PURPOSE: To determine the baseline asthma severity of children admitted to the hospital with acute asthma and to assess differences in the following outcomes with respect to asthma severity: the frequency of pre-admission use of controller medications, the percentage of children prescribed controller medications at hospital discharge (hosp d/c), and the proportions of children receiving in-hospital asthma education and pulmonary consultation.
METHODS: The medical records of 729 children, ages 4-18 yrs (mean age [SD] 7.9 [3.5] years), admitted to the Seattle Children's Hospital between Jan 1999 and Dec 2002 for treatment of acute asthma were reviewed. Baseline asthma severity was determined using the combination of the NHLBI severity classification and controller medication use.
RESULTS: Of the 729 patients, 47% were classified as mild intermittent and 20% as mild persistent, which we combined into a single “mild” group; 23% had moderate persistent and 10% had severe persistent asthma. Fifteen percent of patients with mild asthma were taking controller meds at the time of hospital admission and 46% were prescribed them at hosp d/c, compared to 75% pre-admission and 76% at hosp d/c, and 84% pre-admission and 85% at hosp d/c for the moderate and severe asthma patients, respectively. Only 55% of patients had documentation of asthma education. Pulmonary consultation was obtained in 6% of mild, 18% of moderate, and 30% of severe patients.
CONCLUSION: Many children admitted to the hospital with asthma had baseline mild asthma. A significant number of children with moderate or severe persistent asthma were not taking controller therapy at the time of hospital admission and were not prescribed it at hosp d/c. Asthma education was poorly documented. The frequency of pulmonary consultation increased appropriately with the degree of asthma severity.
CLINICAL IMPLICATIONS: The high proportion of patients hospitalized with acute asthma that have basline mild asthma makes it difficult to use the outcome “percentage of patients discharged with controller therapy” as a quality improvement measure. Efforts should be made to improve the administration and documentation of asthma education.
DISCLOSURE: Edward Carter, No Financial Disclosure Information; No Product/Research Disclosure Information