A M Herrera1, P Brand2, G Cavada3, A Koppmann4, M Rivas5, J Mackenney6, H Sepúlveda7, M E Wevar7, L Cruzat7, S Soto8, M A Pérez9, A León9, I Contreras10, C Alvarez11, B Walker11, C Flores12, V Lezana13, C Garrido13, M E Herrera14, A Rojas14, C Andrades15, E Chala16, R A Martínez17, M Vega18, J A Perillán19, H Seguel20, I Przybyzsweski20. 1. Santa María Clinic, Santa María 500, Santiago 7520378, Región Metropolitana, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago 7620001, Región Metropolitana, Chile. Electronic address: amherreragana@gmail.com. 2. Isala Women's and Children's Hospital, Zwolle, The Netherlands. 3. School of Medicine, University of Chile, Santos Dumont 999, Santiago 8380456, Región Metropolitana, Chile. 4. San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago 8360160, Región Metropolitana, Chile; School of Medicine, University of Chile, Santos Dumont 999, Santiago 8380456, Región Metropolitana, Chile. 5. San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago 8360160, Región Metropolitana, Chile. 6. Roberto del Río Hospital, Av Profesor Zañartu 1085, Santiago 8380418, Región Metropolitana, Chile; School of Medicine, University of Chile, Santos Dumont 999, Santiago 8380456, Región Metropolitana, Chile. 7. Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago 7500539, Región Metropolitana, Chile. 8. Concepción Regional Hospital, San Martín 1436, Concepción 4070038, Región del Bío Bío, Chile. 9. Santa María Clinic, Santa María 500, Santiago 7520378, Región Metropolitana, Chile. 10. Padre Hurtado Hospital, Esperanza 2150, Santiago 8880465, Región Metropolitana Chile. 11. Alemana Clinic, Av Vitacura 5951, Santiago 7650568, Región Metropolitana, Chile; School of Medicine, Desarrollo University, Av Las Condes 12496, Santiago 7590943, Región Metropolitana, Chile. 12. Ovalle Hospital, Ariztía Pte. 7, Ovalle 1842054, Región de Coquimbo, Chile. 13. Gustavo Fricke Hospital, Av Alvarez 1532, Viña del Mar 2570017, Región de Valparaíso, Chile. 14. José Joaquín Aguirre Hospital, Santos Dumont 999, Santiago 8380456, Región Metropolitana, Chile. 15. Valdivia Hospital, Coronel Santiago Bueras y Avaria 1003, Valdivia 5090146, Región de los Ríos, Chile. 16. Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Rancagua 2820945, VI Región, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago 7620001, Región Metropolitana, Chile. 17. Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Rancagua 2820945, VI Región, Chile. 18. Leonardo Guzmán Hospital, Veintiuno de Mayo 1310, Antofagasta 1271847, Región de Antofagasta, Chile. 19. San Juan De Dios Hospital, Huérfanos 3255, Santiago 8350488, Región Metropolitana, Chile; School of Medicine, University of Chile, Santos Dumont 999, Santiago 8380456, Región Metropolitana, Chile. 20. San Juan De Dios Hospital, Huérfanos 3255, Santiago 8350488, Región Metropolitana, Chile.
Abstract
BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.
BACKGROUND:Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.
Authors: A M Herrera; P Brand; G Cavada; A Koppmann; M Rivas; J Mackenney; H Sepúlveda; M E Wevar; L Cruzat; S Soto; M A Pérez; A León; I Contreras; C Alvarez; B Walker; C Flores; V Lezana; C Garrido; M E Herrera; A Rojas; C Andrades; E Chala; R A Martínez; M Vega; J A Perillán; H Seguel; I Przybyzsweski Journal: Allergol Immunopathol (Madr) Date: 2018-12-27 Impact factor: 1.667