Kohei Hasegawa1, Jason Ahn2, Mark A Brown3, Valerie G Press4, Susan Gabriel5, Vivian Herrera5, Jane C Bittner2, Carlos A Camargo2. 1. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: khasegawa1@partners.org. 2. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Banner University Medical Center, Tucson, Arizona. 4. The University of Chicago Medicine, Chicago, Illinois. 5. Novartis Pharmaceuticals, East Hanover, New Jersey.
Abstract
BACKGROUND: Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. OBJECTIVE: To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. METHODS: A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. RESULTS: Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. CONCLUSION: In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.
BACKGROUND: Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. OBJECTIVE: To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. METHODS: A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. RESULTS: Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. CONCLUSION: In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.
Authors: Kohei Hasegawa; Yusuke Tsugawa; Sunday Clark; Carly D Eastin; Susan Gabriel; Vivian Herrera; Jane C Bittner; Carlos A Camargo Journal: Chest Date: 2016-04-04 Impact factor: 9.410
Authors: Yoram Elitsur; Terry Sigman; Runa Watkins; Anthony F Porto; Elaine L Leonard Puppa; Elsie J Foglio; Deborah L Preston Journal: Dig Dis Sci Date: 2016-10-24 Impact factor: 3.199
Authors: Shelley A Boeschoten; Annemie L Boehmer; Peter J Merkus; Joost van Rosmalen; Johan C de Jongste; Pieter L A Fraaij; Richard Molenkamp; Sabien G Heisterkamp; Job B van Woensel; Berber Kapitein; Eric G Haarman; Roelie M Wösten-van Asperen; Martin C Kneyber; Joris Lemson; Stan Hartman; Dick A van Waardenburg; Heleen E Bunker-Wiersma; Carole N Brouwer; Bart E van Ewijk; Anneke M Landstra; Mariel Verwaal; Anja A Vaessen-Verberne; Sanne Hammer; Corinne M Buysse; Matthijs de Hoog Journal: ERJ Open Res Date: 2020-08-17
Authors: Shelley A Boeschoten; Corinne M P Buysse; Peter J F M Merkus; Jacob M C van Wijngaarden; Sabien G J Heisterkamp; Johan C de Jongste; Joost van Rosmalen; Suzan C M Cochius-den Otter; Annemie L M Boehmer; Matthijs de Hoog Journal: Pediatr Pulmonol Date: 2018-04-10