Asthma exacerbations in the pediatric emergency area: Evaluation and prospects for improvement of pre-hospital care
Main Article Content
Keywords
asthma, asthma exacerbation, children, demographics, risk
Abstract
Introduction: The frequency of visits to emergency department for asthma is a significant public health problem in pediatrics. This study aimed to identify the characteristics of children who visited the pediatric emergency department for asthma exacerbation and evaluated their therapeutic management prior to admission.
Methods: A prospective study was conducted over a 6-month period in the pediatric emergency departments of five hospitals involving children aged 1–16 years admitted to the department with a clinical diagnosis of asthma exacerbation.
Results: In all, 143 patients were enrolled in the study. Asthma episodes were moderate to severe in 69.2% of cases (n = 99). Initial treatment prior to admission to the emergency department was adequate in only 17.5% of cases (n = 25). Hospitalization for more than 24 h occurred in 18.2% (n = 26) patients. In children aged <3 years, viral infection was present in 91.4% cases (n = 64) and exacerbations were more severe in younger patients (P = 0.002) and children belonging to low-income stratum (P = 0.025). Only 17.4% (n = 25) were positive for SARS–CoV-2 (antigen test or polymerase chain reaction test), suggesting that the involvement of traditional respiratory viruses in asthma exacerbation continued even during pandemic. Regarding the pre-hospital care, 70.6% (n = 101) had received prior treatment, but this treatment was inadequate in 53.1% cases (n = 76).
Conclusion: This study showed that asthmatic children and their families had little knowledge about the disease and that physicians must be sufficiently aware of current recommendations for managing asthmatic children. Admission to the emergency department for asthma could be avoided partially by better diagnosis and therapeutic education.
References
2. Asher MI et al. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross–sectional study. Lancet. 2021;398(10311):1569–80. 10.1016/S0140-6736(21)01450-1
3. Ellwood P et al. The Global Asthma Network rationale and methods for Phase I global surveillance: Prevalence, severity, management and risk factors. Eur Respir J. 2017;49(1):1-6. 10.1183/13993003.01605-2016
4. Masoli M et al. The global burden of asthma: Executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469–78. 10.1111/j.1398-9995.2004.00526.x
5. Estela DB et al. Have asthma symptoms in Mexico changed in the past 15 years? Time trends from the International Study of Asthma and Allergies in Childhood to the Global Asthma Network. Allergol Immunopathol (Madr). 2021;49(1):1–10. 10.15586/aei.v49i1.35
6. Del-Rio-Navarro BE et al. The burden of asthma in an inner-city area: A historical review 10 years after Isaac. World Allergy Organ J. 2020;13(1):100092. 10.1016/j.waojou.2019.100092
7. Del-Rio-Navarro BE. Asthma in the region of the Americas. Int J Tuberc Lung Dis. 2022;26(1):43–7.
8. Pozo-Beltran CF et al. Knowledge of asthma: Educational intervention with the 2014 GINA guide in primary care physicians. Rev Alerg Mex. 2016;63(4):358–64. 10.29262/ram.v63i4.196
9. Larenas–Linnemann D et al. MIA 2021, comprehensive asthma management. Guidelines for Mexico. Rev Alerg Mex. 2021;68(Suppl 1):s1–22.
10. Serebrisky D and Wiznia A. Pediatric asthma: A global epidemic. Ann Glob Health. 2019;85(1): 1–6. 10.5334/aogh.2416
11. Lipstein EA, Perrin JM, Kuhlthau KA. School absenteeism, health status, and health care utilization among children with asthma: Associations with parental chronic disease. Pediatrics. 2009;123(1):e60–6. 10.1542/peds.2008-1890
12. Fernandez-Soto JR et al. Asthma: Uso adecuado de dispositivos para inhalacion. Bol Med Hosp Infant Mex. 2019;76(1):5–17. 10.24875/BMHIM.18000127
13. Fischer GB, Camargos PA, Mocelin HT. The burden of asthma in children: A Latin American perspective. Paediatr Respir Rev. 2005;6(1):8–13. 10.1016/j.prrv.2004.11.002
14. Gonzalez-Uribe V et al. Frequency of ADIPOQ 276 and ADIPOQ 45 polymorphisms in obese and eutrophic adolescents with and without asthma and their relationship with serum adiponectin levels. Med Res Arch. 2022;10(9):1-8. 10.18103/mra.v10i9.3121
15. Camp PG et al. Emergency department visits for children with acute asthma: Discharge instructions, parental plans, and follow-through of care––A prospective study. CJEM. 2014;16(6):467–76. 10.1017/S1481803500003481
16. Walsh-Kelly CM et al. Emergency department revisits for pediatric acute asthma exacerbations: Association of factors identified in an emergency department asthma tracking system. Pediatr Emerg Care. 2008;24(8):505–10. 10.1097/PEC.0b013e318180fdcb
17. Haktanir Abul M, Phipatanakul W. Severe asthma in children: Evaluation and management. Allergol Int. 2019;68(2):150–7. 10.1016/j.alit.2018.11.007
18. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention [Internet]. 2021 [cited 2021 Nov 3]. Available from https://ginasthma.org/gina-reports
19. Encuesta Nacional de Ocupación y Empleo (ENOE). Población de 15 años y más de edad. INEGI, agosto de 2022 [Internet]. Trimestres: tercero de 2021 al cuarto de 2022. Available from: www.inegi.gob.mx. Accessed 8 August 2022.
