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Changes in the treatment of wheezing children in the emergency department
L G Yamamoto1, K A MacPherson, N C Miller
1Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu 96826.
Insights
Pediatric wheezing treatment saw increased hospitalization and use of oxygen saturation measurements, corticosteroids, and inhaled bronchodilators. Theophylline use significantly declined in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Wheezing is a common respiratory symptom in children presenting to emergency departments.
- Understanding treatment trends is crucial for optimizing pediatric respiratory care.
Purpose of the Study:
- To prospectively examine the pharmacologic treatment trends for wheezing children over a four-year period.
- To identify changes in medication use, diagnostic measurements, and hospitalization rates.
Main Methods:
- Prospective observational study of 10,091 wheezing children in a pediatric emergency department (December 1987 - September 1991).
- Analysis of treatment patterns including medication administration, discharge prescriptions, and hospitalization.
Main Results:
- Increasing trends observed in hospitalization rates, oxygen saturation measurements, corticosteroid use, beta-agonist prescriptions, and aerosolized bronchodilator administration.
- Decreasing trends noted in theophylline use and subcutaneous bronchodilator administration.
- No confirmation of increasing patient severity within the studied cohort.
Conclusions:
- The study highlights a shift in pediatric wheezing management towards corticosteroids and inhaled bronchodilators.
- The declining use of theophylline warrants consideration given ongoing literature debate.
- Observed treatment trends reflect evolving clinical practice in pediatric emergency settings.
Abstract:
This study prospectively examined the pharmacologic treatment of all wheezing children presenting to a pediatric emergency department from December 1987 to September 1991 (10,091 cases). There were increasing trends in rate of hospitalization, use of oxygen saturation measurements, use of corticosteroids and beta agents at discharge, and use of aerosolized bronchodilators administered in the emergency department. This cohort shows decreasing trends in use of theophylline and the use of subcutaneous bronchodilators administered in the emergency department. Increasing patient severity could not be confirmed in this cohort. The increase in use of corticosteroids in wheezing children is well supported in the literature. The use of theophylline appears to have significantly declined while there is still some controversy over its recommendations in the literature.