Background: 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.



中文翻译：

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东南亚三级护理中哮喘急性发作的管理

背景：对东南亚三级医院收治的哮喘急性发作患者的护理进行调查的报道有限。本研究旨在确定 2019 年全球哮喘倡议 (GINA) 指南的遵守程度。方法
：对 2019 年 7 月 1 日至 2019 年 12 月 31 日期间入住马来西亚马来亚大学医学中心 (UMMC) 和吉隆坡班台医院 (PHKL) 的哮喘急性发作患者进行回顾性研究。两个中心均因哮喘入院，近 50% 的患者在前一年出现哮喘恶化。大约 75% 的患者在被问及时认为他们的哮喘得到了控制，尽管他们中的许多人在前一年有过急性加重史。交叉检查时，GINA 定义的哮喘控制水平仍然很低，只有 6.4% 的患者被认为控制良好，而 25.6% 的患者哮喘得到部分控制，68% 的患者哮喘未得到控制。约 72.1% 的患者报告白天症状，65.1% 的患者报告夜间症状，70.9% 的患者需要频繁使用救援吸入器，72.1% 的患者报告在当前哮喘恶化之前活动受到一些限制。根据 GINA 的定义，近四分之一的入院患者出现严重或危及生命的病情加重。这些患者一年内住院次数较多，并且更有可能之前入院时需要无创和有创通气。他们也更有可能接受 GINA 第 5 步治疗，预测 FEV ₁的平均百分比较低，基线血液嗜酸性粒细胞计数较高。多变量分析显示，基线嗜酸性粒细胞计数与严重或危及生命的哮喘发作独立相关（比值比：1.01，95%置信区间：1.00-1.01，p=0.001）。在这项研究中，未能坚持每日控制药物的比例很高（37.2%）。结论：尽管东南亚三级医院哮喘急性发作的管理与国际指南基本一致，但仍有改进的空间。由于患者感知的哮喘控制与指南定义的哮喘控制之间存在显着差异，因此有必要努力提高对不受控制的哮喘危险的认识。