Clinical Outcomes and Associated Factors among Patients with Severe Asthma Exacerbations in a Tertiary Care Hospital

Open Access

Abstract

Background: Severe asthma exacerbations remain an important cause of emergency care, hospitalization, morbidity, and mortality. Identifying factors associated with poor outcomes is essential for early risk stratification and timely management, particularly in resource-limited settings. Objective: To assess the clinical outcomes and identify factors independently associated with poor clinical outcomes among patients with severe asthma exacerbations admitted to a tertiary care hospital in Dhaka, Bangladesh. Methods & Materials: This retrospective observational study was conducted in the Department of Respiratory Medicine, Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh, from June 2024 to May 2025. A total of 160 patients with severe asthma exacerbations were included. Demographic, clinical, precipitating, treatment, and outcome-related data were retrospectively collected from medical records. Categorical variables were expressed as frequency and percentage, and continuous variables as mean ± SD. Associations were assessed using the chi-square test, followed by multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and p<0.05 was considered statistically significant. Results: The mean age was 40 years; 57.5% were female and 64.4% urban residents. Medication non-adherence and recent respiratory infection were present in 39.4% and 43.1%, respectively. At admission, 43.8% had SpO₂ <90% and 75.6% used accessory muscles. Oxygen therapy was required in 88.1%, NIV in 19.4%, mechanical ventilation in 8.8%, and ICU care in 21.9%. Overall, 85.0% improved, while 11.9% had poor outcomes and 2.5% died. Older age, smoking, prolonged asthma, previous exacerbation, non-adherence, infection, low SpO₂, and accessory muscle use predicted poor outcomes. Conclusion: Severe asthma exacerbations were associated with substantial morbidity and mortality. Admission hypoxemia was the strongest predictor of poor clinical outcome, followed by medication non-adherence, previous exacerbation, and accessory muscle use. Early identification of high-risk patients, improved adherence, smoking cessation, and appropriate follow-up may help reduce adverse outcomes.