Wednesday, 6 July 2016

Study finds red flags for asthma patients who need intensive monitoring

A study co-authored by SPHPM biostatistician Catherine Smith on social determinants in asthma-related intensive care unit (ICU) admissions was recently published in Respirology, using data from patients admitted to the Alfred Hospital with acute asthma between 2010 and 2014.

In Australia one in ten people have asthma – that’s around 2.3 million people. A large proportion of asthma deaths occur out of hospital and are associated with psychosocial factors such as illicit substance abuse, mental health problems and social issues.

In this study, researchers wanted to see whether the same characteristics also increase the risk for a patient requiring intensive care admission when they present to emergency departments with acute asthma.

During the study, 482 patients were admitted, 39 of which required intensive care. Of these patients, 26 per cent of those admitted to ICU reported using illicit drugs, compared with just seven per cent of those admitted to the ward.

The study found that patients with illicit drug use were almost four times as likely to require intensive care, and this risk was further increased by preventer therapy non-adherence. Cigarette smokers were also at higher risk. Researchers say that these historical features should be actively sought on admission, and may serve as useful ‘red flags’ to prompt consideration of intensive monitoring.

Senior researcher Dr Eli Dabscheck from the Alfred’s Allergy, Asthma and Clinical Immunology Service and Monash University’s Department of Medicine, said these results will have potentially life-saving implications for asthma sufferers.

“From these findings, we now know that if a patient suffering acute asthma reveals they have been using illicit substances, this should serve as a red flag for more intensive monitoring,” Dr Dabscheck said.

Adjunct Associate Professor Mark Hew from SPHPM, who heads the Alfred’s Allergy, Asthma and Clinical Immunology Service said, “These findings are also important because they identify modifiable risk factors in people with asthma.”

“Doctors reviewing patients with asthma in the community usually check their smoking status. Our study highlights the need to also ask them whether they use illicit substances, and work with them to address these risky behaviours.”

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