Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations

Abstract

Objective: To determine if adherence to an asthma treatment pathway is associated with a decrease in hospitalizations.

Methods: A prospective cohort design was conducted of Thai children aged 2–15 years who visited the emergency department with severe asthma exacerbations, defined as a Buddhasothorn Asthma Severity Score ≥ 8. Patients who received systemic corticosteroids and nebulized short-acting beta-2 agonists combined with ipratropium bromides were classified as the adherence group. The timing of steroid and bronchodilator administration, length of hospital stay, and hospitalization rate were examined in relation to adherence to the asthma pathway. Multivariable logistic regression models and adjusted odds ratios were used to assess associations.

Results: A total of 118 episodes of asthma exacerbations (EAEs) from 59 participants were included. Patients who adhered to the pathway had a significantly higher rate of systemic corticosteroid administration within 1 h of arrival at triage (88.6% vs. 41.9%, adjusted Odds Ratio: aOR 10.21; 95%CI 3.52–29.62). A higher proportion of the patients who adhered to the pathway also received inhaled ipratropium bromide ≥ 2 doses within 1 h of arrival at triage (72.7% vs. 12.2%, aOR 23.51; 95%CI 7.73–71.54) and it was administered significantly faster by 31 min (5 min vs. 36 min, p < 0.001) compared to non-adherence group. The hospitalization rate was significantly lower by almost half of EAEs for adherence group (36.4% vs. 63.5%, aOR 0.41; 95%CI 0.18–0.93).

Conclusions: Accurate assessment of severity and adherence to the clinical pathway can reduce hospitalization in pediatric patients with severe asthma exacerbations.

Keywords:

• Asthma
• clinical pathway
• emergency department
• hospital admissions
• pediatrics

Acknowledgments

We would like to thank Associate Professor Dusit Sujirarat from Department of Epidemiology, Faculty of Public Health, Mahidol University, Thailand and would also like to thank Dr. Charuwan Manmee from the Department of Research & Technology Assessment, Rajavithi Hospital for comments that greatly improved the manuscript. We acknowledge Miss Julaporn Pooliam from the Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital for statistical analyses. We would like to express special thanks to Mr. Michael Jan Everts from the Clinical Research Center, Faculty of Medicine, Thammasat University for editing the English language in this manuscript.

Disclosure statement

The authors report no conflict of interest to declare. The authors are solely responsible for the content and writing of this article.

Additional information

Funding

The authors received no financial support for the research or authorship of this article.