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Relapse following emergency treatment for acute asthma: can it be predicted or prevented?
1Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Québec, Canada.
Insights
Children with frequent emergency department (ED) visits for asthma attacks are at higher risk of relapse. Oral short-acting theophylline may benefit select patients with minimal airway inflammation.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Asthma exacerbations frequently lead to pediatric emergency department (ED) visits.
- Identifying children at high risk for asthma relapse after ED discharge is crucial for effective management.
- Predictive models can aid in stratifying risk and optimizing post-ED care.
Purpose of the Study:
- To identify risk factors for asthma relapse in children following an emergency department visit.
- To develop and validate a predictive model for asthma relapse within 10 days of ED discharge.
- To explore the potential role of specific asthma medications in preventing relapse.
Main Methods:
- Prospective cohort study of 314 children discharged from a pediatric ED after an asthma attack.
- Data collection included parental surveys on medical history, triggers, and sociodemographics.
- Medical records provided information on attack severity, treatment, and discharge medications.
- Multiple logistic regression was used to develop a predictive model on a test sample (n=211) and validated on a separate sample (n=103).
Main Results:
- 31% of children (96/314) experienced asthma relapse, with most occurring within 24 hours.
- A predictive model identified two key factors for relapse: prior annual ED visits for asthma and the use of oral short-acting theophylline.
- The model demonstrated good predictive performance with 73% sensitivity and 50-53% specificity in both test and validation samples.
Conclusions:
- The number of previous emergency department visits for asthma is a significant predictor of relapse.
- Oral short-acting theophylline may have a role in managing acute asthma in children where inflammation is less prominent.
- The developed predictive model offers a stable tool for identifying children at risk of asthma relapse post-ED discharge.
Abstract:
We prospectively followed 314 children discharged from a children's hospital emergency department (ED) following an asthma attack, to identify risk, factors for relapse, i.e. a second ED visit for asthma within the next 10 days. Parents were surveyed concerning their child's past medical history, drugs received prior to the index visit, triggering factors, physician availability, parental anxiety, and sociodemographic variables. Data on severity of the attack, emergency treatment, response to treatment and drugs prescribed on discharge were extracted from the medical record. Ninety-six of the 314 children (31%) relapsed, most (68%) within 24 hours. Using multiple logistic regression, a predictive model was developed on 211 patients ("test sample"). The best model contained two variables: (1) the number of ED visits for acute asthma in the previous year (odds ratio [OR] = 2.4 for 4 or more vs fewer visits, 95% CI = 1.3-4.4) and (2) the intake of an oral short-acting theophylline preparation during the course of the acute treatment (OR = 0.4, 95% CI = 0.2-0.7). The sensitivity, specificity and positive predictive values of this model for predicting relapse were 73, 53, and 40%, respectively. When applied to a second randomly selected "validation sample" of 103 children, sensitivity was 73%, specificity 50%, and PPV 41%, thus indicating the stability of the model. The model identifies the number of ED visits in the previous year as an important risk factor for relapse. It also suggests that oral short-acting theophylline may still have a role in the treatment of patients in whom the contribution of inflammation to airway obstruction is minimal.