Are acute asthma guidelines being adhered to? A review of practice in a tertiary hospital

Abstract

Background. Asthma is the most common chronic disease of childhood and presents a diagnostic and management dilemma to many healthcare practitioners. The use of guidelines in managing paediatric acute asthma is essential to improve quality of life and reduce morbidity and mortality.

Objective. To review the adherence of medical practitioners to the South African (SA) guideline for the management of acute asthma in children.

Methods. A one-year retrospective chart review was undertaken at the King Edward VIII Hospital in Durban, SA, in 2014. Asthmatic patients younger than 12 years who presented to the paediatric resuscitation unit were included. Demographic data, clinical parameters and the initial management of the asthma exacerbations at presentation were recorded and compared with the recommendation of the SA guideline (2013). Any deviation from the guideline was regarded as a lack of adherence to the protocol.

Results. A total of 39 cases were reviewed, of which 24 (61.5%) were male. The severity of the asthma exacerbation was unclassified in the majority of cases (92.3%). Deviations from the recommended protocol included the administration of supplemental oxygen in 6 cases, chest radiography in 22 cases (56.4%) when it was not indicated and unnecessary antibiotic use in 10 cases (25.6%). All patients received β2 -agonists via an oxygen-driven nebuliser.

Conclusion. Adherence to the current acute asthma guideline was poor in this study setting. Both imaging and antibiotics were used unnecessarily, which are associated with inherent risks of cancer and antibiotic resistance, respectively.