Management of Asthma Exacerbations in Southeast Asian Tertiary Care

Figures & data

Table 1 Sociodemographic Characteristics of Patients According to Severity of Exacerbations

Characteristics	Total Patients N=172	Patients with Moderate AEBA n=130	Patients with Severe or Life-Threatening AEBA n=42	p-value of Univariate Analysis
Gender, n (%)
Male	56 (32.6)	39 (30.0)	17 (40.5)	0.208
Female	116 (67.4)	91 (70.0)	25 (59.5)
Age, mean ± SD (years)	50.3 ± 19.3	50.0 ± 18.5	51.1 ± 21.8	0.761
Ethnicity, n (%)  Malay	80 (46.6)	55 (42.3)	25 (59.5)	0.267
Indian	62 (36.0)	50 (38.5)	12 (28.6)
Chinese	20 (11.6)	17 (13.1)	3 (7.1)
Others	10 (5.8)	8 (6.2).	2 (4.8)
Smoking status, n (%)
Never smoker	143 (83.1)	111 (85.4)	32 (76.2)	0.107
Current smoker	18 (10.5%)	10 (7.7)	8 (19.0)
Former smoker	11 (6.4%)	9 (6.9)	2 (4.8)
Age of onset, mean ± SD (years)	20.9 ± 17.8	21.2 ± 17.4	19.8 ± 18.9	0.660
Childhood asthma, n (%)
Yes	93 (54.1)	67 (51.5)	26 (61.9)	0.241
No	79 (45.9)	63 (48.5)	16 (38.1)
Family history of asthma, n (%)
Yes	96 (55.8)	69 (53.1)	27 (64.3)	0.203
No	76 (44.2)	61 (46.9)	15 (35.7)
Atopy, n (%)
No	120 (69.8)	97 (74.6)	23 (54.8)	0.015
Yes	52 (30.2)	33 (25.4)	19 (45.2)	Multivariate: 0.096
Co-morbidities, n (%) *
No	63 (36.6)	52 (40.0)	11 (26.2)	0.106
Yes	109 (63.4)	78 (60.0)	31 (73.8)

Note: *List of comorbidities are shown in the supplementary table S1.

Abbreviation: AEBA, acute exacerbation of bronchial asthma.

