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Does Good Nebulization Therapy in the Emergency Room Reduce the Need for Hospitalization in Asthmatic Children?
Abdulhadi H Almazroea1, Ahmad H Alharbi2, Bushra A Alawfi1
1Pediatrics, Taibah University, Al-Madinah Al-Munawwarah, SAU.
Insights
Asthma severity significantly impacts emergency room nebulization outcomes in children. Moderate to severe asthma exacerbations greatly increase hospital admission rates compared to mild cases.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Respiratory Care
Background:
- Asthma is a prevalent chronic respiratory condition in Saudi Arabian children, affecting 8-25%.
- Inadequate emergency room (ER) treatment for asthma exacerbations can lead to hospitalization, increasing costs and infection risks.
- Nebulization therapy quality depends on factors like patient position, medication dose, oxygen flow rate, and treatment duration.
Purpose of the Study:
- To investigate factors influencing nebulization therapy in the ER for pediatric asthma.
- To evaluate the relationship between ER nebulization techniques and hospital admission rates for asthmatic children.
Main Methods:
- An observational, cross-sectional study was conducted at Maternity and Children Hospital (MCH) in Medina.
- Data were collected from 289 children (ages 2-14) with asthma exacerbation in the ER from December 2021 to May 2023.
- Patient data were gathered through observation and medical records, analyzed using SPSS version 26.0.
Main Results:
- The study included 289 children, with 64% males and a median age of 4 years.
- Over 83% of patients had mild asthma; 16.3% had moderate to severe asthma.
- 92.4% of patients were discharged, and 76.5% received an appropriate nebulization dose.
Conclusions:
- Asthma exacerbation severity is the primary determinant of hospital admission for pediatric asthma patients.
- Patients with moderate to severe asthma had significantly higher admission rates (44.7%) compared to mild asthma (0.4%).
- Nebulization technique factors like patient position, oxygen flow rate, and medication dose did not show a significant clinical impact on hospitalization rates.
Introduction:
Asthma is a chronic inflammatory disorder characterized by obstruction, hyperresponsiveness, and inflammatory changes in the airways. The overall prevalence of asthma in Saudi Arabian children ranges from 8% to 25%. Studies have shown that children who did not respond adequately to treatment in the emergency room (ER) were admitted to hospital for additional treatment which increased the cost and risk of hospital-acquired infections. The quality of nebulization therapy is influenced by several factors such as the position, dose, oxygen flow rate, and duration of treatment. Objectives: In this study, we aimed to explore factors that affect nebulization therapy in ER and to assess the relation between nebulization technique in ER and hospital admission for asthmatic children, and these aims were achieved over the period from December 2021 to May 2023.
Methodology:
An observational cross-sectional study was conducted in Maternity and Children Hospital (MCH) in Medina at the ER over the period from December 2021 to May 2023 for all children admitted to ER with asthma exacerbation. The sample size used to include patients in the study is 289 calculated using the Openepi website. Data were collected by observation and using medical records of the patients and analyzed using Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA).
Results:
The total number of the sample was 289 children ages between two to 14 years. Sixty-four percent (n=185) reported as their gender as male while 36% (n = 104) as female. The median age of the children was four years old (interquartile range [IQR] = 4), and their median weight was 15 kg (IQR = 8.15). Also, more than 83% of the patients has mild asthma, while 16.3% of the sample were diagnosed with moderate to severe asthma. Besides, 92.4% of the sample was discharged from a hospital, and 76.5% received an appropriate dose of nebulization.
Discussion:
After reviewing the results of the statistical analysis, the main findings were that the severity of asthma exacerbation was the most important factor influencing the outcome. It was found that 0.4% of patients with mild asthma were admitted to the hospital, compared to 44.7% of patients with moderate to severe asthma.
Conclusion:
Our study assessed whether effective nebulization therapy in the ER will reduce the need for hospitalization in asthmatic children and the results indicate that the severity of asthma exacerbation was the most significant factor impacting hospital admission in asthmatic patients and influenced other factors of nebulization therapy. However, the other factors, such as the patient position, oxygen flow rate, and the dose of medications did not show any clinically significant impact on hospitalization rates.
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