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Reduction of morbidity in asthmatic children given a spacer device
1Division of General Pediatrics (Emergency Medicine), Albert Einstein College of Medicine, Bronx Municipal Hospital Center, NY.
Insights
Providing a spacer device significantly improved asthma symptom resolution and reduced school absenteeism in children treated in an urban emergency department. This simple intervention enhances the well-being of pediatric asthma patients.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Public Health
Background:
- Asthma is a common chronic respiratory disease in children.
- Effective management of asthma exacerbations in emergency departments (EDs) is crucial for improving patient outcomes.
- Noncontinuous care settings, like EDs, present unique challenges for consistent asthma management.
Purpose of the Study:
- To assess if providing a spacer device with a brief demonstration improves asthma symptom resolution in children.
- To evaluate the impact of spacer device use on school attendance.
- To determine if spacer device use reduces unscheduled medical visits for asthma in pediatric ED patients.
Main Methods:
- A randomized controlled trial was conducted in a pediatric emergency department.
- Eighty-four children presenting with asthma were randomized into two groups: spacer device group and control group.
- Follow-up assessments were conducted via telephone at 1 week, and 2, 4, and 6 months post-enrollment.
Main Results:
- The spacer group experienced significantly earlier resolution of wheezing (0 vs. 2 days) and reduced cough days (1 vs. 3 days) at 2 and 4 months.
- Children using spacer devices missed significantly fewer school days (0 vs. 2 days) at 2 and 4 months.
- No significant differences were observed at 1-week and 6-month follow-ups.
Conclusions:
- The use of a spacer device is an effective and efficient intervention for pediatric asthma patients in urban ED settings.
- Spacer devices improve symptom resolution (cough and wheeze) and reduce school absenteeism.
- This intervention can enhance the overall functioning of children with asthma.
Study Objective:
To evaluate whether providing a spacer device and a single, brief demonstration regarding its proper use would result in earlier resolution of asthma symptoms, improved school attendance, and decreased frequency of unscheduled medical visits for asthma among children receiving noncontinuous care in an urban emergency department (ED).
Design:
Randomized controlled trial.
Setting:
Urban hospital pediatric ED.
Participants:
Eighty-four children with the chief complaint of asthma.
Intervention:
Children were enrolled in the ED at the time of an asthma attack and randomly assigned to one of two treatment groups. The spacer group received an inhaled beta-agonist at discharge from the ED with a spacer device. The control group received inhaled or oral beta-agonists without a spacer device. Both groups received other medications at the discretion of the evaluating physician who was not the interviewer in any case. A baseline questionnaire was completed and follow-up by telephone was done at 1 week, and 2, 4, and 6 months after enrollment.
Measurements And Results:
The spacer group reported significantly earlier resolution of wheezing (0 days vs 2 days, p < 0.01) at the 2- and 4-month follow-up assessments. They reported significantly fewer days of cough after an asthma attack at 2 months (1 day vs 3 days, p < 0.01) and 4 months (0 days vs 3 days, p < 0.01). The spacer group missed significantly fewer days of school following an asthma attack at 2 and 4 months (0 days vs 2 days, p = 0.05). There was no difference between the two groups on any outcome measures at the 1-week and 6-month follow-up assessments.
Conclusions:
Introducing a spacer device to patients in a busy, inner-city pediatric ED is an effective and efficient intervention that improves the functioning of asthmatic children in terms of resolution of cough and wheeze and school absenteeism.