Most of the children readmitted to hospitals for asthma in Australia were preschoolers.
Asthma hospital readmissions are not just on the rise in children, children are returning to hospital for preventable reasons, according to a recent Australian study.
Asthma is the most common chronic pediatric disease in industrialized countries, affecting approximately 10% of children.
The study, published in the asthma diaryfound that about 1 in 3 children return to hospital for asthma, up from 1 in 5 a decade ago.
The study looked at 767 children, aged 3 to 18, who were admitted to 3 hospitals in Victoria between 2017 and 2018 with a diagnosis of asthma. The researchers used linked administrative databases, electronic medical records and national pharmaceutical data. In addition, caregivers and 277 general practitioners (GPs) responded to surveys regarding the home environment and clinicians’ usual asthma management practices, respectively.
The clinician survey asked about the GP’s pediatric experience and training, their confidence in caring for children with asthma, and routine asthma management. They were also asked to read the case of a patient with persistent asthma symptoms and choose several care options, in line with guidelines from the National Asthma Council Australia.
Factors that may alter the odds of readmission to hospital included:
- Using Asthma Action Plans (AAPs)
- Documented reviews of inhaler technique as well as asthma education
- A scheduled follow-up visit to the hospital before discharge
- Allergy Management Review
- Discharged with asthma medication
- Prescription of controller medications, such as inhaled corticosteroids or leukotriene antagonists
The primary endpoint was readmission for asthma within 12 months; secondary outcomes included emergency department (ED) return for asthma and use of rescue oral corticosteroids.
Of the 767 patients, children, 34.3% were readmitted to hospital for asthma, and the majority of them were aged 3 to 5 years, accounting for 69.2% of readmissions.
Children aged 6 to 11 were the second largest group to be readmitted, followed by adolescents aged 12 to 18.
Of the total number of children, 20.6% were readmitted once and 13.7% had 2 or more readmissions in 12 months. Only 7.6% of the group returned to the emergency room without needing to be admitted.
Although none of the factors associated with hospital or home environments were related to hospital readmissions, the effect of clinicians reporting care that did not conform to clinical guidelines increased the likelihood of readmission (OR, 1.57 95% CI, 1.00-2.47; P= .05).
While most physicians said they provided PAAs and were aware of the guidelines, “more than 40% of GPs reported non-guideline care for questions regarding children with persistent asthma”, wrote the authors.
According to Katherine Chen, PhD, of the Murdoch Children’s Research Institute, more than a third of the children had not had their inhaler technique examined and only about a quarter were prescribed preventative medication or were asked to continue to use it.
Additionally, she said, nearly 75% of patients were discharged from hospital without controller medication and more than 80% did not have a follow-up visit with a booked specialist.
Chen KYH, Chu W, Jones R, et al. Modifiable factors associated with pediatric asthma readmissions: a linked multicenter cohort study. J Asthma. Published online June 24, 2022. doi:10.1080/02770903.2022.2089996