The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

ANASSESSMENT OF A RESPIRATORY THERAPIST-DIRECTED ASTHMA PROGRAM

Jaime Dewar,BS,CRT, Lisa Bueltel,MS, RRT, RCP, F.Herbert Douce,MS,RRT, Respiratory TherapyDivision, The Ohio State University, Columbus,Ohio and The American Health NetworkAsthma Center, Columbus, OH.

Background:For optimal management of asthma, The National Heart, Lung, and Blood Institute(NHLBI) has established Guidelines for the Diagnosis and Management of Asthma.These guidelines suggest that when asthma is properly managed, emergency roomvisits, unscheduled doctors visits, hospitalizations, and school or work daysmissed due to asthma are decreased. The Asthma Center is a respiratory therapist-directedasthma education and treatment program designed to adhere to the NHLBI guidelines.Objective: The objective of this study was to determine if participants in theAsthma Center improve spirometric test results and decrease frequency of symptoms,emergency room visits, hospitalizations, unscheduled doctors visits and schoolor work days missed due to asthma.

Design, Sample, andProcedures: This was a retrospective study comparing one year of historicaldata and initial spirometric data from 82 new participants in the Asthma Centerwith the same data after they had been enrolled in the program for at leastone year. The historical data was collected from medical records and includednumber of emergency room visits, hospitalizations, unscheduled doctors visits,school or work days missed due to asthma, use of spacer and peak flow meter,and the frequency of symptoms (coughing, wheezing, shortness of breath, chesttightness, and sinus infection). The spirometric data included peak expiratoryflow (PEF), forced vital capacity (FVC), forced expiratory volume in one second(FEV1), forced expiratory flow between 25% and 75% of the FVC (FEF25-75%). Datawere analyzed using a one sample t-test and chi square tests with statisticalsignificance defined as p < 0.05.

Results: Therewere statistically significant (p<0.05) improvements in all spirometric testsand symptoms. FVC improved by 11%; FEV1 improved by 18%; PEF improved by 27%,and FEF25%-75% improved by 31%. Of the patients who complained of asthma-relatedsymptoms, 76% reported improvement in coughing; 73% reported improvement inwheezing; 85% reported improvement in shortness of breath; 80% reported improvementin chest tightness; 51% reported improvement in their sinus problems. Whilethere were no statistically significant differences between the number of emergencyroom visits or hospitalizations, there were statistically significant (p<0.05)decreases in the number of unscheduled doctors visits (3.19 ± 4.6) and daysof school or work lost (1.95 ± 3.3) due to asthma. Prior to the initial visitonly 1.2% used a peak flow meter and 15.7% used a spacer. After a year enrolledin the Asthma Center 97.6% used a peak flow meter and 100% used a spacer.

Conclusion: Arespiratory therapist-directed asthma management program designed to adhereto the NHLBI guidelines for optimal management of asthma can improve spirometricmeasurements and decrease the frequency of asthma-related symptoms, the numberof unscheduled doctors visits, and the number of school or work days misseddue to asthma.

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