Evaluation of asthma management in the acute setting

Asthma prevalence is increasing worldwide and its management continues to be challenging in the acute setting. The aim of this study is to evaluate asthma management in the emergency department in view of the recommended guidelines. A random sample of 72 adult asthmatic patients attending the emergency room in Ribat University Hospital [RUH] was selected. Management of each patient was observed. A questionnaire based on the recommended guidelines was filled [history, examination, use of pulse oximeter, use of peak flow meter/fev1, types of medications used for treatment and mode of discharge] for each patient. All patients [100%] were initially assessed with brief history and clinical examination. Peak expiratory flow rate and oxygen saturation were measured in only 13% and 10% of the patients respectively. All patients received salbutamol by nebulizer whereas only 8 patients received oxygen therapy, with significant relation to asthma severity [P<0.05]. A significant relation was also found between asthma severity and both steroid and antibiotic prescription. More than one fifth of the patients discharged themselves without or against doctor advice, which may be a major cause of relapse. These findings indicate that initial assessment of asthmatic patients in the ER of RUH is mainly subjective and their treatment is not consistent with recommendations of the international guidelines for asthma management, which necessitate the provision of acute asthma management pathway

Non-obstructive patterns of spirometry among obese patients presenting with symptoms and signs of mild to moderate asthma

Asthmatic patients typically show obstructive pattern on spirometry; with positive response to bronchodilators. However, there is paucity of data regarding presentation of obese patients with non-obstructive patterns of spirometry. A sample of 295 known asthmatic patients [74% over-weights or obese and 26% nonobese] was selected from those attending respiratory clinic of Yastabshiron Hospital for follow up. A portable spirometer [All flow, Clement Clarke International, UK] was used for measurement of FEV1, FVC, FEV1/FVC ratio and PEF for each patient. Measurements were carried out on presentation and then 15 minutes following inhalation of 0.5 mg salbutamol using a spacer. Typical obstructive pattern was found in only 17.4% of obese patients, normal pattern in 18.3%, restrictive in 45.9% and combined pattern in 18.3%. The relation between obesity and patterns of spirometry was found to be statistically insignificant [P= 0.808]. Significant proportions of all patterns showed positive reversibility tests [P= 0.000]. It is concluded that all patterns of spirometry are expected in obese patients with mild to moderate asthma. Reversibility tests are highly significant among asthmatic patients, irrespective to their spirometric pattern