Patterns of asthma admissions in children

Admissions for childhood asthma have declined over the past 10 years in the U.K. The reasons for this decline are not known. There are few published data on Irish children. The study was completed in a paediatric unit in a regional general hospital, with a stable urban/rural catchment population of approximately 45,000 children under 15 years. H.I.P.E. data on paediatric asthma admissions were analysed from 1990-2004. A prospective study of all acute asthma admissions of children aged 1-14 years over a 12 -month period was also undertaken, data were compared to a similar study in 1990, and a retrospective study in 1995. The number of admissions rose to a peak in 1995, and there was a large decline in the number of admissions thereafter. The fall was most marked in school age children. The prospective study showed that the treatment of asthma in the community, and in hospital was more aggressive. There were more children diagnosed, and on prophylactic therapy prior to admission. There was greater use of oxygen and nebulised ipratropium in hospital; milder cases were discharged sooner. Subjective assessment of severity of attacks on admission indicated increased severity, but objective measures showed less change. We have shown that the fall in asthma admissions was accompanied by more aggressive management in the community, with little changes in the attack severity in those admitted. The reduction in admissions was most evident in school age children. These data are consistent with the hypothesis that better management of asthma in the community is responsible for the reduction in admissions.