Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study

Craig, Simon, Powell, Colin V. E., Nixon, Gillian M., Oakley, Ed, Hort, Jason, Armstrong, David S., Ranganathan, Sarath, Kochar, Amit, Wilson, Catherine, George, Shane, Phillips, Natalie, Furyk, Jeremy, Lawton, Ben, Borland, Meredith L., O'Brien, Sharon, Neutze, Jocelyn, Lithgow, Anna, Mitchell, Clare, Watkins, Nick, Brannigan, Domhnall, Wood, Joanna, Gray, Charmaine, Hearps, Stephen, Ramage, Emma, Williams, Amanda, Lew, Jamie, Jones, Leonie, Graudins, Andis, Dalziel, Stuart and Babl, Franz E. 2022. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ Open Respiratory Research 9 (1) , e001137. 10.1136/bmjresp-2021-001137

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Abstract

Rationale Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. Objectives To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. Methods Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). Measurements and main results Of 14 029 children (median age 3 (IQR 1–3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3–63.2 hours) than children without escalation 6.7 hours, IQR 3.5–16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). Conclusions Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	Re-use permitted under CC BY-NC. No commercial re-use. http://creativecommons.org/licenses/by-nc/4.0/
Publisher:	BMJ Publishing Group
ISSN:	2052-4439
Funders:	part funded by a grant from the National Health and Medical Research Council (NHMRC, Centre of Research Excellence grant (GNT1058560)
Date of First Compliant Deposit:	27 April 2022
Date of Acceptance:	27 February 2022
Last Modified:	10 May 2023 03:26
URI:	https://orca.cardiff.ac.uk/id/eprint/149396

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