Validity of acute severe asthma criteria in asthmatic patients presenting to the emergency department in Medina Hospitals, Saudi Arabia

Introduction: Bronchial asthma estimated to affect about 15% of the population, Asthmatic episodes can be traumatic given the affected person's trachea constriction hence limiting the amount of air entering the respiratory system. Patient history is key in diagnosing acute severe asthma which includes frequency of visit to the ER, adherence to medication, smoking condition, allergen and irritant exposure and upper respiratory tract infection. An episode of acute severe asthma is considered a medical emergency. Medication given to a patient during an episode of acute severe asthma attack should be done so as soon as possible as some of the medication takes between 6-12 hours before becoming effective. Aim of the study: The aim of this study is to identify the number of asthmatic cases that fit the criteria of acute severe asthma and to verify the applicability of these criteria on asthmatic patients presenting to the emergency department of different hospitals in Medina, Saudi Arabia. Materials and Methods: This study was a prospective descriptive design, where a convenience sample of 50 patients was collected from patients with average age 43.9 +/- 13.7 years. The study was conducted between May 2019 and October 2019, using a data collection sheet to register patient's data. Patients were met at the emergency departments of different governmental hospitals situated in Medina, Saudi Arabia. All patients were subjected to careful history taking and careful clinical examination with stress on heart rate, respiratory rate, O-2 saturation by pulse oximetry, Peak expiratory flow rate measurement as well as laboratory testing were done to all patients. Confidentiality of the information was maintained and the data were analyzed using SPSS version 21. Results: Thirty out of 50 patients (60.0%) had met the criteria for acute severe asthma based on PEF (33% - 50%) while 40% did not meet the criteria for acute severe asthma and considered as having moderate asthma. The most commonly known precipitating factor of asthma was allergens (62%) and about 76% of them were non adherent to bronchodilator inhaler. The mean PEF was 45.5%+/- 9.98 whereas the mean oxygen saturation level was 90.9%+/- 2.78. We also found that PEF was the sole independent significant factor of acute severe asthma based on the regression model (OR=1.224, p-<0.001). Conclusion: 40% of asthmatic patients presented to the emergency departments did not meet the criteria for acute severe asthma and considered as having moderate asthma. During asthma exacerbations, inabilities to talk in full sentence and decrease in PEF are considered as red flag signs of acute severe asthma.