Infective triggers for asthma exacerbations in Malta

<b>Background:</b> Asthma guidelines do not provide guidance on management of infective asthma exacerbations. <b>Aim:</b> The primary aim was to identify whether asthmatics were investigated for possible infective triggers during an exacerbation. The secondary aim was to identify micro-organisms responsible and if these were treated appropriately. <b>Method:</b> The clinical notes of patients discharged with a diagnosis of asthma exacerbation between November 2018 and March 2019 from Mater Dei Hospital, Malta, were reviewed. <b>Results:</b> Our cohort included 245 patients (66.5% female, mean age 58.3±SD21.5 years, mean length of admission 6.4 days). Chest X-ray was performed in 98.8%, of which 7.4% showed consolidation. Sputum cultures were analyzed in 21.6%, of which 28.4% were positive, with Haemophilus influenzae being the most common (11%). Blood cultures were taken in 14.3%, of which 8.6% were positive. Respiratory screen throat swab was performed in 69.4%, of which 55.9% were positive. 81.1% of positive respiratory screens showed a viral cause, most commonly human rhinovirus, influenza A and coronavirus. 31.4% of the total cohort had a confirmed viral infection, while 12.7% of the total had a confirmed bacterial infection. Antibiotics were prescribed in 64.4% and antivirals in 3.7%. When comparing bacterial versus viral triggers, there was no statistical significance in age, white cell count, C-reactive protein and length of admission. <b>Conclusion:</b> Our findings conclude that most patients were thoroughly investigated for infective triggers. Antibiotics may have been overprescribed in those who had an exacerbation that was not triggered by a bacterial infection. This study calls for the development of guidelines on the management of infective asthma exacerbations.