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SHORT-TERM CLINICAL OUTCOMES OF ACUTE TREATMENT OF CHILDHOOD ASTHMA

SHORT-TERM CLINICAL OUTCOMES OF ACUTE TREATMENT OF CHILDHOOD ASTHMA. Javier Benito-Fernández, MD Director of Paediatric Emergency Department Hospital de Cruces- Bilbao (Spain). Background.

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SHORT-TERM CLINICAL OUTCOMES OF ACUTE TREATMENT OF CHILDHOOD ASTHMA

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  1. SHORT-TERM CLINICAL OUTCOMES OF ACUTE TREATMENT OF CHILDHOOD ASTHMA Javier Benito-Fernández, MD Director of Paediatric Emergency Department Hospital de Cruces- Bilbao (Spain)

  2. Background • Acute asthma exacerbations account for 6% of children’s visits to the ED with 15-20% of patients requiring admission (ED observation unit or hospital ward). • Hospitalization and relapse rates may not to be reliable indicators of true astma morbitiy in children after exacerbations. • Parameters as health-related quality of life, persistence of symptoms or the need of prolonging treatment in the weeks after consultation in ED could be more usefull.

  3. Objectives • To show the overall morbidity and risk factors in children after an asthma exacerbation • To evaluate the factors that may contribute to improving the short-term outcome of children after discharge from an ED visit for acute asthma.

  4. Factors that can affect hospitalization rate • Changes in the criteria of hospitalization admission • Changes in ED treatment • Differences in severity of illness • Acces to the health care system

  5. Number of asthma episodes / year Hospital de Cruces 1996 - 2006

  6. Hospitalization rates for asthma Hospital de Cruces

  7. Hospitalization rates along 2003, 2006 and 2007Hospital de Cruces > 2 years 0 - 2 years

  8. Other parameters of outcome after ED treatment • Persistence of symptoms • Need for prolonging treatment • Absenteeism from school Quality of life

  9. Short-term outcome

  10. Short-term outcome

  11. Maesurement of health-related quality of life -all of the time -most of the time -some of the time -a little of the time -none of the time Gorelick MH, Brousseau DC, Stevens MW. Validity and responsiveness of a brief, asthma-specific quality-of-life instrument in children with acute asthma. Ann Allergy Asthma Immunol. 2004 Jan;92(1):47-51.

  12. Quality of life scores according to 14-days outcomes Gorelick MH, Brousseau DC, Stevens MW. Validity and responsiveness of a brief, asthma-specific quality-of-life instrument in children with acute asthma. Ann Allergy Asthma Immunol. 2004 Jan;92(1):47-51.

  13. Interventions suggested to improve patients outcome • Prolonged ED treatment or short-stay unit care Evans R 3rd. LeBailly S. Gordon KK. Sawyer A. Christoffel KK. Pearce B. Restructuring asthma care in a hospital setting to improve outcomes. Chest. 116(4 Suppl 1):210S-216S, 1999 Oct. • Changes in home care Gorelick MH. Meurer JR. Walsh-Kelly CM. Brousseau DC. Grabowski L. Cohn J. Kuhn EM. Kelly KJ. Emergency department allies: a controlled trial of two emergency department-based follow-up interventions to improve asthma outcomes in children. Pediatrics. 117(4 Pt 2):S127-34, 2006 Apr. • More intensive outpatient follow-up Smith SR. Jaffe DM. Fisher EB Jr. Trinkaus KM. Highstein G. Strunk RC. Improving follow-up for children with asthma after an acute Emergency Department visitJournal of Pediatrics. 145(6):772-7, 2004 Dec.

  14. Factors predicting short-term outcome after ED visit for asthma Benito-Fernandez J, Onis-Gonzalez E, Alvarez-Pitti J, Capape-Zache S, Vazquez-Ronco MA, Mintegi-Raso S. Factors associated with short-term clinical outcomes after acute treatment of asthma in a pediatric emergency department. Pediatr Pulmonol. 2004 Aug;38(2):123-8.

  15. Factors predicting short-term outcome after ED visit for asthma Benito-Fernandez J, Onis-Gonzalez E, Alvarez-Pitti J, Capape-Zache S, Vazquez-Ronco MA, Mintegi-Raso S. Factors associated with short-term clinical outcomes after acute treatment of asthma in a pediatric emergency department. Pediatr Pulmonol. 2004 Aug;38(2):123-8.

  16. Factors predicting short-term outcome after ED visit for asthma Benito-Fernandez J, Onis-Gonzalez E, Alvarez-Pitti J, Capape-Zache S, Vazquez-Ronco MA, Mintegi-Raso S. Factors associated with short-term clinical outcomes after acute treatment of asthma in a pediatric emergency department. Pediatr Pulmonol. 2004 Aug;38(2):123-8.

  17. ED strategies to improve short-term outcome • Early initiation of inhaled corticosteroids in addition to a brief course of oral corticosteroids • Educational interventions in ED (i.e: promote the use of MDI) • Close follow-up “Objective: improve quality of life in children after an asthma exacerbation”

  18. Risk factors for poor outcome Stevens MW, Scribano PV and Gorelick MH. Screening for poor short-term outcome in acute pediatric asthma. Ann Allergy Asthma Immunol. 2007;98:432-439.

  19. In ED scenary: Who patients should be considered to start treatment with inhaled corticosteroids? “Chidren over 2 years old who attend to ED with a moderate-severe asthma reagudization should be prescribed on inhaled corticosteroids added to the standard treatment with beta-agonist and systemic corticosteroids”

  20. Summary • Hospitalization rates are not reliable indicators of true asthma morbitiy in children after exacerbations. • There is evidence of a poor short-term outcome in children after an ED visit for asthma mainly related to a lack of illness control • From ED, educational interventions, early indication of IC and close follow-up seems to be the best strategies to improve patients outcome

  21. Thanks

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