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Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a
1Department of Child Health, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, UK.
Insights
A nurse-led asthma home management training program significantly reduced childhood asthma re-admissions from 25% to 8%. This intervention, delivered during hospitalization, empowers families to manage asthma effectively and prevent future attacks.
Area of Science:
- Pediatric Pulmonology
- Health Education
- Evidence-Based Medicine
Background:
- Childhood asthma frequently leads to hospital re-admissions, with over 25% of children readmitted within a year.
- Effective strategies are crucial to mitigate the high rate of pediatric asthma re-hospitalizations.
Purpose of the Study:
- To evaluate the efficacy of a nurse-led asthma home management training program in reducing hospital re-admissions for children with acute asthma.
- To determine if hospital admission is an optimal time for delivering asthma home management education.
Main Methods:
- A prospective randomized controlled trial involving 201 children (aged 2+) admitted with acute asthma.
- Children were assigned to either an intervention group receiving nurse-led training or a control group.
- The training program focused on individualized asthma management plans, including medication guidance and follow-up support.
Main Results:
- The intervention group demonstrated a significant reduction in re-admissions, decreasing from 25% to 8% over a 2-14 month follow-up period (p=0.002).
- No increase in emergency room visits or urgent community asthma treatments was observed in the intervention group.
- Significant improvements in day and night morbidity were noted 3-4 weeks post-discharge for children in the intervention group.
Conclusions:
- A nurse-led asthma home management training program administered during hospitalization is effective in significantly reducing subsequent asthma-related hospital admissions in children.
- Hospitalization presents a critical opportunity for delivering impactful asthma home management education to families.
Background:
Re-admissions to hospital in childhood asthma are common with studies reporting that 25% or more of children will be re-admitted within a year. There is a need for strategies to reduce re-admissions.
Methods:
A prospective randomised control study of an asthma home management training programme was performed in children aged two years or over admitted with acute asthma. Two hundred and one children were randomised at admission to either an intervention group (n = 96) which received the teaching programme or a control group (n = 105). A nurse-led teaching programme used the current attack as a model for the management of future attacks and included discussion, written information, subsequent follow up and telephone advice aimed at developing and reinforcing individualised asthma management plans. Parents were also provided with a course of oral steroids and guidance on when to start them.
Results:
The groups were similar in degree of social deprivation, length of stay, number of previous admissions, acute asthma treatment, and asthma treatment at discharge. Subsequent re-admissions were significantly reduced in the intervention group from 25% to 8% in individual follow up periods that ranged from two to 14 months (chi 2 = 9.63; p = 0.002). This reduction was not accompanied by any increase in subsequent emergency room attendances nor, in the short term, by any increase in urgent community asthma treatment. The intervention group also showed significant reductions in day and night morbidity 3-4 weeks after admission to hospital.
Conclusions:
A nurse-led asthma home management training programme administered during a hospital admission can significantly reduce subsequent admissions to hospital for asthma. Acute hospitalisation may be a particularly effective time to deliver home management training.