Application of healthcare protocols for the patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management

Abstract

The aim of this work was to determine the optimal strategy for the treatment of patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management as a basis for a universal therapeutic scheme taking account of the social status of the patient and localization of the medical facility. The study included 100 patients with bronchial asthma (BA) admitted to the Allergic Department of Regional Clinical Hospital. Those of group 1 were given systemic glucocorticosteroids (SGCS) parenterally or inhalation glucocorticosteroids (IGCS) through a metered dose inhaler. Patients of group 2 received SGCS parenterally or IGCS through a nebulizer. Examination included determination of external respiratory function, pulse oximetry, and ECG. Both modalities improved the patients’ clinical conditions within the first 4 hours, with the use of bronchodilators and IGCS through the nebulizer in combination with SGCS producing the most pronounced effect on peak expiratory flow rate. The per patient cost of medication therapy in group 1 was 131.5 rubles/day compared with 199.7 rubles in group 2. The cost of the complete treatment course was 1577.44 and 1797.78 rubles respectively. However, the number of one bed-days spent in the hospital for patients of group 2 was smaller than in group 1 which accounted for the cost of the complete treatment course 27 573.60 and 37 431.64 rubles respectively (р=0,04). It is concluded that the optimal therapeutic modality for the patients with severe exacerbation of bronchial asthma includes the use of bronchodilators and IGCS through a nebulizer in combination with SGCS. It not only improves clinical and functional characteristics of the patients but also reduces their hospital stay and the total cost of the treatment.