Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit

A multicenter observational study

Kohei Hasegawa, Jason Ahn, Mark A. Brown, Valerie G. Press, Susan Gabriel, Vivian Herrera, Jane C. Bittner, Carlos A. Camargo, Taruna Aurora, Barry Brenner, William Calhoun, John E. Gough, Ravi C. Gutta, Jonathan Heidt, Mehdi Khosravi, Wendy C. Moore, Nee Kofi Mould-Millman, Stephanie Nonas, Richard Nowak, Veronica Pei & 9 others Beatrice D. Probst, Sima K. Ramratnam, Matthew Tallar, Carly Snipes, Suzanne S. Teuber, Stacy A. Trent, Roberto Villarreal, Taketo Watase, Scott Youngquist

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. Objective To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. Methods A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. Results Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. Conclusion In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.

Original languageEnglish (US)
Pages (from-to)10-16.e1
JournalAnnals of Allergy, Asthma and Immunology
Volume115
Issue number1
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Hospitalized Child
Multicenter Studies
Observational Studies
Intensive Care Units
Asthma
Guidelines
Hospitalization
Adrenal Cortex Hormones
Outpatients
Insurance
Medical Records

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit : A multicenter observational study. / Hasegawa, Kohei; Ahn, Jason; Brown, Mark A.; Press, Valerie G.; Gabriel, Susan; Herrera, Vivian; Bittner, Jane C.; Camargo, Carlos A.; Aurora, Taruna; Brenner, Barry; Calhoun, William; Gough, John E.; Gutta, Ravi C.; Heidt, Jonathan; Khosravi, Mehdi; Moore, Wendy C.; Mould-Millman, Nee Kofi; Nonas, Stephanie; Nowak, Richard; Pei, Veronica; Probst, Beatrice D.; Ramratnam, Sima K.; Tallar, Matthew; Snipes, Carly; Teuber, Suzanne S.; Trent, Stacy A.; Villarreal, Roberto; Watase, Taketo; Youngquist, Scott.

In: Annals of Allergy, Asthma and Immunology, Vol. 115, No. 1, 01.07.2015, p. 10-16.e1.

Research output: Contribution to journalArticle

Hasegawa, K, Ahn, J, Brown, MA, Press, VG, Gabriel, S, Herrera, V, Bittner, JC, Camargo, CA, Aurora, T, Brenner, B, Calhoun, W, Gough, JE, Gutta, RC, Heidt, J, Khosravi, M, Moore, WC, Mould-Millman, NK, Nonas, S, Nowak, R, Pei, V, Probst, BD, Ramratnam, SK, Tallar, M, Snipes, C, Teuber, SS, Trent, SA, Villarreal, R, Watase, T & Youngquist, S 2015, 'Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit: A multicenter observational study', Annals of Allergy, Asthma and Immunology, vol. 115, no. 1, pp. 10-16.e1. https://doi.org/10.1016/j.anai.2015.05.004
Hasegawa, Kohei ; Ahn, Jason ; Brown, Mark A. ; Press, Valerie G. ; Gabriel, Susan ; Herrera, Vivian ; Bittner, Jane C. ; Camargo, Carlos A. ; Aurora, Taruna ; Brenner, Barry ; Calhoun, William ; Gough, John E. ; Gutta, Ravi C. ; Heidt, Jonathan ; Khosravi, Mehdi ; Moore, Wendy C. ; Mould-Millman, Nee Kofi ; Nonas, Stephanie ; Nowak, Richard ; Pei, Veronica ; Probst, Beatrice D. ; Ramratnam, Sima K. ; Tallar, Matthew ; Snipes, Carly ; Teuber, Suzanne S. ; Trent, Stacy A. ; Villarreal, Roberto ; Watase, Taketo ; Youngquist, Scott. / Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit : A multicenter observational study. In: Annals of Allergy, Asthma and Immunology. 2015 ; Vol. 115, No. 1. pp. 10-16.e1.
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abstract = "Background Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. Objective To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. Methods A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. Results Among 385 children hospitalized for asthma, 130 (34{\%}) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65{\%} were taking ICSs at the time of index hospitalization, and 19{\%} had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85{\%} were prescribed ICSs. Furthermore, 62{\%} of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. Conclusion In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.",
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T1 - Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit

T2 - A multicenter observational study

AU - Hasegawa, Kohei

AU - Ahn, Jason

AU - Brown, Mark A.

AU - Press, Valerie G.

AU - Gabriel, Susan

AU - Herrera, Vivian

AU - Bittner, Jane C.

AU - Camargo, Carlos A.

AU - Aurora, Taruna

AU - Brenner, Barry

AU - Calhoun, William

AU - Gough, John E.

AU - Gutta, Ravi C.

AU - Heidt, Jonathan

AU - Khosravi, Mehdi

AU - Moore, Wendy C.

AU - Mould-Millman, Nee Kofi

AU - Nonas, Stephanie

AU - Nowak, Richard

AU - Pei, Veronica

AU - Probst, Beatrice D.

AU - Ramratnam, Sima K.

AU - Tallar, Matthew

AU - Snipes, Carly

AU - Teuber, Suzanne S.

AU - Trent, Stacy A.

AU - Villarreal, Roberto

AU - Watase, Taketo

AU - Youngquist, Scott

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. Objective To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. Methods A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. Results Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. Conclusion In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.

AB - Background Despite the significant burden of childhood asthma, little is known about prevention-oriented management before and after hospitalizations for asthma exacerbation. Objective To investigate the proportion and characteristics of children admitted to the intensive care unit (ICU) for asthma exacerbation and the frequency of guideline-recommended outpatient management before and after the hospitalization. Methods A 14-center medical record review study of children aged 2 to 17 years hospitalized for asthma exacerbation during 2012-2013. Primary outcome was admission to the ICU; secondary outcomes were 2 preventive factors: inhaled corticosteroid (ICS) use and evaluation by asthma specialists in the pre- and posthospitalization periods. Results Among 385 children hospitalized for asthma, 130 (34%) were admitted to the ICU. Risk factors for ICU admission were female sex, having public insurance, a marker of chronic asthma severity (ICS use), and no prior evaluation by an asthma specialist. Among children with ICU admission, guideline-recommended outpatient management was suboptimal (eg, 65% were taking ICSs at the time of index hospitalization, and 19% had evidence of a prior evaluation by specialist). At hospital discharge, among children with ICU admission who had not previously used controller medications, 85% were prescribed ICSs. Furthermore, 62% of all children with ICU admission were referred to an asthma specialist during the 3-month posthospitalization period. Conclusion In this multicenter study of US children hospitalized with asthma exacerbation, one-third of children were admitted to the ICU. In this high-risk group, we observed suboptimal pre- and posthospitalization asthma care. These findings underscore the importance of continued efforts to improve prevention-oriented asthma care at all clinical encounters.

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