A retrospective review of the management of hospital presentations due to exacerbations of asthma

Abstract

Introduction/Aim Effective asthma management involves addressing educational, environmental, pharmacological, and psychosocial factors, and this also applies to inpatient management of acute exacerbations. Hospital admission provides a good opportunity to clarify a patient's diagnosis and optimise their long term control. Society guidelines recommend that a review of the patient's medications, and inhaler technique, and provision of an action plan, should be performed prior to discharge, and failure to do so may contribute to future risk of exacerbation and fixed airway obstruction. This study aims to evaluate the management of patients with acute asthma presenting to the Gold Coast health service, with particular attention to diagnostic clarification and the evaluation of patient self‐management skills.

Methods A retrospective review of patients presenting to hospitals within the Gold Coast health service, with a diagnosis of an acute asthma exacerbation, from July 2016, to June 2017, was performed.

Results 149 presentations with acute asthma were evaluated (80% female). 47 patients (32%) were managed by a specialist respiratory team, and 102 (68%) were manged by general medicine or emergency medicine. Patients under the care of a respiratory team at the time of discharge were more likely to be objectively evaluated for airflow obstruction via spirometry or peak flow (72% vs 22%; P=<0.001), were more likely to have inhaler technique scrutinised (62% vs 25%; P = <0.001) and their written action plan reviewed (60% vs 28% P = <0.001), and more likely to receive education from a specialised respiratory nurse (57% vs 23%; P = <0.001).

Conclusion Referral of patients presenting to the Gold Coast health service with acute asthma exacerbations to an inpatient respiratory team improved adherence to guideline recommendations regarding inpatient asthma management, including diagnostic clarification and self‐management strategies. The institution of a formal acute asthma management pathway would be expected to improve adherence further.