Risk for adverse outcomes in asthma: Assess to impress!

Abstract

Background: Asthma is a heterogeneous disease with different severity degrees and several modifiable risk factors that might place the patient at risk for exacerbations. Their adequate management is crucial to achieve disease control. When indicated, the referral to expert advice should be considered.

Aim: Analyze the characteristics of exacerbated asthmatics, namely their risk factors for adverse outcomes, disease severity and strategies for follow-up.

Methods: Retrospective study of asthmatic patients admitted for acute exacerbations in a Pneumology ward of a central university hospital during 2014. GINA 2015 criteria were used to assess disease control.

Results: Most of the 83 admissions were due to infectious exacerbations, with a peak during the winter months, and 67.2% of those had no influenza or pneumococcal vaccination. Median age was 56 years (IR=35), mostly female (72.3%). Comorbidities like overweight (68.6%) and smoking history with COPD overlap (25%) were most noticed. At least one risk factor was present in 89.2% and a significant number (18.1%) had no medical management or chronic medication. From the 24.1% of patients managed in primary care, two thirds were on Step 3 or 4 GINA treatment and had at least one criteria for expert referral. Only a small percentage had a written action plan.

Conclusions: The most noticed comorbidities are modifiable with directed strategies (obesity, smoking habits, vaccination). Several important steps of assessment and management of asthmatic patients suggested by international guidelines were not fulfilled so we conclude that there is a need to raise awareness to a more precise evaluation of asthmatics in order to achieve a better disease control and avoid severe exacerbations.