Management of Acute Asthmatic Exacerbation in Children at Pranangklao Hospital

Abstract

Acute asthmatic exacerbation is one of the most common diseases in childhood; however, the treatments in Thailand are still not fully performed as standard guidelines. The purpose of this research was to study currently practiced management at one of the hospitals in Thailand. The descriptive retrospective study was conducted in 348 pediatric patients, aged 1 - 15, who were diagnosed and treated with acute asthmatic exacerbation in Pranangklao Hospital from March 1, 2019 to February 29, 2020. The study found that, among 348 pediatric asthma patients, 29 % (101 cases) had acute asthmatic exacerbation. The majority of these clinical cases (75 patients, accounted for 74.2 %) were treated at Emergency Department while 16 patients (15.8 %) were admitted. Of these numbers, 22.8 % (23) experienced more than one exacerbation per year. The patients were male 66.3 % (67) and female 33.7 % (34), mean age 7.8 ± 3.3 years  and 36.6 % (37) also had associated diseases. These patients were treated according to the GINA guidelines and the severity was evaluated by several physical examinations listed from the highest to the lowest percentage as follows. The pulmonary auscultation was performed 100 % (101), while 83.2 % (84) were checked for pulse rate, 78.2 % (79) were checked for breathing rate, 74.3 %t (75) did a pulse oximetry, and 20.8 % (21) were evaluated for accessory muscle use. However, the examination of peak flow was not found in any cases. In terms of medication, the use of short-acting bronchodilators, Beta2-agonist, was found in 99 % (100) of them and Anticholinergic bronchodilators were used in 83.3 % (10) of moderate or severe acute asthmatic exacerbation. Additionally, 100 % (101) of these patients had appropriate nebulization time. The systemic corticosteroids was used 56.4 % (57). Supplemented oxygen was given to only 19.2 % (5) of patients. In hospital discharge process, 2.4 %(2) of patients were assessed for their vital signs, symptoms and pulse oximetry before discharged. The oral corticosteroid drugs and asthma control drugs were prescribed for 61.2 %(52) and  35.3 % (30) of patients, respectively. Only 11.8 %(10) was checked method of inhaler correctly and only 7 % (6) received action plan. Lastly, 67 % (57) had follow-up appointments at outpatient departments, whereas 6 % (5) were arranged for checkups at an asthma clinic. These results indicated that pediatric patients with acute exacerbation of asthma at Pranangklao Hospital did not received treatments that fully met the GINA guidelines.