Inpatient Childhood Asthma Controller Medication Escalation and Increased Time-to-Readmission

Area of Science:

• Pediatric Pulmonology
• Clinical Pediatrics
• Health Services Research

Background:

• Childhood asthma readmission rates remain a significant public health concern.
• The effectiveness of intensifying asthma therapy during hospitalization in preventing readmissions is not well-established.

Purpose of the Study:

• To investigate the association between escalating asthma medication during hospitalization and the time to asthma readmission in pediatric patients.
• To determine if increased controller therapy impacts readmission risk for childhood asthma exacerbations.

Main Methods:

• Retrospective cohort study including 986 children (ages 5-17) hospitalized for asthma exacerbations between 2021-2023.
• Asthma medication escalation defined as initiation, step-up, or addition of controller medication classes.
• Primary outcome measured was time to readmission for asthma exacerbation.

Main Results:

• Asthma medication was escalated in 33% of patients; 25% were readmitted.
• Escalation of asthma medication was associated with a reduced risk of readmission (Hazard Ratio [HR] = 0.65, P=0.01).
• Reduced readmission risk with escalation was significant when discharged by pulmonary services (HR=0.43) but not hospital medicine (HR=1.05).

Conclusions:

• Inpatient escalation of controller asthma therapy is linked to a decreased hazard of readmission.
• Further research is necessary to establish optimal asthma discharge therapy management strategies.
• Findings suggest a potential benefit of intensified inpatient asthma management for reducing pediatric readmissions.