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Published on: April 25, 2016
Systemic glucocorticoid at discharge after hospitalization for pediatric asthma: a prospective pilot study
Srish Sharma1, Mary Jane Underdown2, Taylor Stukes Duffin2
1Wake Forest School of Medicine, Winston-Salem, NC, USA.
Insights
Children discharged without systemic corticosteroids after hospitalization for asthma exacerbation experienced poorer asthma control and more missed school days. This highlights the importance of appropriate post-discharge management for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Research
Background:
- Hospitalization for status asthmaticus indicates severe asthma exacerbation in children.
- Post-discharge management strategies significantly impact long-term asthma control.
- Systemic corticosteroids are a common treatment for acute asthma, but their role at discharge requires further investigation.
Purpose of the Study:
- To investigate the association between systemic corticosteroid prescription at discharge and asthma control in children previously hospitalized for status asthmaticus.
- To evaluate the impact of discharge corticosteroid treatment on missed school days.
Main Methods:
- A prospective observational study included 56 children aged 5-17 years admitted for acute asthma exacerbation.
- Patients were divided into two groups: those prescribed systemic corticosteroids at discharge and those not.
- Asthma control was assessed using the Asthma Control Test (ACT), and missed school days were recorded. Multivariable regression models were used for analysis.
Main Results:
- Patients discharged without systemic corticosteroids were less likely to have received noninvasive ventilation, pulmonology consultation, and continuous albuterol during hospitalization.
- These patients also showed a trend toward shorter hospital stays.
- Discharge without systemic corticosteroids was significantly associated with poorer asthma control (beta = -2.21) and more missed school days (coefficient = 0.87).
Conclusions:
- Children not prescribed systemic corticosteroids upon discharge after hospitalization for asthma exacerbation exhibited worse asthma control and increased school absenteeism.
- Despite potentially less severe inpatient management, these children experienced poorer outcomes post-discharge.
- Findings suggest that systemic corticosteroids at discharge may play a crucial role in optimizing recovery and preventing future exacerbations in pediatric asthma patients.
Objective:
We examined asthma control in children hospitalized for status asthmaticus 7-10 days after discharge with or without an additional prescription for systemic corticosteroids.
Methods:
This was a prospective observational study of patients aged 5-17 years with a documented history of asthma or β-agonist responsive wheezing admitted to the hospital for an acute asthma exacerbation. We compared patients who had any systemic corticosteroid prescribed at discharge with those who were not prescribed systemic corticosteroids at discharge. The primary outcomes were asthma control after discharge, as defined by the Asthma Control Test (ACT), and missed school days, which we modeled with multivariable linear and Poisson regression, respectively.
Results:
A total of 56 patients were included in the study, 29 (52%) received dexamethasone inpatient and then were discharged without additional prescribed systemic corticosteroids. Those without a corticosteroid prescription at discharge were less likely to have received noninvasive ventilation (p = 0.02), pulmonology consultation (p = 0.02), and continuous albuterol (p = 0.01) during hospitalization. These patients also tended toward shorter length of stay (p = 0.07) compared to those receiving systemic corticosteroid prescription at discharge. In multivariable models, being discharged without systemic corticosteroid prescription was associated with poorer asthma control after discharge [beta (95% CI), -2.21 (-2.65 to -1.77)] and more missed school days [coefficient estimate (95% CI), 0.87 (0.07-1.68)].
Conclusions:
After hospitalization for an asthma exacerbation, patients not given systemic corticosteroids at discharge tended to have worse asthma control following discharge despite having less severe disease and requiring less aggressive inpatient management.
Abstract:
Supplemental data for this article can be accessed at publisher's website.
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