Related Experiment Video
Updated: Nov 25, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Hospitalization, Asthma Phenotypes, and Readmission Rates in Pre-school Asthma
Helena Donath1, Sven Kluge1, Georgia Sideri1
1Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany.
Insights
Severe asthma exacerbations are common in preschool children, leading to frequent hospitalizations. Current treatments, including inhaled corticosteroids, did not significantly reduce readmission rates, indicating a need for reevaluation of care strategies for this age group.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Research
Background:
- Preschool children with asthma experience severe exacerbations, emergency visits, and hospital admissions disproportionately more than older children.
- Limited real-world research exists on severe asthma phenotypes and personalized discharge treatments in this young age group.
- Understanding these factors is crucial for improving asthma management in preschoolers.
Purpose of the Study:
- To analyze the distribution of asthma phenotypes in preschool children hospitalized for severe exacerbations.
- To investigate the discharge treatment strategies and their effectiveness in preventing readmissions.
- To identify potential areas for improvement in managing severe asthma in 1-5 year olds.
Main Methods:
- Retrospective analysis of electronic health records for children aged 1-5 years hospitalized with asthma (ICD J45) between 2008 and 2017.
- Defined acute severe asthma exacerbation by dyspnea, oxygen demand, and/or systemic steroid use.
- Analyzed age, gender, hospitalization duration, asthma phenotype, treatment, and 12-month readmission rates.
Main Results:
- Of 572 patients, 205 met criteria for acute severe asthma.
- Asthma phenotypes included allergic (56.1%), eosinophilic (15.2%), and non-allergic (28.7%).
- High readmission rate (20.5%) within 12 months post-discharge was observed, irrespective of phenotype-tailored treatment or eosinophil counts. Treatments included inhaled corticosteroids (ICS), ICS + long-acting beta-agonists (LABA), leukotriene receptor antagonists (LTRA), or salbutamol as needed.
Conclusions:
- Despite current guideline-based therapies (ICS, ICS+LABA, LTRA), the readmission rate for severe asthma exacerbations in preschool children remains high.
- Current asthma care and treatment strategies for this vulnerable population require continuous reevaluation and potential modification.
- Improved management is necessary to better control asthma and prevent hospitalizations in preschool children.
Abstract:
Objective: Children with pre-school asthma suffer disproportionally more often from severe asthma exacerbations with emergency visits and hospital admissions compared to school children. Despite this high disease burden, there are only a few reports looking at this particular severe asthma cohort. Similarly, there is little real-life research on the distribution of asthma phenotypes and personalized treatment at discharge in this age group. Patients and Methods: Retrospective analysis of the electronic charts of all children aged 1-5 years with asthma hospitalizations (ICD J45) at the Frankfurt University between 2008 and 2017. An acute severe asthma exacerbation was defined as dyspnea, oxygen demand, and/or systemic steroid therapy. Age, gender, duration of hospitalization, asthma phenotype, treatment, and readmission rate were analyzed. Results: Of 572 patients, 205 met the definition of acute severe asthma. The phenotypic characterization showed 56.1% had allergic asthma, 15.2% eosinophilic asthma and 28.7% non-allergic asthma. Of these patients, 71.7% were discharged with inhaled corticosteroids (ICS) or ICS + long-acting-beta-agonists (LABA), 15.1% with leukotriene antagonists (LTRA) and 7.3% salbutamol on demand. The rate of emergency presentations (emergency department and readmission) within 12 months after discharge was high (n = 42; 20.5%). No phenotype tailored treatment was detectable. Neither the number of eosinophils (>300/μl) nor the treatment at discharge had an effect on emergency visits and readmission rate. Conclusion: Despite protective therapy with ICS, ICS + LABA, or LTRA, the readmission rate was high. Thus, current care and treatment strategies should be reevaluated continuously, in order to better control asthma in pre-school children and prevent hospitalization.
Related Concept Videos
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:29Asthma-I: Introduction
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:30Asthma-IV: Nursing Management
First, in...