Management of Acute Asthma in Southeast Asian Tertiary Care.

Abstract

Background: There have been limited reports looking into acute asthma care for patients admitted to tertiary hospitals in Southeast Asia. This study aims to determine the extent in which the 2019 Global Initiative for Asthma (GINA) guidelines were being met. It highlights aspects of excellent clinical management and areas requiring improvement. Methods: A cross-sectional prospective study of patients with acute asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1st July 2019 to 31st December 2019. Results: Of 172 patients admitted, 67.4% were females. There was proper documentation of asthma control assessment (100%), baseline controller and reliever medications (100%), peak expiratory flow measurements (78%), and inhaler technique review (69.8%). However, there was poor documentation of written asthma action plans (25%). 51.2% had not been admitted in the previous year. At baseline, 90% of patients had been prescribed inhaled corticosteroid (ICS). However, 40.5% of patients were not compliant with controller medications. Based on the GINA assessment for asthma control, 68% had uncontrolled asthma. While 91.9% of patients had a previous diagnosis of asthma, only 48.8% of patients had objective testing to support the diagnosis. All patients with newly-diagnosed asthma (8.1%) were commenced on a corticosteroid-containing-inhaler. Conclusion: Although acute asthma management in tertiary hospitals in Southeast Asia is relatively congruous with international guidelines, there is room for improvement. As the majority of patients found to have uncontrolled asthma were non-compliant with their controller medications, efforts to increase awareness on the perils of uncontrolled asthma is warranted.