Infective triggers for asthma exacerbations in Malta

Abstract

BACKGROUND: Several asthma exacerbations can be triggered by respiratory infections. Asthma guidelines do not provide detailed guidance on management of infective asthma exacerbations. The aims of this study were to identify whether asthmatics were investigated for infective triggers during an exacerbation, to identify micro-organisms responsible, and if these infective exacerbations were treated appropriately.

METHOD: The clinical notes and investigation results of patients discharged with a diagnosis of asthma between November 2018 and March 2019 from Mater Dei Hospital, Malta, were reviewed.

RESULTS: Our cohort included 245 patients of which 66.5% were female. Chest X-ray was performed in 98.8%, of which 7.4% revealed consolidation. Results from respiratory screens via throat swab and sputum cultures were analysed and overall, 46.1% of the total number of patients had asthma exacerbations with an on-going infectious process. 63.7% of these were confirmed to be viral, commonly human rhinovirus and influenza A, while 22.1% had an on-going bacterial infection. Antibiotics were prescribed in 64.5% of the total, and antivirals in 3.7% of all patients including those with no on-going infectious process. When comparing bacterial versus viral triggers, there was no statistical significant difference in age, white cell count and C-reactive protein levels.

CONCLUSION: Most patients in our hospital with an exacerbation of asthma were investigated for infective sources. However, most were prescribed antibiotics, albeit there having been no evidence of a bacterial process. The use of procalcitonin could guide antibiotic prescription needs. This highlights the importance of formal guidelines to ensure judicial antibiotic use while reducing the burden of antibiotic resistance and any potential adverse effects.