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Published on: November 4, 2010
Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations
Suttipong Ittiporn1,2, Kanlaya Prajongdee3
1Division of Allergy and Clinical Immunology, Department of Pediatrics, Buddhasothorn Hospital, Chachoengsao, Thailand.
Insights
Adhering to asthma treatment pathways significantly improves early medication delivery for severe pediatric asthma exacerbations. This adherence nearly halves hospitalization rates, highlighting the pathway
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pathway Implementation
Background:
- Severe asthma exacerbations in children pose a significant burden on healthcare resources.
- Timely and appropriate treatment is crucial for managing pediatric asthma emergencies.
- Standardized treatment pathways aim to optimize care delivery and patient outcomes.
Purpose of the Study:
- To evaluate the association between adherence to a pediatric asthma treatment pathway and hospitalization rates.
- To assess the impact of pathway adherence on the timing of critical interventions for severe asthma exacerbations.
Main Methods:
- Prospective cohort study of 59 Thai children (aged 2-15 years) with severe asthma exacerbations (Buddhasothorn Asthma Severity Score ≥ 8).
- Patients receiving systemic corticosteroids and nebulized short-acting beta-2 agonists with ipratropium bromide were classified as the adherence group.
- Analysis included timing of medication administration, length of stay, and hospitalization rates using multivariable logistic regression.
Main Results:
- Adherence to the pathway was associated with significantly higher rates of corticosteroid (88.6% vs 41.9%) and ipratropium bromide (72.7% vs 12.2%) administration within 1 hour.
- Medication administration was faster in the adherence group, with ipratropium bromide given 31 minutes sooner.
- The hospitalization rate for severe asthma exacerbations was nearly halved in the adherence group (36.4% vs 63.5%).
Conclusions:
- Accurate severity assessment and adherence to the asthma clinical pathway are associated with reduced hospitalizations in pediatric severe asthma exacerbations.
- Implementation of standardized treatment pathways can optimize emergency care for children with severe asthma.
- Early administration of corticosteroids and bronchodilators is a key component of effective asthma management in the emergency department.
Abstract:
Objective: To determine if adherence to an asthma treatment pathway is associated with a decrease in hospitalizations.Methods: A prospective cohort design was conducted of Thai children aged 2-15 years who visited the emergency department with severe asthma exacerbations, defined as a Buddhasothorn Asthma Severity Score ≥ 8. Patients who received systemic corticosteroids and nebulized short-acting beta-2 agonists combined with ipratropium bromides were classified as the adherence group. The timing of steroid and bronchodilator administration, length of hospital stay, and hospitalization rate were examined in relation to adherence to the asthma pathway. Multivariable logistic regression models and adjusted odds ratios were used to assess associations.Results: A total of 118 episodes of asthma exacerbations (EAEs) from 59 participants were included. Patients who adhered to the pathway had a significantly higher rate of systemic corticosteroid administration within 1 h of arrival at triage (88.6% vs. 41.9%, adjusted Odds Ratio: aOR 10.21; 95%CI 3.52-29.62). A higher proportion of the patients who adhered to the pathway also received inhaled ipratropium bromide ≥ 2 doses within 1 h of arrival at triage (72.7% vs. 12.2%, aOR 23.51; 95%CI 7.73-71.54) and it was administered significantly faster by 31 min (5 min vs. 36 min, p < 0.001) compared to non-adherence group. The hospitalization rate was significantly lower by almost half of EAEs for adherence group (36.4% vs. 63.5%, aOR 0.41; 95%CI 0.18-0.93).Conclusions: Accurate assessment of severity and adherence to the clinical pathway can reduce hospitalization in pediatric patients with severe asthma exacerbations.
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