210 Am J Exp Clin Res, Vol. 4, No. 2, 2017 http://www.ajecr.org American Journal of Experimental and Clinical Research Am J Exp Clin Res 2017;4(2):210-213 Original Article Usefulness of chest radiographs in the management of acute asthma in adult asthmatics in a developing country Piyusha Milani Atapattu 1 *, Chemindra Biyanwila 2 , Manamalabaduge Upul Jerard Fernando 3 1 Department of Physiology, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka 2 Outpatient Department, Provincial General Hospital, Badulla, Sri Lanka 3 Lady Ridgeway Hospital for Children, Dr. Denister De Silva Mawatha, Colombo 08, Sri Lanka 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 : Acute asthma, chest radiograph, developing country Introduction Patients with acute severe asthma require hospital admission for immediate management, as inadequate treatment may lead to respiratory failure, coma and death [1] with up to 8% mortality in admissions to intensive care [2]. Exacerbations of asthma may be triggered by underlying pulmonary pathology [3], with one study reporting 37% with respiratory tract infection [4]. Rate of relapse varies from 7-15% and depends on the aggressiveness of the treatment given [2]. Chest radiographs are widely available, even in most hospitals in developing countries, and can detect a variety of lung pathologies, thus when an adult is admitted to hospital for acute asthma, chest radiographs are often obtained. Chest radiographs may reveal expected findings in asthma, including hyperinflation and prominent perihilar markings, which do not require specific management [5], or more sinister pathologies such as consolidation, pneumothorax, pulmonary edema, pulmonary tuberculosis and lung collapse which necessitate additional specific management in addition to the standard treatment for asthma [5, 9]. Studies on the usefulness of chest radiographs in acute asthma have shown varying results, with some authors recommending admission chest radiographs be obtained for all patients hospitalized with acute asthma [6, 10], whereas other studies suggesting that routine admission chest radiographs are unnecessary [11]. Several studies of chest radiographs in adults have reported that the results of chest radiographs influenced treatment in only 1 to 5 percent of patients [11, 12]. Obtaining unnecessary chest radiographs is costly and exposes the patients to radiation. In addition, facilities such as additional labor and transportation of patient or X-ray machine are required to obtain a radiograph. It is therefore useful to know how important chest radiography is in the management of acute asthma. We reviewed the usefulness ___________________________________________________________ * Corresponding author: Dr. Piyusha Milani Atapattu (piyushaatapattu@yahoo.com).