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Inadequate asthma treatment practices and noncompliance in Israel
Gideon Eshel1, Ravit Raviv, Ron Ben-Abraham
1Pediatric ICU, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. fredericag@asaf.health.gov.il
Insights
Many children with severe asthma are not receiving recommended maintenance treatment, leading to frequent hospitalizations. Improved adherence and education are crucial for better asthma management in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Critical Care Medicine
Background:
- Childhood asthma morbidity and mortality remain a significant concern despite therapeutic advancements.
- Recent guideline changes have reduced pediatric intensive care unit (PICU) admissions for severe asthma.
- The Israeli healthcare system provides comprehensive medical services nationwide.
Purpose of the Study:
- To evaluate preventive and acute asthma treatment in children admitted to PICUs.
- To identify areas for improvement in asthma care for severe cases.
- To analyze admission and readmission rates for pediatric asthma exacerbations.
Main Methods:
- A 5-year retrospective chart audit of acute asthma admissions in two general community hospital PICUs.
- Evaluation of prehospitalization preventive management and acute treatment prior to PICU admission.
- Recording of patient admission and readmission numbers.
Main Results:
- Only 3% of index admissions were the first asthma episode; 25% of patients required readmission, with 15% to the PICU.
- Despite a history of exacerbations, only 60% received continuous treatment, and 29% had discontinued it.
- Inhaled corticosteroids were underutilized (<33%), with beta-2 agonists being the primary maintenance therapy.
Conclusions:
- A significant proportion of children with severe asthma receive suboptimal maintenance treatment due to poor compliance, lack of education, or inadequate healthcare.
- This likely contributes to preventable asthma exacerbations and unnecessary PICU utilization.
- Implementation of recommended guidelines and educational programs is essential to improve pediatric asthma care.
Abstract:
Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. The changes over the past decade in the guidelines for treatment of children with severe asthma have led to a reduction in admissions and readmissions to the pediatric intensive care unit (PICU). The Israeli medical infrastructure is exemplary in its capability of extending appropriate medical services to its entire population. Our objective was to look at the background of preventive maintenance treatment and treatment during an acute episode in children admitted to PICUs with severe asthma, and to identify areas that could be targeted for change. A 5-year retrospective chart audit on acute asthma admissions was conducted in two PICUs of general community hospitals representative of the provision of medical care in Israel. The prehospitalization preventive management and acute treatment prior to PICU admission were evaluated, and the number of admissions and readmissions was recorded. The index admission was the first episode of acute asthma for only 3% of the children: 25% of patients required readmission, and 15% of these to the PICU. In spite of a proven history of acute exacerbations of the disease, only 60% were on continuous treatment between attacks, and 29% of them had abruptly discontinued treatment, most of them shortly before the onset of the index attack. Inhaled steroids were used as maintenance and preventive treatment by less than one-third of the children, with the other two-thirds receiving mainly beta-2 agonists drugs. In conclusion, an unacceptably large proportion of asthmatic children do not receive the recommended maintenance and preventive treatment because of poor compliance, lack of education, or insufficient healthcare provision. This has probably led to avoidable recurrences of acute asthma exacerbations and unnecessary use of PICU facilities. These findings suggest that steps for implementing recommended guidelines and an educational program are needed.