© Borgis - Postępy Nauk Medycznych 7/2017, s. 344-350
*Klaudiusz Nadolny1-3, Katarzyna Starosta-Głowińska4, Anna Rej-Kietla2, Tomasz Kulpok-Bagiński2, 3, Artur Borowicz1, Michał Kucap1, 2, Tomasz Ilczak5, Dariusz Timler4, Monika Chorąży6, Marzena Wojewódzka-Żelezniakowicz7, Maciej Badoński7, Daniel Ślęzak8, Robert Gałązkowski9, Łukasz Szarpak10, Jerzy Robert Ładny7
A retrospective analysis of dispatches of emergency medical units to diagnosed bronchial asthma cases in the population of the Voivodeship Rescue Service in Katowice area in the years 2015-2016
Analiza retrospektywna wyjazdów zespołów ratownictwa medycznego do rozpoznanej astmy oskrzelowej w populacji objętej działalnością Wojewódzkiego Pogotowia Ratunkowego w Katowicach w latach 2015-2016
1Voivodeship Rescue Service in Katowice
Head of Service: Artur Borowicz
2College of Strategic Planning in Dąbrowa Górnicza
Head of College: Anna Rej-Kietla, MD, PhD, LLM
3Institute of Public Health, Faculty of Public Health, Medical University of Silesia in Katowice
Head of Institute: Elżbieta Grochowska-Niedworok, PhD (Pharmacy)
4Institute of Emergency and Disaster Medicine, Medical University of Łódź
Head of Institute: Dariusz Timler, MD, PhD
5Institute of Emergency Services, Department of Nursing and Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała
Head of Institute: Associate professor Rafał Bobiński, MD, PhD
6Department of Neurology, Medical University of Białystok
Head of Department: Jan Kochanowicz, MD, PhD
7Department of Emergency Medicine and Disasters, Medical University of Białystok
Head of Department: Professor Jerzy Robert Ładny, MD, PhD
8Department of Emergency Medicine, Faculty of Health, Medical University of Gdańsk
Head of Department: Professor Andrzej Basiński, MD, PhD
9Department of Emergency Medical Service, Medical University of Warsaw
Head of Department: Grzegorz Michalak, MD, PhD
10Department of Emergency Medicine, Medical Univeristy of Warsaw
Head of Department: Zenon Truszewski, MD, PhD
Wstęp. Astma oskrzelowa jest chorobą cywilizacyjną, dotyka około 300 milionów ludzi na całym świecie i jest przyczyną 250 tysięcy zgonów rocznie.
Cel pracy. Ocena częstości występowania astmy oskrzelowej w badanej populacji w latach 2015-2016 ze zwróceniem szczególnej uwagi na charakterystykę grupy, objawy fizykalne pacjenta oraz postępowanie zespołów ratownictwa medycznego.
Materiał i metoda. Analizie retrospektywnej poddano dokumentację medyczną tj. karta zlecenia wyjazdu i karta medycznych czynności ratunkowych zespołów ratownictwa medycznego należących do Wojewódzkiego Pogotowia Ratunkowe w Katowicach, które kończyły się rozpoznaniem astmy oskrzelowej. Do badania włączone 2879 zrealizowanych wizyt.
Wyniki. Częściej astma oskrzelowa występuje u kobiet. Średnia wieku badanych wyniosła 56,21 lat. Współczynnik zapadalności wyniósł 53,3/100000. Najczęstszym miejscem wezwania był dom osoby poszkodowanej (72,94%, p<0,05). Członek rodzinny najczęściej wzywał pogotowie ratunkowe (57,62%, p<0,05). Najwięcej interwencji odnotowano w pierwszym kwartale. Częściej dysponowany na miejsce zdarzenia był zespół specjalistyczny (55,43% vs 44,56%, p<0,05). Wykazano różnice statystyczne w odniesieniu do kodu pilności wezwania (p<0,05). Skóra pacjenta najczęściej była prawidłowa. Cechy centralizacji krążenia odnotowano w 81 przypadkach. W większości przypadków oddech u pacjenta był wydolny (81,26 %). Najczęstszym szmerem oddechowym były świsty (2230 przypadki, 77,45 %).
