RESUMEN
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.
Asunto(s)
Ruidos Respiratorios , Enfermedades Respiratorias/tratamiento farmacológico , Adolescente , Corticoesteroides/administración & dosificación , Agonistas Adrenérgicos beta/administración & dosificación , Broncodilatadores/administración & dosificación , Niño , Preescolar , Estudios de Cohortes , Quimioterapia/tendencias , Servicio de Urgencia en Hospital , Femenino , Hospitalización/tendencias , Humanos , Lactante , Recién Nacido , Masculino , Nebulizadores y Vaporizadores , Estudios Prospectivos , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/fisiopatología , Teofilina/administración & dosificaciónRESUMEN
This study examined the changes from the initial peak flows and oxygen saturations (OSAT) of wheezing children at presentation to the emergency department through their treatment in the emergency department. Data was collected prospectively on 785 patients 5 to 20 years of age during an 11-month period from November 1, 1990, to September 30, 1991. Both the initial OSAT and peak flows were correlated with the number of bronchodilator treatments required in the emergency department and with the need for hospitalization. Both the initial OSAT and the peak flows had a limited ability to predict the need for hospitalization. Oxygen saturation appears to be a valid measure of wheezing severity and is more easily obtained in children of all ages. Following bronchodilator treatment, peak flow results in a larger quantitative improvement than OSAT; however, this difference does not appear to have any significant advantage. Aerosolized albuterol and subcutaneous epinephrine resulted in a similar degree of improvement as measured by peak flow and by oxygen saturation, with clinically similar changes in heart rate.
