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Multicenter study of chronic asthma severity among emergency department patients with acute asthma
Marion R Sills1, Adit A Ginde, Sunday Clark
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
A high prevalence of persistent asthma was found in children visiting the emergency department (ED) for acute asthma. This supports initiating inhaled corticosteroids (ICS) controller therapy in the ED for better asthma management.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Asthma Management
Background:
- Asthma controller therapy initiation is guided by chronic asthma severity.
- Inhaled corticosteroids (ICS) are the preferred controller therapy for asthma.
- Emergency department (ED) visits for acute asthma present an opportunity for initiating controller therapy.
Purpose of the Study:
- To describe the chronic asthma severity distribution among children presenting to the ED with acute asthma.
- To inform the initiation of inhaled corticosteroids (ICS) in the emergency department (ED) setting.
Main Methods:
- Prospective enrollment of 311 children aged 2–17 years across 14 U.S. sites presenting to the ED with acute asthma.
- Chronic asthma severity categorized into intermittent, mild persistent, moderate persistent, or severe persistent based on daytime symptoms, nighttime symptoms, and medication usage.
- Analysis of demographic data, primary care provider status, and past year asthma-related outcomes.
Main Results:
- 82% of children presenting to the ED with acute asthma had persistent asthma (37% mild, 24% moderate, 20% severe).
- Children with persistent asthma reported more moderate-severe symptoms, poorer control, and higher past-year ED visit rates compared to those with intermittent asthma.
- Inhaled corticosteroid (ICS) prescription rates at discharge were low (12% overall) but higher for children with persistent asthma (24% vs. 4%).
Conclusions:
- The prevalence of persistent asthma among children in the ED for acute exacerbations is higher than previously reported.
- Findings support the guideline-recommended initiation of inhaled corticosteroids (ICS) in the ED for children with persistent asthma.
- Optimizing controller therapy initiation in the ED can improve long-term asthma control for pediatric patients.
Objective:
The initiation of controller therapy for asthma depends on chronic asthma severity. To facilitate initiation of inhaled corticosteroids (ICSs), the preferred controller therapy, in the emergency department (ED), the objective of the study was to describe chronic asthma severity, as defined by the national asthma guidelines, among children presenting to the ED with acute asthma.
Methods:
Investigators at 14 U.S. sites prospectively enrolled consecutive children 2–17 years presenting to the ED with acute asthma. Three factors (daytime symptoms, nighttime symptoms, and medication usage) were used to categorize children into four chronic asthma severity groups: intermittent, mild persistent, moderate persistent or severe persistent.
Results:
This multistate cohort of 311 children had a mean age of 7.7 years, was 51% Black, and 89% had a primary care provider (PCP). Regarding chronic severity, 18% were intermittent and 82% persistent: 37% mild persistent, 24% moderate persistent, and 20% severe persistent. Chronic severity groups did not differ by demographics or PCP status. Patients with persistent asthma were more likely to report moderate-severe asthma symptoms (58% versus 19%; p < .001), poor asthma control (2% versus 18%; p = .002), and more ED visits (median, 2 versus 1; p < .001) in the past year. The groups did not differ in acute asthma severity, ED treatment, or admission rate. Rate of discharge prescription for ICSs was low, albeit higher among children with persistent asthma (24% versus 4%; p = .003).
Conclusions:
The high prevalence of persistent asthma among ED patients exceeds the prevalence reported previously, and supports ED initiation of ICS, as recommended by national guidelines.
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