asthma exacerbation at KNH A cross sectional study Author: Lilian - - PowerPoint PPT Presentation

Response to initial therapy among patients with acute asthma exacerbation at KNH

A cross sectional study

Author: Lilian Okoth Msc.

Co Authors: 1.Wakasiaka Sabina 2.Kirui Angeline 3.Kagema Joan

Background

• Asthma is an important NCD with significant

morbidity in both children and adult population

• Asthma affects about 300 million worldwide
• It is estimated that at least 4 million people

have asthma in Kenya (KAPTLD,2014)

Problem statement

• Asthma is often under diagnosed inadequately

assessed and undertreated in most instances

• Acute exacerbation is a significant issue in the

clinical management of patients with asthma

• Frequency of emergency room visits is an

important indicator in overall control of asthma

Justification

• Treatment response is varied among asthma

patients and optimization is key in the management of acute exacerbation

• No studies have been done to evaluate

response to initial treatment in our emergency setting

Aim /Objective

• To establish response to initial treatment

among adult patients with acute asthma exacerbations visiting emergency care departments in KNH

Materials and methods

• We recruited adult (15 – 60) patients from

emergency departments and asthma clinic visit who presented with acute exacerbation

• Questionnaire was administered in the

treatment room to eligible patients after

• btaining consent

Materials &Methods

• Information on;

Age, sex, occupation , smoking history, level of education, prior bronchodilator use, asthma symptoms and duration of acute symptoms before visiting emergency unit was obtained

• Evaluation of patients was done to include;

respiratory parameters i.e PEF, oxygen saturations, before treatment was initiated

• This was repeated after a cycle of treatment

lasting 20 – 30 minutes

• Height and weight were then obtained to

calculate BMI

• The prevalence of self reported previously

diagnosed diseases – diabetes, hypertension heart conditions, COPD, previous diagnosis of pulmonary TB and allergies was established

• Patients were taken through standard treatment

protocols for acute exacerbations i.e beta2 agonists delivered nebulization or inhalation via MDIs

• The participants were reviewed by clinicians after

each cycle of treatment to assess whether they require repeat treatment. This was selected as best definition of response

• Adequate response as; complete resolution of

respiratory symptoms, stable vital signs, O2 saturation >92%. on room air and PEF >60% of predicted.

• Partial response; minimal resolution of

respiratory symptoms, stable vital signs, O2 saturation >92% on/off oxygen therapy, PEF between 33% and 60% of predicted.

• Poor response; no resolution of symptoms,

signs of fatigue or exhaustion,O2 saturation <92%.

Results

• A total of 89 patients with asthma exacerbations were

recruited

• 66 females (74%) with a mean age of 38.34(SD 10.83)

years, between 16 – 57 yrs

• Majority had mild/moderate exacerbation (57,64%) at

assessment, based on GINA criteria on PEF

• Mean BMI was 26.64 (SD.6.7) and 4 (5%) were current

smokers while 11(12%) were ex smokers.

• The common co morbidities were allergy/acute rhinitis

(n=18,21%) followed by hypertension & COPD(n=13,15%) and others (n=10, 10%)

• Regarding use of reliever medication prior to ED visit,

64(72%) used rescue medications before the ED visit

• 76 (85%) of patients reported having asthma attack

after being in contact with known triggers

• Majority 54,(60.7%) of the respondents’

demonstrated poor response, 14,(15.7%) had partial response while only 19,(21.3%) of the cases responded adequately at 1st treatment cycle

• Regarding symptoms of attack , among the

poor responders wheezing, 38(43%) had chest tightness while 19,(21%) were complaining of shortness of breath/dyspnoea and 17(19%) were observed to had chest in drawing

• PEFR mean was 66.5(SD 9.2), SPO2 mean

96.3% (SD1.62) after receiving initial therapy in 1st cycle

Table 1. clinical characteristics of patients

Variables n(%) or mean + SD Age (years) 38.16 + 10.8 Sex , female 66(74.2) BMI, kg/m2 26.64 +6.7 BMI, > 25kg/m2 40 (56) Smoking history Past smoker 11 (12) Current 4 (5) Co morbidities Allergic rhinitis 18(23) Hypertension 13(14) COPD 12 (14) Baseline pulmonary function tests PEFR (% predicted) > 50% 57 (64) Spo2 > 90 65 (73) Use of inhaler prior to ED visit 64( 72)

• Response was significantly associated with

BMI as patients with normal weight were to demonstrate adequate response as compared to overweight ( p=0.005, AOR 0.005 - .392) consisted with other studies ( Braido etal,2016, golden et al,2006)

Discussion

• Response was not significantly associated with

demographics factors or severity of exacerbation

• r duration of symptoms before presentation.
• BMI was associated with response as patients

with normal weight were likely to demonstrate adequate response as compared to overweight ( p=0.005 AOR 0.005 - .392) consisted with Braido et,al(2016), golden et al (2006)

Conclusion

• Response to initial therapy in acute asthma

was observed to be poor

• BMI is associated with response to therapy in

patients with asthma exacerbation

• There is need for case controlled studies to

identify other risk factors for poor response in acute asthma

Limitations

• Conditions associated with severe

exacerbations such as pneumonia and asthma COPD overlap syndrome were not evaluated in this present study

• Further studies are needed to evaluate risk

factors for poor response and the predictors for future exacerbations in these patients

Implication to practice

• Adequate clinical assessment and identification
• f risk factors to poor response is important ,

particularly to guide on safe discharge and follow up of patients after the emergency rooms visits

Acknowledgements

• The KNH Research & Programs department
• Emergency department , and chest clinic of

KNH.

• My supervisors
• My mentors – Dr. Anne Njuguna

Thank you

God Bless