Usefulness of chest radiographs in the management of acute asthma in adult asthmatics in a developing country

Piyusha Milani Atapattu, Chemindra Biyanwila, Manamalabaduge Upul Jerard Fernando

Abstract


Chest radiographs are widely available, even in most hospitals in developing countries, and can detect a variety of lung pathologies. When adults are admitted to hospital with acute asthma, chest radiographs are often obtained. Studies on the usefulness of chest radiographs in acute asthma have shown varying results. This study aimed at evaluating the usefulness of chest radiographs in the management of acute asthma in adult asthmatics in a developing country. Plain chest radiographs performed within 24 hours of admission in 115 consecutive adult asthmatic patients (asthma defined by Asthma Education and Prevention programme NIH-1997) admitted to National Hospital of Sri Lanka were reviewed prospectively for one year. The relationship between radiographic findings and clinical findings and leucocyte count were evaluated. Significance was calculated using Fisher exact test. Among 115 participants there were 56 males and 59 females, with mean age of 47.77 years. Chest radiographs were abnormal in 40.9%, the abnormalities including hyperinflation (8.7%), consolidation (15.7%), segmental/greater atelectasis (5.2%), pneumomediastinum (0.9%), features of obstructive lung disease (6.1%), solitary lung nodule (0.9%), and pulmonary edema (3.5%). There was no significant association of abnormal radiographs with leucocytosis (p=0.322), elevated body temperature (p=3.109), and high pulse rate (p=0.157). The incidence of abnormalities on admission chest radiographs in patients with acute asthma was high, though immediate management was influenced in only less than half of the patients with abnormal radiographs. Chest radiographic abnormalities had no significant association with elevated blood leukocyte count, body temperature, and pulse rate.  Using clinical criteria to identify those requiring chest radiographs within the first 24 hours in adults admitted with acute asthma may improve the cost effectiveness of chest radiographs without compromising patient care.


Keywords


Internal Medicine, acute asthma, chest radiograph, developing country

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References


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