The following findings are from Periodic Survey #22 which explored the management of acute asthma in pediatric office settings. The survey was initiated by the PROS Network to serve as comparison data for the network's asthma study directed by Anthony J. Alario, MD. These findings were presented by Dr. Alario at the 1993 annual meeting of the Ambulatory Pediatric Association; an article for publication is being developed.

PS#22 was an eight-page self-administered questionnaire sent to a random sample of 1600 active US FAAPs. A total of five mailings were conducted from June through September 1993 for a response of 1137 surveys or 71.1%.

The survey asked scenario-based questions with clinically-related contingencies regarding management of a 9-year old child with a moderately severe acute asthma exacerbation in an office-based setting.

Asthma Management:

In response to an inquiry about the initial treatment of a 9-year old patient with a moderately severe acute asthma exacerbation in the office, one-half of the respondents said they would initially begin treatment with an asthma medication; about 20% would first assess a peak expiratory flow rate (PEFR); and the remainder would check oxygen saturation or provide oxygen by mask.

• 87% of pediatricians said a nebulized beta-agonist such as albuterol, metaproterenol, or terbutaline given by compressed air nebulizer would be their initial choice of medication.

• If the patient had good response to the initial treatment, 21% said they would give no further medication; however, 44% would continue to use a nebulized beta-agonist and 35% said they use oral steroids.

• If the patient had poor or marginal clinical response to the initial treatment, 25% said they would at that point send the patient to the emergency department, 58% would begin or continue use of a nebulized beta-agonist, and 24% would continue treatment using subcutaneous medication.

• When asked to recommend home management for this patient, 79% said they would recommend an inhaled beta-agonist medication by metered dose inhaler (MDI).

Nearly one-half of the respondents said they would give a patient with acute asthma exacerbation 2 treatments of a subcutaneous medication, nebulized or inhaled bronchodilators before discharging the patient home from the office; 27% would give the patient 3 treatments, and 24% would give 1 treatment. The average time interval between these treatments is 22 minutes.

Almost all pediatricians (94%) have a compressed air-nebulizer available in their office, 87% have oxygen available, 85% have hand-held peak flow meters, and 77% have reservoirs/chambers for metered dose delivery.

When asked about their familiarity with the National Heart, Lung, and Blood Institute (NHLBI) Guidelines on Asthma Management, about one-half of pediatricians indicated they have received and reviewed the Guidelines; another 10% said they have the Guidelines but have not yet reviewed them. About one-fourth (27%) know they have not received the Guidelines, while another 12% don't know.