20. Park S, Jung SY, Kwon JW. Sex differences in the association between asthma incidence and modifiable risk factors in Korean middle-aged and older adults: NHIS–HEALS 10-year cohort. BMC Pulm Med. 2019;19(1):248. 10.1186/s12890-019-1023-3
21. Rosychuk RJ et al. Sex differences in outcomes after discharge from Alberta emergency departments for asthma: A large population-based study. J Asthma. 2018;55(8):817–25. 10.1080/02770903.2017.1373805
22. Brigham EL et al. Associations between parental health literacy, use of asthma management plans, and child's asthma control. Clin Pediatr (Phila). 2016;55(2):111–7. 10.1177/0009922815587089
23. Saraya T et al. Epidemiology of virus-induced asthma exacerbations: With special reference to the role of human rhinovirus. Front Microbiol. 2014;5:226. 10.3389/fmicb.2014.00226
24. Sears MR. Epidemiology of asthma exacerbations. J Allergy Clin Immunol. 2008;122(4):662–8. 10.1016/j.jaci.2008.08.003
25. Johnston NW, Sears MR. Asthma exacerbations. 1: Epidemiology. Thorax. 2006;61(8):722–8. 10.1136/thx.2005.045161
26. Girard GA. Poverty and inequity in adolescent health care. Adolesc Med State Art Rev. 2009;20(3):887–99, viii–ix. 10.1542/9781581104578-poverty
27. Callander EJ, Schofield DJ. Effect of asthma on falling into poverty: The overlooked costs of illness. Ann Allergy Asthma Immunol. 2015;114(5):374–8. 10.1016/j.anai.2015.02.017
28. Gottlieb DJ, Beiser AS, O'Connor GT. Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston. Chest. 1995;108(1):28–35. 10.1378/chest.108.1.28
29. Cantu P et al. Downward neighborhood poverty mobility during childhood is associated with child asthma: Evidence from the Geographic Research on Wellbeing (GROW) survey. J Urban Health. 2019. 96(4):558–69. 10.1007/s11524-019-00356-2
30. Volerman A et al. Determinants of asthma knowledge and practices among caregivers of children with moderate-to-severe persistent asthma. Ann Allergy Asthma Immunol. 2021;127(3):392–4. 10.1016/j.anai.2021.06.001
31. Chan M et al. Community-based interventions for childhood asthma using comprehensive approaches: A systematic review and meta-analysis. Allergy Asthma Clin Immunol. 2021;17(1):19. 10.1186/s13223-021-00522-9
32. Khan MS, O'Meara M, Henry RL. Background severity of asthma in children discharged from the emergency department. J Paediatr Child Health. 2003;39(6):432–5. 10.1046/j.1440-1754.2003.00183.x
33. Zemek RL, Bhogal SK, Ducharme FM. Systematic review of randomized controlled trials examining written action plans in children: What is the plan? Arch Pediatr Adolesc Med. 2008;162(2):157–63. 10.1001/archpediatrics.2007.34
34. Pegoraro F et al. Asthma action plans: An international review focused on the pediatric population. Front Pediatr. 2022;10:874935. 10.3389/fped.2022.874935
35. Afolabi T, Fairman KA. Association of asthma exacerbation risk and physician time expenditure with provision of asthma action plans and education for pediatric patients. J Pediatr Pharmacol Ther. 2022;27(3):244–53. 10.5863/1551-6776-27.3.244
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.