Wnioski. Odsetek wizyt do astmy w stosunku do wszystkich realizowanych wizyt jest stosunkowo niski. W większości interwencji stan pacjenta jest stabilny i nie wymaga zaawansowanych procedur ratowniczych.
Introduction. Bronchial asthma is a civilization disease. There are 300 million people in the world who suffer from this disease and 250 thousand fatal cases a year caused by asthma.
Aim. The aim is to assess the frequency of bronchial asthma incidence in the population under research in the years 2015-2016. There is a special focus on the characteristic features of the group, the physical symptoms of the patients, and the actions taken by the emergency medical units in question.
Material and methods. The retrospective analysis has covered medical documentation, i.e. dispatch order forms and emergency medical procedure forms of the Voivodeship Rescue Service in Katowice. The number of forms being subject to research has been limited only to cases with a diagnosed bronchial asthma. There have been 2879 dispatch cases included in the research.
Results. Bronchial asthma is more frequent in women. The average age of patients under research was 56.21. The attack rate was 53.3/100 000. The most frequent dispatch destination was the patient’s home (72.94%, p < 0.05). The members of patients’ families most often called emergency service (57.62%, p < 0.05). Most of the interventions were reported in the first quarter of the year. Special medical emergency units (55.43 vs 44.56%, p < 0.05) were dispatched more often than basic units. There were some statistical differences reported that related with the emergency priority code (p < 0.05). In most of the cases, there were no issues with the patients’ skin. There were centralization of circulation symptoms in 81 cases. In most of the cases, the patient’s breath was efficient (81.26%). The most common type of reported breath sound was wheezing (2230 cases, 77.45%).
Conclusions. The asthma cases ratio compared with the overall number of visits is quite low. In most of the interventions, patients are in a stable condition and do not require any advanced emergency medical procedures.
The Global Initiative for Asthma, GINA, was created in the USA in the early 1990s. It was an initiative of the National Heart Lung and Blood Institute alongside the World Health Organization (WHO) (1). It was already in 1995 that the first guidance of bronchial asthma procedures was published. The guidance had been changing, and the last guidance instructions were published on 6 May 2014, which is called the World Asthma Day (2). The main point of the GINA mission is reducing the incidence and mortality due to bronchial asthma. The 1998 report launched inhalatory glycocorticosteroids, which was a milestone in the history of asthma treatment (3). The newest GINA 2014 guidance was presented in 8 chapters. There is also a chapter about children in this guidance.
Globally, there are 235-300 million people suffering from asthma. Moreover, asthma is the cause of 250 000 fatal cases a year (4).
The characteristics of asthma includes temporary symptoms of bronchial hypersensitivity and reversible obstruction, the latter being caused by smooth muscle contraction and mucosal inflammation. One can differentiate two types of asthma, i.e.:
– extrinsic asthma – depending on immunological factors, usually having its origins in the patient’s childhood,
– intrinsic asthma – where there is no causal factor and the disease progresses with age (5).
Chronic inflammation of respiratory tracts is typical of asthma. What is more, asthma is characterized by wheezing, dyspnoea, chest pressure and cough. These symptoms may vary in intensity and frequency as the obstruction of the air flow in the respiratory tracts may vary as well (6, 7).
A sudden exacerbation of asthma is a life-threatening event. At the same time, it is one of the justified causes of calling the emergency medical units. Bronchial asthma exacerbation may depend on many factors. Some of them are allergens and higher incidence of other respiratory diseases, including infections. This led us to conduct this research that focuses on the demographic factors and the seasonality of interventions to patients with sudden asthma exacerbation. We would also like to point out to physical symptoms in patients with sudden asthma exacerbation. According to the available sources, in case of a life-threatening event, the organism is expected to gradually centralize blood circulation, which usually makes skin pale and sweaty (8-12).
