title: Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit.
abstract: BACKGROUND
  To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline.
  
  
  METHODS
  We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015.
  
  
  RESULTS
  Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1-3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers.
  
  
  CONCLUSIONS
  The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.
authors.affiliation: Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Olufemi Olumuyiwa
authors.initials: OO
authors.lastname: Desalu
authors.affiliation: Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
authors.forename: Adekunle Olatayo
authors.initials: AO
authors.lastname: Adeoti
authors.affiliation: Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
authors.forename: Olarinde Jeffrey
authors.initials: OJ
authors.lastname: Ogunmola
authors.affiliation: Department of Pharmacology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.
authors.forename: Joseph Olusesan
authors.initials: JO
authors.lastname: Fadare
authors.affiliation: Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
authors.forename: Tolutope Fasanmi
authors.initials: TF
authors.lastname: Kolawole
keywords: Asthma; audit; emergencies; guidelines; management