Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit

Abstract

Background:To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline.Patients and Methods:We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015.Results:Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1–3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers.Conclusion:The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.

A Retrospective Audit of Pharmacologic and Non-Pharmacologic Management of Childhood Acute Asthma Exacerbation at Usmanu Danfodiyo University Teaching Hospital, Sokoto: Adherence to Global Treatment Guidelines

“…Larger studies are, however, required to validate our scoring method. Notwithstanding, our findings on total adherence are contrasting to the low adherence reported in previous pediatric ( Adeniyi et al, 2017 ) and adult ( Desalu et al, 2016 ) studies in Nigeria. Low adherence to GINA guidelines had been reported among 59.1% resident doctors managing childhood acute asthma exacerbations in a tertiary hospital in Southeastern Nigeria ( Ayuk et al, 2017a ).…”

“…However, adherence was good to only documentation of presence of trigger factors and moderate to other recommendations for initial asthma assessment. Desalu et al (2016) reported poor documentation of history/physical examinations and smoking status of adult asthma patients in Nigeria compared to moderate adherence to their documentation in our study. A previous study involving 30 children on emergency admission for acute asthma exacerbations in Lagos, Nigeria showed that trigger factors were documented for 26.7% of the patients ( Okoromah et al, 2006 ), which was far lower than the observed 79.8% in our patients.…”

“…A previous study involving 30 children on emergency admission for acute asthma exacerbations in Lagos, Nigeria showed that trigger factors were documented for 26.7% of the patients ( Okoromah et al, 2006 ), which was far lower than the observed 79.8% in our patients. Similarly, a high rate (71.8%) for trigger factors had been documented among adult asthma patients in Nigeria ( Desalu et al, 2016 ).…”

“…Previous studies evaluating physicians’ adherence to asthma treatment guidelines did not use scoring methods ( Zar and Lalloo, 2013 ; Desalu et al, 2016 ; Ayuk et al, 2017a ). Data from such studies should; therefore, be interpreted with caution.…”

“…Earlier studies from Nigeria evaluating clinical management of asthma in children and adults according to the GINA and other international guidelines were questionnaire based and focused on physicians’ knowledge of GINA guidelines, application of the guidelines’ contents in clinical practice, and availability of facilities and resources in tertiary hospitals to support international standards for asthma management ( Desalu et al, 2016 ; Adeniyi et al, 2017 ; Ayuk et al, 2017a ; Chima et al, 2017 ). However, the physicians’ claim of good knowledge of and adherence to the treatment guidelines may not necessarily translate into appropriate implementation of the guidelines in clinical practice.…”