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Implementation of an Institutional Asthma Care Guideline in Hospitalized Children: Effects on Clinical Outcomes and

Supawadee Intusup1, Kanokpan Ruangnapa1, Wanaporn Anuntaseree1

  • 1Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Journal of Asthma and Allergy
|June 22, 2026
PubMed

Insights

Implementing an asthma care guideline improved pediatric asthma treatment timeliness and clinical outcomes. However, this led to increased hospital length of stay and costs, indicating a trade-off in resource utilization.

Area of Science:

  • Pediatric Pulmonology
  • Healthcare Quality Improvement
  • Clinical Guideline Implementation

Background:

  • Acute asthma exacerbations are a significant cause of pediatric hospitalizations.
  • Inconsistent inpatient management of pediatric asthma persists despite existing guidelines.
  • Variability in care may impact clinical outcomes and healthcare resource use.

Purpose of the Study:

  • To assess the effect of an institutional inpatient asthma care guideline on treatment processes.
  • To evaluate the guideline's impact on clinical outcomes in children with asthma.
  • To determine the influence of the guideline on hospitalization costs for pediatric asthma patients.

Main Methods:

  • Retrospective quality improvement cohort study of children (aged 1-15) hospitalized for acute asthma (2016-2024).
  • Patients categorized into pre-implementation, post-implementation, and post-revision phases.
  • Guideline standardized care (bronchodilators, respiratory support, discharge) using Plan-Do-Study-Act cycles.

Main Results:

  • Time to first bronchodilator significantly decreased post-implementation (117 to 70 minutes).
  • Use of nebulized steroids and high-flow nasal cannula increased significantly (P < 0.001).
  • Hospital length of stay and costs increased post-implementation (P = 0.004 and P < 0.001, respectively).

Conclusions:

  • Institutional asthma guidelines improved treatment timeliness and early clinical improvement in children.
  • Guideline implementation was associated with increased hospital length of stay and costs.
  • A trade-off exists between optimizing clinical management and healthcare resource utilization.
Abstract

Keywords:
acute asthmaclinical practice guidelineinpatient managementpediatricpre–post intervention study

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