Hospital management of children with acute asthma exacerbations in Kuwait: adherence to international guidelines.

OBJECTIVES

To evaluate the in-patient management of children with acute exacerbation of bronchial asthma and its adherence to international guidelines.

SUBJECTS AND METHODS

Medical records of 100 consecutive admissions for acute exacerbation of asthma to the paediatric wards at Mubarak Al-Kabeer Hospital, Kuwait, from October through December 1999 were retrieved. Data relevant to asthma symptoms, severity, treatment regimens and discharge plan were collected and evaluated. The mean age of patients was 4.3 years, ranging from 2 to 12 years. Admissions totalled 82 males and 18 females, with hospital stays ranging from 1 to 11 days (mean = 2.6 days).

RESULTS

There were no fatalities. Reported episodes were severe (17%), moderate (11%) and mild (9%); degree of severity was not documented in 63 cases. Pulse, respiratory rate, colour and use of accessory muscles were not documented in 48, 48, 47 and 63% of the patients, respectively. Arterial blood gas was checked in 16 patients and pulse oximetry in 71. Full blood count, serum urea and electrolytes were obtained in 86 patients and chest radiographs in 76. All patients received nebulized salbutamol. However, some received additional medications: ipratropium bromide (79%), steroids (95%), intravenous aminophylline (5%) and antibiotics (43%). Two children were shifted to an intensive care unit, 1 of whom needed intubation. On discharge, there was no documentation of follow-up arrangements, or prophylactic anti-inflammatory drugs or other medications in 52, 81 and 32 patients, respectively.

CONCLUSION

Patient management showed deficits, and documentation was inadequate. Areas of particular concern were assessment of patients, unnecessary investigations and use of antibiotics, and lack of post-discharge planning and prophylaxis with steroids. Adherence to the international guidelines was partial.