A considerable proportion of pediatric patients discharged from an inner-city hospital emergency room after standard treatment for acute asthma had poor short-term outcomes, according to HRSA-supported research published in the June edition of Pediatrics.

The one-year study, titled “Short-term Outcomes After Acute Treatment of Pediatric Asthma,” looked at outcomes among 367 2- to 18-year-olds over a two-week period following ER treatment for acute asthma at the Children’s Hospital of Philadelphia. 

Asthma was defined as a prior doctor’s diagnosis or at least two prior wheezing episodes that required treatment.  The children’s ER treatment followed standard care for acute asthma – frequent use of beta-agonists, a type of bronchial dilator; early use of steroids; and a recommendation for follow-up with a primary asthma care provider within a week.  All children were released from the hospital after treatment.

According to information gathered from caretakers within two weeks after the patient’s ER visit, between 23 percent and 49 percent of the patients had poor outcomes, as defined in one of two ways by the study.

Eighty-five of the 367 patients, or 23 percent, had poor outcomes, defined as at least one of the following:

• a relapse resulting in hospital admission;
• a week or more of wheezing and two weeks or more of coughing; and
• decreased activity persisting at two weeks or missing five or more days of school or daycare.

As many as 180 patients, or 49 percent, showed poor outcome when the definition was broadened to include two weeks or more of coughing or wheezing, decreased activity for at least two weeks, or missing more than two days of school or daycare. 

Researchers concluded that conventional markers of successful ER treatment, such as avoiding hospital admission or relapse, do not adequately describe the outcomes children with acute asthma frequently experience.  They suggest that health care providers consider factors such as persistent wheezing or coughing and missed days of school in evaluating treatment plans and interventions.

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