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Treat cases of asthma exacerbation as a myocardial infarction

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Modifiable factors optimised by GPs can reduce the socio-economic burden caused by paediatric asthma hospital readmissions.

Hospital readmissions among Australian children with asthma are increasing, according to a recent study published in the Journal of Asthma in June.

The study titled “Modifiable factors associated with paediatric asthma readmissions: a multi-centre linked cohort study”, showed that linked datasets are important for objectively identifying the health services burden of asthma. The datasets, according to the study, confirm the important role of the general practitioner (GP) in the management of paediatric asthma.

The study highlighted gaps in children’s asthma care throughout their care journey such as reviewing their baseline asthma control, inhaler technique and asthma medication, lack of booked follow-up arrangements before discharge, and guideline discordant care.

The study recruited 767 children, aged three to 18 years, who were admitted to three hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma. The primary outcome showed hospital readmission with asthma within 12 months. The secondary outcomes showed returns in the emergency department and the use of oral corticosteroids. Following this, their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices.

The results of the study showed that within 12 months of admission, 263 participants (34.3 per cent) were readmitted to a hospital for asthma with participants between the ages of three to five years accounting for 69.2 per cent of those readmitted. None of the hospital or home environmental factors appeared to be associated with hospital readmissions, however, the study showed that the estimated effect of GP guideline discordant care reported on the odds of readmission was OR 1.57, 95 per cent CI 1.00–2.47, p = 0.05.

Commenting on the study, Dr. Mohammed Zaheeruddin, Specialist Paediatrician, Fakeeh University Hospital, Dubai said, “This study reflects the growing number of paediatric asthma cases in the community which can be related to many modifiable and non-modifiable factors. Paediatric asthma cases have an impact on the daily routine and lifestyle of a child, especially if they keep getting sick and readmitted to hospitals with severe lung attacks.”

In Australia, asthma is a leading cause of paediatric hospital admissions, with the majority considered preventable. The occurrence demonstrates suboptimal control, which has been a strong facilitator of readmission. It is also important to note that hospitalisations are a psychosocial burden on the child and family, as well as an economic burden on the health system.

The 2017 Lancet commission on asthma calls for each asthma exacerbation to be treated as a “lung attack,” similar to a “heart attack,” and to prompt a holistic evaluation of the child’s asthma management including comorbidities, adherence, environmental and psychosocial factors to improve asthma control and prevent future readmissions. With evidence-based and targeted interventions at each hospital admission, readmissions could be reduced.

The study aimed to use hospital and emergency administrative data linked at the level of the child to identify rates of hospital readmission and emergency department re-presentation for asthma within a 12-month period and to estimate the effects of modifiable hospital, general practitioner and home environmental factors on hospital readmission, emergency department presentations and rescue oral corticosteroid use.

Dr. Zaheeruddin explained that GPs can play a strong role in managing the condition and preventing readmissions. “They are the first point of contact in such cases. A GP will need to evaluate the patient in detail, give them a proper treatment plan and most importantly educate with proper counselling of parents and the child,” he said.

“Many readmissions of paediatric asthma cases are due to non-compliance of preventive treatment. As a GP, one needs to counsel parents and the child repeatedly regarding preventive steps of such lung attacks (paediatric asthma exacerbations),” he added.

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Asma Ali Zain is an independent journalist and a regular contributor at Omnia Health.

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