An overview of asthma exacerbation hospital management in Portugal

EvASTHMApt aimed to assess the relation between clinical practice and outcomes of patients’ attending hospital emergency rooms (ER) due to asthma exacerbations (AE) in Portugal. AE management was evaluated in a prospective, multicentric, observational study in 13 ERs with a structured phone interview follow-up (FU) at 30 and 60 days. Results: 237 patients (pts) (65% adults) were included (Oct/16 - Mar/17). Main trigger factor was infection (78%). Previous control medication with steroids (ICS) was used by 57% of pts and 4% were under systemic steroids (SCS). In previous year 52% of adults and 68% of children had AE (47%>2 AE) and 10% and 5% hospitalizations, respectively. Only 18% adults and 22% children has spirometry in previous year. At ER, 74% of pts received SCS and oxygen (O2) rates varied between hospitals (adults:15-75%; children:0-53%). 22% (44 adults; 9 children) were hospitalized, 7% in ICUs, 96% requiring SCS, 90% O2 and 31% had comorbidities, mostly respiratory infection, tracheo-bronchitis and pneumonia. At discharge (ER and hospitalization), 77% pts changed medication, 62% were prescribed with ICS and 46% SCS; 2.5% received no asthma treatment. Around 72% pts completed FU at 30 and 60-days: medical appointment was scheduled in 59%, ⅓ of which within 60 days after discharge. At 30 and 60-days FU, 22% and 26% had AE leading to ER visit in 9% and 8% respectively. Conclusion: Most pts attending ER due to asthma AE had AE in the previous year. Almost ½ were not taking ICS and ¼ had another AE in the 60 days after ER. Improvement areas in asthma care at ER were identified: increase monitoring such spirometry and medication use, as well as point of care increase in ICS treatment (⅓ pts left ER without ICS) and timely medical appointment (59% pts had one in the 60 days FU).