Response To Initial Therapy In Acute Asthma Among Patients Attending Kenyatta National Hospital, Emergency Departments

Abstract

Background: Asthma is a chronic inflammatory disease of the airways. It is a globally significant Non Communicable Disease (NCD) affecting persons of all ages but whose prevalence varies widely from one region to another. Treatment of exacerbations involves use of drugs; relievers (bronchodilators) and controllers (anti inflammatory drugs). The preferred mode of administration for most asthma medications is through inhalation via metered dose inhalers (MDI), dry powder inhalers (DPI) and nebulizers. Aim: To describe response to initial therapy in management of acute asthma among patients with exacerbations at the emergency setting (E.R) at Kenyatta national teaching and referral hospital. Materials & Methods: Cross sectional descriptive study in which mixed methods of data collection was adopted. Target population consisted of patients with acute exacerbations of asthma visiting the emergency room and the chest clinic. Sampling was done by Page xv purposive method and participants were evaluated by a clinician at the emergency or clinic visit. Data was collected using structured questionnaires. Findings from physical examination, physiologic and vital parameters were recorded initially. This included height, weight, and assessment of respiratory symptoms, PEF and baseline vitals. This was repeated after every treatment cycle (30 – 60 minutes) until decision was made by clinician to review patient’s management. Informed consent was obtained from eligible participants after verbal introductions and assent from participants who were younger than eighteen years and no parent or guardian refused to give permission for the child to be interviewed. Approval was obtained from KNH/UON Ethics and Research Committee. Data was analyzed using Statistical Packages for Social Sciences (IBM.20). Analysis was by descriptive statistics, determinants were first tested in univariate analysis and then bivariate analysis was done. A p-value [<0.05] was used to characterize statistically significant results. Results: Majority of respondents were females (66, 74%), as compared to males. Mean age was 38.3 +10.83 years (range 16 – 57 yrs). Majority of the respondents (54, 60.7%) demonstrated poor response to initial therapy while only 19 (21.3%) of the subjects demonstrated adequate response. Of clinical characteristics, majority of respondents exhibited symptoms suggestive of asthma exacerbation; coughing in (65, 75%), wheezing in (70, 78.7%), chest tightness in (48, 53.9%) and shortness of breath in (75, 84.3%) of the subjects. More than half of respondents (56%) were reviewed in the E.R while the rest were seen in the chest clinic. The mean BMI for respondents was 26.64 and was found to be significantly associated with response (p =0.005). The mean PEF was 60.8% of predicted value and mean oxygen saturation at 92% (median 95, IQR 89.5 – 97.0) among the subjects at baseline evaluation. The cumulative change in PEF and saturations was significant post therapy (p.000). Response was not significantly associated with demographic characteristics (p > .05), however there was less likelihood of adequate response among the younger patients < 20 years as compared to older age groups but was not found to be statistically significant (AOR = 0.006,CI 0.000 -1.423, P=.067). Likewise respondents without history of shortness of breath and chest tightness at presentation were 7.206 times and 4.477 times more likely to have adequate response as compared to those with history of the same, however no statistical association was observed between response and clinical characteristics (p value .025, .047). Conclusion: Level of response to initial therapy in acute asthma is associated with BMI. This information can be used to support weight reduction strategies in asthma education with the aim of optimization of patient outcomes.