathol Lab Med. 2006;130(4):447-51.
Hogg JC, Timens W. The pathology of chronic obstructive pulmonary disease. Annu Rev Pathol. 2009;4:435-59.
Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2022;59:2102730.
Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10(5):447-58.
Rowe B, Spooner C, Ducharme F, Bretzlaff J, Bota G. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001(1):CD002178.
Medicine NIfE. EMS protocol in Thailand 2020 [cited 2021 10 Nov]. Available from: https://www.niems.go.th/1/Ebook/Detail/1162?group=21.
Huabbangyang T, Sangketchon C, Piewthamai K, Saengmanee K, Ruangchai K, Bunkhamsaen N, et al. Perception and Satisfaction of Patients' Relatives Regarding Emergency Medical Service Response Times: A Cross-Sectional Study. Open Access Emerg Med. 2022;14:155-63.
Huabbangyang T, Klaiangthong R, Silakoon A, Sretimongkol S, Sangpakdee S, Khiaolueang M, et al. The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study. Int J Emerg Med. 2023;16(1):9.
Plongthong K, Chenthanakij B, Wittayachamnankul B, Tianwibool P, Phinyo P, Tangsuwanaruk T. Factor Affecting Length of Stay More Than 6 Hours in Emergency Department. JHSR. 2021;15(3):381-90 [Thai].
Cohen J. Statistical power analysis for the behavioral sciences (revised ed.). New York: Academic Press; 1977.
Alangari AA. Corticosteroids in the treatment of acute asthma. Ann Thorac Med. 2014;9(4):187-92.
Chapman KR, Verbeek PR, White JG, Rebuck AS. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med. 1991;324(12):788-94.
Fishe JN, Gautam S, Hendry P, Blake KV, Hendeles L. Emergency medical services administration of systemic corticosteroids for pediatric asthma: A statewide study of emergency department outcomes. Acad Emerg Med. 2019;26(5):549-51.
Levy ML, Bacharier LB, Bateman E, Boulet L-P, Brightling C, Buhl R, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33(1):7.
Kirkland SW, Cross E, Campbell S, Villa-Roel C, Rowe BH. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. Cochrane Database Syst Rev. 2018;6(6):CD012629.
Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014;133(3):493-9.
Halpin DM, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, et al. Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD science committee report on COVID-19 and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021;203(1):24-36.
Ardestani ME, Kalantary E, Samaiy V, Taherian K. Methyl prednisolone vs Dexamethasone in Management of COPD Exacerbation; a Randomized Clinical Trial. Emerg (Tehran). 2017;5(1):e35.
Kowjiriyapan Y. Comparative efficacy of metered dose inhaler with spacer and nebulized bronchodilator in the treatment of COPD acute exacerbation in the emergency department, Chiangrai Prachanukroh Hospital. CMJ. 2022;13(3):117-31 [Thai].
Fishe JN, Hendry P, Brailsford J, Salloum RG, Vogel B, Finlay E, et al. Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation trial with a stepped wedge design. Contemp Clin Trials. 2020;97:106141.
Tyler A, Cotter JM, Moss A, Topoz I, Dempsey A, Reese J, et al. Outcomes for pediatric asthmatic inpatients after implementation of an emergency department dexamethasone treatment protocol. Hosp Pediatr. 2019;9(2):92-9.
Knapp B, Wood C. The prehospital administration of intravenous methylprednisolone lowers hospital admission rates for moderate to severe asthma. Prehosp Emerg Care. 2003;7(4):423-6.
Moore SG. Intravenous dexamethasone as an analgesic: a literature review. AANA j. 2018;86(6):488-93.
- Abstract Viewed: 816 times
- pdf Downloaded: 738 times
