Hospitalizations for Asthma in Children Are Linked to Undertreatment and Insufficient Asthma Education

Abstract

Background. Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. Objectives. The objective of this study was to describe the characteristics of children hospitalized with an asthma exacerbation to identify modifiable factors leading to hospitalization. Methods. The study was conducted in 14 pediatric units and included children 3–17 years of age who were hospitalized for an asthma exacerbation. The present analysis covers 498 children with known asthma. Staff physicians used a standardized questionnaire to collect data. Asthma history came from a parental interview and included usual asthma care, frequency of symptoms and quick-relief medication use in the previous month, frequency of exacerbations and number of unscheduled healthcare visits during the past year, and prior asthma-related hospitalizations. Results. More than half the children had previously been hospitalized for an exacerbation, 42% used continuous inhaled corticosteroids, and 57% had a regular follow-up for asthma. Asthma had been well controlled over the past year for 11%, 12% had experienced exacerbations during the past year but that had been optimally controlled during the previous month, and 11% had recently become poorly controlled (infrequent exacerbations in the previous year and non-optimal control in the previous month). The remaining 327 children (66%) were consistently poorly controlled (non-optimal asthma control in the previous month and frequent exacerbations over the previous year). Among this group, 69% had at least one of the following preventable risk factors for hospitalization: no regular controller therapy (49%), no asthma action plan (40%), or no follow-up for asthma (35%). Conclusions. Two-thirds of the children with asthma hospitalized for an exacerbation had been consistently poorly controlled during the previous year. They were frequently undertreated and insufficiently educated about asthma. Further efforts are needed to improve asthma treatment and education in France.

• asthma
• asthma control
• children
• exacerbation
• hospitalization

Acknowledgments

We thank the clinicians from the pediatrics wards of the hospitals involved in this study (Aubagne, Avignon, Créteil, Dunkerque, Evreux, Le Havre, Lens, Lille (Jeanne de Flandre), Marseille, Martigues, Paris (Necker-Enfants-malades), Poissy-Saint-Germain, Roubaix, Rouen (CHU Charles Nicolle)).