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Asthma: an increasing problem in children?
1Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
Insights
Asthma outpatient visits increased significantly, particularly in young children, but hospital admissions decreased due to improved treatments like aerosolized beta-2 agonists and better patient education. This study analyzed asthma trends and factors influencing admissions in children.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Public Health
Background:
- Asthma is a significant respiratory condition in children, with increasing outpatient visits observed over time.
- Understanding trends in asthma admissions and associated factors is crucial for effective healthcare management.
Purpose of the Study:
- To analyze asthma trends, including nonhospitalized and hospitalized cases, at a major children's hospital.
- To identify factors correlated with asthma admissions and evaluate treatment impacts.
Main Methods:
- Retrospective analysis of asthma outpatient (OPD) visits and inpatient (IPD) cases from 1986-1995.
- Review of 2,312 admission charts to identify true asthma cases and analyze demographic and treatment data.
- Statistical correlation analysis to assess trends and relationships between variables.
Main Results:
- Asthma OPD visits significantly increased, especially in children aged 0-5 years.
- Despite rising OPD visits, age-adjusted asthma admission rates showed a significant decreasing trend.
- Introduction of aerosolized beta-2 agonists and improved patient education correlated with reduced admissions.
Conclusions:
- Asthma prevalence, indicated by OPD visits, is rising in children, particularly the very young.
- Effective interventions, including new therapies and enhanced patient care, can significantly reduce asthma hospitalizations.
- Environmental factors showed a correlation with asthma trends, while family history of allergies did not.
Abstract:
The study of asthma trend, nonhospitalized and hospitalized cases, and factors correlated with asthma admissions were carried out at Queen Sirikit National Institute of Child Health (Children's Hospital) between 1986-1995. Asthma OPD visits had increased significantly (r = 0.9039, p < 0.001). The age distribution of the cases are 0-2, 2-5, 5-10 and > 10 years old group. The number of visits in 0-2 and 2-5 years groups were significantly increased (r = 0.908, p = 0.000, r = 0.904, p = 0.000), while in 5-10 and >10 years old groups were not (r = 0.054, p = 0.137, r = -0.565, p = 0.089). Although the OPD visits were increasing, there was a decreasing trend in the age-adjusted percentage of admissions (r = -0.798, p = 0.006). The percentage of admissions was significantly decreased in 0-2, 2-5, and >10 years old groups (r = -0.881, p = 0.001, r = -0.632, p = 0.05, r = -0.815, p = 0.004, respectively). The correlation with the environment was observed (r = 0.915, p < 0.001). There was no correlation with allergic diseases in the family (r = 0.2825, p = 0.4). The 2,312 admission charts (86.69% of total IPD cases) were reviewed and there were 1,855 cases of true asthma. Almost 70% of cases were in the under-five age group and the male to female ratio was 1.3:1. The increasing trend in steroid use was observed (r = 0.693, p = 0.026), while the use of antibiotics was unchanged (r = 0.068, p = 0.852). The percentage of admissions began to decline in 1989 when the aerosolized beta-2 agonists were introduced in the hospital and declined further in 1991 when increased use of aerosolized therapy and prophylactic drugs was observed. Better patient education and regular follow-up care during the past five years are believed to be one of the major contributions to this reduction in admissions.