The assessment of the frequency of bronchial asthma incidence in the population under research in the years 2015-2016. There is a special focus on the characteristic features of the group, the physical symptoms of the patients, and the actions taken by the emergency medical units in question.
Material and methods
The retrospective analysis has covered dispatch order forms and emergency medical procedure forms of the Voivodeship Rescue Service in Katowice in the years 2015-2016 (n = 479 872). The number of forms being subject to research has been limited only to cases with a diagnosed bronchial asthma (J45 and J46 in ICD-10). Taken into account the above mentioned criteria, there have been 2879 dispatch order forms included in the research (tab. 1).
Tab. 1. Criteria of inclusion
|Number of dispatch cases in the years 2015-2016|
n = 479 782
|Number of other cases managed by the units n = 476 903||Diagnosed bronchial asthma n = 2879|
All calculations have been prepared in the IBM SPSS 24.0. software. Contingency tables and chi-squared tests have been performed to estimate the relationships between the specific qualitative variables. In the case of comparing and contrasting the groups with regard to quantitative variables, the conformity of distributions to the normal distribution has been assessed by means of the Kolmogorov-Smirnov test. Non-parametric methods have been applied because of discrepancies between the distributions and the normal distribution. In order to evaluate the significance of discrepancies, the Mann-Whitney test has been applied. A graph has been prepared in the cases of significant results. P < 0.05 values have been assumed statistically significant.
The Voivodeship Rescue Service in Katowice is the largest public emergency medical dispatch center in Poland. It provides services to 2.7 million people and manages 85 emergency medical units of the system of Emergency Medical Services (EMS).
The research could be conducted upon receiving a written consent of the CEO of the Voivodeship Rescue Service in Katowice. There has been a detailed analysis of the demographic data of cases with diagnosed bronchial asthma, i.e. sex, age, place and type of event as well as the region of the area. The conversations between emergency medical dispatchers and witnesses have been analysed with a special focus on the main reason and the emergency priority code of the call. The cases have been divided into two groups: the group with a specialized emergency medical unit, and the group with a basic emergency medical unit dealing with the case. Actions taken by the members of the specific units have been reviewed on the basis of the emergency medical procedure forms to check the type of the applied emergency medical procedures.
In the years 2015-2016, there were app. 1.3 million calls reported in the area of Katowice, Jastrzębie-Zdrój and Gliwice (three integrated dispatch centers of the Voivodeship Rescue Service in Katowice – VRS). At the same time, there were 479 782 dispatched units in this area. 2879 of them were related to diagnosed bronchial asthma (0.6%). To be more specific, most of the cases were reported in Katowice (1314 cases – 45.7%), fewer were noted in Gliwice (1082 cases – 37.5%), and the least were registered in Jastrzębie-Zdrój (483 cases – 16.8%). The group includes 1150 (39.8%) male patients and 1729 (60.2%) female patients (fig. 1). There were no statistically significant differences between the specific distributions of sex in the particular dispatch centers (p = 0.218). The bronchial asthma attack rate in the population under research resulted in 53.3/100 000 and was higher in women (32.05/100 000) than in men (21.25/100 000).
Fig. 1. The division of incidents regarding sex
The attack rate increases along with age. The age median of the patients involved in the research was 56.21 years. There were no statistically significant differences between the dispatch centers as far as age is concerned (p = 0.089).
Most of the cases with diagnosed bronchial asthma were in the largest districts of the area manager by the VRS in Katowice. A majority of such incidents was reported in the district of Katowice (387 cases – 13.44%). The least cases were registered in the district of Mysłowice (54 cases – 1.87%) (fig. 2).
Fig. 2. The number of interventions with a division into cities and districts
Bronchial asthma incidents most frequently occurred in the patients’ homes (2213 cases – 79.34%). The second place of occurrence take public places (474 cases – 16.46%). The lowest number of cases was noted in road traffic (2 cases – 0.06%). There have been no statistically significant differences between the specific distributions of sex in the context of the place of incident (p = 0.126). Statistically significant differences in the context of the place of incident have been found as far as age is concerned (p < 0.0005) (tab. 2).
