Childhood asthma: proper managements do reduce severity

Asthma is an increasing problem, both in children and adults which is due to an increase in environmental pollution. The current management of asthmatic patients is different from the previous decade as more understanding of the mechanism of asthma pathology is known.

To study the prevalence of hospitalized asthmatic patients of different age groups in the past decade and to compare the results of different treatments during each 5-year period, 1986-1990, 1991-1995 and 1997-2001.

A retrospective review of the Out-patient Department (OPD) and In-patient Department (IPD) cases of asthma patients, sorted by International Classification of Diseases (ICD 9 & 10) at the Queen Sirikit National Institute of Child Health (QSNICH), previously known as Children's Hospital was carried out. The patients were divided into 3 groups according to the 5-year period of admissions: 1986-1990, 1991-1995 and 1997-2001. Comparison of the prevalence, age distribution, management, severity and outcomes of the patients in different groups using the standard statistical package SPSS for windows.

The prevalence of asthma increased from 7,476 OPD visits in 1986 to the peak of 15,576 visits in 1997 and about 13,000-14,000 stable visits from 1998 through 2001. About 2-3 per cent of these OPD cases were admitted to the hospital. After the hospital charts had been reviewed, 2,927 cases of true asthma cases (81.9%) were studied and they were divided into 3 groups, group 1, 2 and 3 consisting of 1,140, 716 and 1,071 patients, respectively. About 60-80 per cent of the admitted cases were children under 5 years old. With the different management of hospitalized cases between the 3 periods, a significant reduction in the readmission rate was outstanding from 14 per cent to 5 per cent and the maximum number of readmissions was reduced from 8 times to 5 times (the majority was 2 times). The length of stay and the percentage of complicated respiratory failure cases were not different.

The asthma prevalence is increasing. Young children 0-2 years of age tend to have more severe diseases that need hospitalization. Current management, inhaled beta 2 agonists, together with anti-inflammatory drugs do reduce asthma severity to a certain degree. Early intervention of controller medications and regular follow-up care do reduce the readmissions. Further newer treatment of asthma is required for better outcomes of these asthmatic patients.