Hospital discharge using salbutamol as required after acute attacks of wheeze in children: a service evaluation

Area of Science:

• Pediatrics
• Respiratory Medicine
• Pharmacology

Background:

• Standard UK hospital practice involves discharging children with acute wheeze on a fixed-dose salbutamol (bronchodilator) weaning regimen.
• This approach may lead to overuse of medication and suboptimal management strategies.

Purpose of the Study:

• To evaluate the safety and efficacy of a new practice: administering bronchodilators only as needed (PRN) after 4-hourly assessments for children post-acute wheeze hospitalization.
• To compare this PRN approach with traditional fixed-dose weaning regimes.

Main Methods:

• A multidisciplinary team collaborated with eight families to develop PRN salbutamol guidance for children after hospital treatment for acute wheeze.
• Data on salbutamol usage and reattendance rates were collected and compared to the previous year's cohort using fixed-dose weaning.

Main Results:

• 103 families participated, showing significant reductions in salbutamol use: 73% on day 1, 69% on day 2, and 50% on day 3 compared to the previous regime.
• Families found the PRN advice easy to follow, and there was a trend towards lower reattendance rates within one week.
• Parents who had previously experienced the fixed-dose regime preferred the new PRN approach.

Conclusions:

• Providing information to support as-needed salbutamol use enables parents to safely manage children with acute wheeze at home.
• This PRN strategy results in significantly lower doses of salbutamol compared to standard fixed-dose weaning regimens.
• The findings support a shift in clinical practice towards PRN bronchodilator use for children recovering from acute wheeze.