Use of emergency medical services by patients with decompensated obstructive lung disease

Murata, Glen H; Gorby, Michael S; Chick, Thomas W; Halperin, Alan K

« Previous Next »Annals of Emergency Medicine
Volume 18, Issue 5 , Pages 501-506, May 1989

Use of emergency medical services by patients with decompensated obstructive lung disease

Glen H Murata
- Ambulatory Care Service, VA Medical Center, Albuquerque, New Mexico, USA
- Department of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
- Address for reprints: Glen H Murata, MD, Ambulatory Care Service (11AC), Veterans Administration Medical Center, 2100 Ridgecrest Drive, SE, Albuquerque, New Mexico 87108.
Michael S Gorby
- Ambulatory Care Service, VA Medical Center, Albuquerque, New Mexico, USA
- Department of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
Thomas W Chick
- Pulmonary Section, VA Medical Center, Albuquerque, New Mexico, USA
- Department of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
Alan K Halperin
- Ambulatory Care Service, VA Medical Center, Albuquerque, New Mexico, USA
- Department of Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA

Received 6 September 1988; received in revised form 8 December 1988; accepted 25 January 1989.

Little information is available about the risk of relapse when patients with decompensated obstructive lung disease are treated in an emergency department for dyspnea. The purpose of our study was to determine if the risk of relapse was related to the severity and type of airway obstruction or to the time and duration of treatment. Over a period of 29 months, 496 patients with decompensated chronic obstructive pulmonary disease (COPD), asthma, or both were seen in the ED of the Albuquerque Veterans Administration Medical Center. Of 868 visits in which patients were treated and released, 244 (28.1%) were followed by a relapse within 14 days. Those who relapsed had a slightly higher one-second forced expiratory volume at baseline than those who did not (50.1 ± 22.2% versus 45.5 ± 20.6% predicted, P = .054). For 94 patients (group 1), asthma was the exclusive clinical diagnosis, and all available pulmonary function tests showed a bronchodilator response. For 268 patients (group 2), COPD was the exclusive diagnosis, and all tests showed no bronchodilator response. One hundred thirty-four patients (group 3) were either diagnosed as having both disorders or had varying bronchodilator response on sequential testing. The risk of relapse for group 3 patients (35.6%) was higher than for those in groups 2 (23.1%, P < .001) or 1 (19.7%, P = .001). The frequency of relapse was higher for nighttime than daytime visits (36.1% versus 24.5%, P = .006) and for weekend than weekday visits (33.6% versus 26.6%, P = .049). Prognosis did not vary with the season or duration of treatment. Seventy-one patients (14.3%) accounted for 50.8% of all visits, 63.1% of nighttime visits, 49.6% of weekend visits, and 68.3% of relanses. Most of these patients were members of group 3 and had both fixed and reversible components of airway obstruction. Further studies should be done to determine why these patients have such poor prognoses.

Key words: emergency medical services, chronic obstructive pulmonary disease

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