Table 2 Clinical Characteristics of Patients Prior to Asthma Exacerbation

Characteristics	Total Patients N = 172	Patients with Moderate AEBA n = 130	Patients with Severe or Life-Threatening AEBA n = 42	p-value of Univariate Analysis	p-value of Multivariate Analysis
Daytime symptoms, n (%)					0.997
Yes	124 (72.1)	88 (67.7)	36 (85.7)	0.024
No	48 (27.9)	42 (32.3)	6 (14.3)
Nocturnal symptoms, n (%)
Yes	112 (65.1)	84 (64.6)	28 (66.7)	0.808	-
No	60 (34.9)	46 (35.4)	14 (33.3)
Rescue SABA use, n (%)  Yes  No	122 (70.9) 50 (29.1)	88 (67.7) 42 (32.3)	34 (81.0) 8 (19.0)	0.100	-
Limitation of activity, n (%)
Yes	124 (72.1)	88 (67.7)	36 (85.7)	0.024	0.997
No	48 (27.9)	42 (32.3)	6 (14.3)
Level of asthma control before exacerbation, n (%)					-
Well controlled	11 (6.4)	8 (6.1)	3 (7.2)	0.939
Partially controlled	44 (25.6)	34 (26.2)	10 (23.8)
Uncontrolled	117 (68.0)	88 (67.7)	29 (69.0)
Exacerbations in the previous year, n (%)
No	87 (50.6)	73 (56.2)	14 (33.3)	0.010	0.118
Yes	85 (49.4)	57 (43.8)	28 (66.7)
No. of previous admission for asthma, mean ± SD	3.9 ± 1.4	4.0 ± 1.4	3.6 ± 1.3	0.090	-
No. of previous exacerbations not requiring hospitalizations/year, mean ± SD	1.1 ± 0.9	1.1 ± 0.9	1.4 ± 0.8	0.031	0.211
No. of previous exacerbations requiring hospitalizations/year, mean ± SD	2.0 ± 1.6	1.8 ± 1.3	2.8 ± 1.9	<0.001	0.965
Previous non-invasive ventilation (NIV), n (%)					0.996
No	150 (87.2)	130 (100)	20 (47.6)	<0.001
Yes	22 (12.8)	0 (0)	22 (52.4)
Previous invasive ventilation, n (%)
No	162 (94.2)	128 (98.5)	34 (81.0)	<0.001	0.998
Yes	10 (5.8)	2 (1.5)	8 (19.0)
Pre-bronchodilator FEV1, mean ± SD (% predicted)	61.9 ± 16.1	64.5 ± 15.6	53.6 ± 14.9	<0.001	0.108
Baseline blood eosinophil count, mean ± SD (cell/µL)	238.3 ± 233.8	196.2 ±217.4	368.6 ± 237.4	<0.001	0.001 OR: 1.01 95% CI: 1.00–1.01
Treatment prescribed prior to exacerbation, n (%)				0.003*	0.668
GINA Step 1: As-needed low dose inhaled corticosteroids (ICS)-formoterol	2 (1.2)	2 (1.5)	0 (0)
GINA Step 2: Low dose inhaled ICS or as-needed low dose ICS-formoterol or Leukotriene receptor antagonist (LRTA) only	70 (40.7)	59 (45.4)	11 (26.2)
GINA Step 3: Low dose ICS-long acting beta2-agonist (LABA) or medium dose ICS or low dose ICS with LRTA	2 (1.2)	2 (1.5)	0 (0)
GINA Step 4: Medium dose ICS-LABA or High dose ICS with Tiotropium and LRTA	77 (44.8)	58 (44.6)	19 (45.2)
GINA Step 5: High dose ICS-LABA or add on low dose OCS	21 (12.2)	9 (6.9)	12 (28.6)
Adherence to treatment, n (%)
Yes	108 (62.8)	75 (56.7)	34 (81.0)	0.007	0.036
No	64 (37.2)	55 (43.3)	8 (19.0)		OR: 6.06 95% CI: 1.13 −32.49
Reported main triggers, n (%)
Upper respiratory tract infection	62 (36.0)	52 (40.0)	10 (23.8)	0.006	0.257
Haze	60 (34.9)	34 (26.2)	26 (61.9)		0.195
Reduction in controller treatment	50 (29.1)	44 (33.8)	6 (14.3)

Note: *Comparison between patients in GINA Step 5 versus those in Steps 1–4.

Abbreviation: AEBA, acute exacerbation of bronchial asthma.

Table 3 Clinical Data During Assessment of Exacerbation and Management

	Total Patients, N=172
Oxygen saturation at presentation, mean ± SD (%)	94.2 ± 3.7
PEFR measurement on initial assessment, n (%)
Yes	134 (77.9)
No	38 (22.1)
Arterial blood gas analysis performed, n (%)
Yes	102 (59.3)
No	70 (40.7)
Presence of hypercapnia, n (%)
Yes	40 (23.3)
No	132 (76.7)
Prescription of systemic corticosteroids, n (%)
Yes	172 (100)
No	0
Administration of regular nebulised bronchodilators, n (%)
Yes	172 (100)
No	0
Length of hospital stay, median and range (days)	4 (3–10)
Critical care team review, n (%)
Yes	58 (33.7)
No	114 (66.3)
Admission to intensive care unit (ICU), n (%)
Yes	22 (11.6)
No	150 (88.4)
Of those admitted to ICU, n= 22
Invasive mechanical ventilation, n (%)	5 (25.0)
No invasive mechanical ventilation, n (%)	17 (75.0)
Length of ICU stay, median and range (days)	4 (3–10)
Total hospital stay for ICU admission, median and range (days)	8 (6–16)

Table 4 Discharge Plans

	No. of Patients, N = 172
PEFR before discharge, n (%)
Yes	172 (100)
No	0 (0)
Discharged on ICS therapy, n (%)
Yes	172 (100)
No	0 (0)
Inhaler technique review, n (%)
Yes	120 (69.8)
No	52 (30.2)
Written personal asthma action plan, n (%)
Yes	43 (25)
No	129 (75)

Abbreviation: PEFR, peak expiratory flow rate.