(RxWiki News) Asthma hospitalizations can often be prevented with regular, continuous condition management. However, it's not always easy for kids to manage their asthma.
A recent study suggests that pediatric asthma is poorly managed, often resulting in hospitalization.
The researchers found that only half of the participants followed global guidelines for asthma control. The findings suggest that the other half of the participants could have avoided hospitalization with better asthma management.
"Keep all pediatric asthma appointments."
The lead author of this study was Marina Bianchi, MD, from the Istituto di Ricerche Farmacologiche Mario Negri in the Department of Public Health Laboratory for Mother and Child Health, in Milan, Italy.
The study looked at 183 youths between the ages of 6 and 17 — all of whom were hospitalized for asthma between January 2004 and December 2006. None of them had been hospitalized for asthma in the 24 months prior to the study.
In addition, the participants all received one or more types of anti-asthma therapy 12 months before and/or after hospitalization: an anti-asthma drug prescription, a spirometry test (measures air going in and out of lungs in order to diagnose asthma), and/or a referral to visit a pneumologist (doctor who specializes in lungs and breathing) or an allergologist (doctor who specializes in allergies).
The researchers used administrative databases to compare the medical profiles of the participants with the Global Initiative for Asthma (GINA) guidelines on asthma management and prevention in order to see if the participants' hospitalizations were due to a severe case of asthma or bad asthma management.
GINA maintains that proper condition management means minimal chronic symptoms and no hospitalizations. The guidelines recommend regular doctor appointments where a patient can be evaluated for potential signs of an attack.
The researchers explain that, unlike adults, the most important predictors of a possible attack for pediatric asthma patients are previous hospitalizations, attacks and airflow problems measured by spirometry tests.
During the 12 months prior to hospitalization, the findings showed that 101 participants (55 percent) had received anti-asthma therapy, and 82 (45 percent) had not. Out of the 101 participants who received therapy before hospitalization, only 77 continued to receive therapy in the 12 months after hospitalization.
The researchers found that out of these 77 participants, 39 continued with the same treatment, 20 had their treatment changed without adding any additional medication, and 18 had medication added to their treatment.
Out of the 82 participants who had not received therapy before hospitalization, 64 started treatment during the 12 months after hospitalization.
The researchers also discovered that 126 (69 percent) of the participants had not had a spirometry test and/or a referral to a specialist in the 12 months before hospitalization.
In the 12 months after hospitalization, 72 (39 percent) of the participants received a spirometry test, and 46 (25 percent) of the participants received a referral to a specialist. Combined, the researchers found that these two groups represented only 52 percent of all the study participants.
The researchers then compared the findings to GINA by categorizing the participants into three groups:
- Those who had incomplete therapy both before and after hospitalization
- Those who received therapy after hospitalization
- Those who received therapy before and after hospitalization.
Group 1 was made up of the participants that the researchers believed did not follow the guidelines and represented 44 percent of the hospitalizations. Group 2 was made up of the participants that potentially followed the guidelines and 31 percent of the hospitalizations. Group 3 represented only 24 percent of the hospitalizations and consisted of the participants who researchers confirmed followed the guidelines.
The researchers believe this lack of compliance with asthma guidelines is likely due to inaccurate asthma diagnosis, and/or lack of parental support. In addition, the researchers suggest that many of the hospitalizations in the study could have been prevented through correct management.
The authors noted a few limitations.
First, the researchers did not have information about the care received while hospitalized. Second, the databases only indicated that the participants were hospitalized for asthma and did not include information on an actual asthma diagnosis by a doctor. Third, the study did not consider the whether it was the doctor or patient that did not follow the guidelines.
This study was published online in the October edition of PLOS One.
Funding was provided by Regione Lombardia.