Tab. 2. The statistical analysis of age in the context of various places of incident
|Place of incident||Average||Median||Standard deviation||Minimum||Maximum||N|
|In other public place (including road traffic)||43.88||46.00||24.913||1||93||474|
It was the members of patients’ families who called emergency service most often (1659 cases – 57.62%).
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Płatny dostęp tylko do jednego, POWYŻSZEGO artykułu w Czytelni Medycznej
(uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony)
Płatny dostęp do wszystkich zasobów Czytelni Medycznej
1. Bousqet J, Jeffery PK, Busse WW et al.: Asthma. From bronchoconstriction to Airways inflammation and remodelling. Am J Respir Crit Care Med 2000 May; 161(5): 1720-1745.
2. Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention. WHO/NHLBI Workshop Report 2014.
3. Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention. WHO/NHLBI Workshop Report 2011.
4. World Health Organization Fact Sheet Fact sheet No 307: Asthma. 2011.
5. Grzywa-Celińska A, Lachowska-Kotowska P, Prystupa A et al.: Astma i stan astmatyczny w codziennej praktyce lekarskiej. Medycyna Ogólna i Nauki o Zdrowiu 2013; 19(4): 397-402.
6. Nadolny K: Rekomendacje postępowania w ratownictwie medycznym. Wydawnictwo Elamed. Katowice 2015.
7. Blakey JD, Price DB, Pizzichini E et al.: Identifying Risk of Future Asthma Attacks Using UK Medical Record Data: A Respiratory Effectiveness Group Initiative. J Allergy Clin Immunol Pract 2016 Dec 22. pii: S2213-2198(16)30564-5. DOI: 10.1016/j.jaip.2016.11.007.
8. Arikoglu T, Akyilmaz E, Yildirim DD et al.: The relation of innate and adaptive immunity with viral-induced acute asthma attacks: Focusing on IP-10 and cathelicidin. Allergol Immunopathol (Madr) 2016; 45(2): 160-168.
9. Gaszyński W: Intensywna terapia i wybrane zagadnienia medycyny ratunkowej. Wyd. Lekarskie PZWL, Warszawa 2010.
10. Jakubaszko J. (red.): Medycyna ratunkowa, Wyd. Elsevier Urban & Partner, Wrocław 2008.
11. Sikorska A, Sikorski M (red.): Badanie kliniczne. Wyd. Czelej, Lublin 2001.
13. Semik-Orzech A, Barczyk A, Pierzchała W: The influence of sensitivity to fungal allergens on the development and course of allergic diseases of the respiratory tract. Pneumonol Alergol Pol 2008; 76(1): 29-36.
14. Murray and Nadel’s textbook of respiratory medicine. 5th ed. Saunders/Elsevier, Philadelphia 2010, s. Chapter 38: 713-897.
15. Żukiewicz-Sobczak W, Sobczak P, Imbor K et al.: Zagrożenia grzybowe w budynkach i w mieszkaniach – wpływ na organizm człowieka. Medycyna Ogólna i Nauki o Zdrowiu 2012; 18(2): 141-146.
16. Kuschnir FC, Gurgel RQ, Solè D et al.: Prevalence of asthma in Brazilian adolescents. Rev Saude Publica 2016 Feb; 50 (suppl. 1): 13. DOI: 10.1590/S01518-8787.2016050006682.
17. Hoonhorst SJ, Lo Tam Loi AT, Koenderman L et al.: Lower corticosteroid skin blanching response is associated with severe COPD. PLoS One 2014 Mar 12; 9(3): e91788. DOI: 10.1371/journal.pone.0091788.
18. Samoliński B, Adam Sybilski A: Importance of allergic rhinitis in a patient with asthma. Post Dermatol Alergol 2010; XXVII(3): 223-229.