Management of Asthma Exacerbations in Southeast Asian Tertiary Care

Mau-Ern Poh,1 Sundari Ampikaipakan,2 Chong-Kin Liam,1 Chee-Shee Chai,3 Deventhari Ramanaidoo,1 Helmy Haja Mydin2 1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2The Lung Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 3Department of Medicine, Faculty of Medicine, University Malaysia Sarawak, Sarawak, MalaysiaCorrespondence: Mau-Ern PohDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, MalaysiaTel +603-79494422Email ernestpoh@gmail.comBackground: There have been limited reports looking into the care of patients with asthma exacerbations 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.Methods: A retrospective study of patients with asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1 July 2019 to 31 December 2019.Results: There were significant numbers of patients with previous admissions for asthma in both centres, with almost 50% experiencing an exacerbation in the previous year. Approximately 75% of the patients considered their asthma to be controlled when asked, despite many of them having had a history of acute exacerbations in the previous year. When cross-checked, the level of GINA-defined asthma control remained low, with only 6.4% of the patients deemed to have good control, while asthma was partially controlled in 25.6% of the patients and uncontrolled in 68% of the patients. About 72.1% of the patients reported daytime symptoms, 65.1% of the patients reported night-time symptoms, 70.9% of the patients required frequent usage of rescue inhalers and 72.1% of the patients reported some limitation in their activity prior to the current asthma exacerbation. Almost a quarter of the patients who were admitted had severe or life-threatening exacerbations as defined by GINA. These patients had more hospitalizations in a year and were more likely to have previous admissions requiring non-invasive and invasive ventilation. They were also more likely to be on GINA Step 5 treatment, had a lower mean percent predicted FEV1 and a higher baseline blood eosinophil count. Multivariate analysis revealed that baseline eosinophil count were independently associated with severe or life-threatening asthma exacerbations (odds ratio: 1.01, 95% confidence interval: 1.00– 1.01, p=0.001). Failure to adhere to daily controller medications was high in this study (37.2%).Conclusion: Although the management of asthma exacerbations in tertiary hospitals in Southeast Asia is largely congruous with international guidelines, there is room for improvement. As there is a marked discrepancy between patient-perceived and guideline-defined asthma control, efforts to increase awareness on the dangers of uncontrolled asthma are warranted.Keywords: acute care, Southeast Asia, severe asthma, international guidelines, managemen