Acute severe asthma at the Port-of-Spain General Hospital, Trinidad

ABSTRACT

We studied attendance for acute asthma at an Accident and Emergency department over a three-month period. Clinical details were recorded for 1248 subjects with an estimated ascertainment rate of 54 percent. Of 1213 subjects with known age, there were 453 (37 percent) aged 0-11 years, 141 (12 percent) aged 12-17 years, and 619 (51 percent) aged 18 years or older. There were 846 (70 percent) Afro-Trinidadian; 751 (62 percent) had previous attacks; and 667 (55 percent) had previous hospital admissions. Indicators of the severity of the attack were recorded as follows; heart rate, 968 (80 percent). respiratory rate, 985 (81 percent), peak flow rate, 495 (41 percent). The patient's usual maintenance treatment included inhaled salbutamol in 767 (63 percent) and inhaled corticosteroid in 286 (24 percent). Inhaled corticosteroids were more often used by patients aged > 18 years or who had previous hospital admissions for asthma. The acute attack was treated with nebulized salbutamol in 1031 (85 percent), nebulized atrovent in 769 (63 percent), intravenous corticosteroids in 268 (22 percent) or oral corticosteroids in 370 (31 percent). Overall corticosteroids were given in the acute attack to 623 (51 percent), corticosteroids were more often given to those > 18 years and those with higher respiratory rates (OR 1.41, 95 percent CI 1.02 yo 1.96). Only 247 (20 percent) had planned follow up arrangements recorded. We conclude that asthma attacks are common and often recurrent. Prophylactic treatment with inhaled corticosteroids may be under-utilized. Acute attacks are mostly treated with bronchodilators. Planned follow-up is not usual. It is possible that morbidity might be reduced through greater use of prophylactic treatment in those with recurrent symptoms.(AU)