According to a new study, hospital readmission rates for asthma are increasing among children, highlighting the health care gaps for the most common chronic childhood illness.
The study, led by the Murdoch Children’s Research Institute and published in the Diary of Asthmafound that about one in three children, mostly preschoolers, are re-hospitalized for asthma, compared with one in five a decade ago.
Murdoch Children’s Dr. Katherine Chen said most asthma hospital presentations were preventable, stressing the need for a holistic evaluation of each child’s asthma treatment to prevent future readmissions.
The study included 767 children, ages three to 18, who were admitted to three hospitals in Victoria between 2017-2018 with a diagnosis of asthma† It found that 34.3 percent were readmitted to the hospital for asthma, with 69.2 percent of those aged three to five doing well. Of the 767 participants, 20.6 percent were readmitted once and 13.7 percent had two or more readmissions in 12 months.
“Our study revealed gaps in childhood asthma care,” said Dr. chen. More than a third of the children had not had an assessment of their inhalation technique and only about a quarter were prescribed a preventative or asked to continue taking it.
“Nearly three-quarters were discharged without preventive medication and more than 80 percent had no follow-up clinic booked at the hospital, often reserved for children with difficult-to-control asthma. Most families should therefore monitor their child’s asthma follow-up. navigate with their primary care physician.”
dr. Chen said there was also a recent spike in asthma admissions due to the rise in respiratory infections and children lacking immunity to common viruses following COVID-19 lockdowns.
Murdoch Children’s Professor Harriet Hiscock said the findings confirmed the important role of primary care physicians in treating pediatric asthma and how targeted interventions in each hospital could reduce readmissions.
Less than 10 percent were readmitted within 30 days, indicating the importance of ongoing community care and longer-term asthma control. The need to regularly review overall asthma management, minimize risk factors, arrange follow-up, and support optimal care in the community are critical.
Interactive digital symptom monitoring with specialist nursing support, homeschooling and a culturally tailored education program can also help.”
Professor Harriet Hiscock, Murdoch Childrens Research Institute
Professor Hiscock said linked data sets were important for objectively measuring the burden of asthma cases on health services.
“Our current data set cannot verify whether the follow-up appointment was attended, whether health care providers arranged post-discharge follow-up, and whether the drugs were used as prescribed,” she said. Integrating data sets such as health services and medication use into clinical care will improve the physician’s understanding of the child’s asthma control and adherence, and would help provide targeted treatments.”
Asthma is the most common chronic childhood disease in industrialized countries, affecting 8-10 percent of children. In Australia, it is a leading cause of preventable hospitalizations in children.
The daughter of Melbourne-based Megan Snelgrove’s mother, Aurora, 10, who was diagnosed with asthma at the age of four, is hospitalized two to three times a year for asthma.
“We initially had trouble navigating the system because Aurora has a very specific type of asthma, hypersecretory asthma, which presents slightly differently from typical asthma and is treated differently.
“Aurora has a complicated case and it has been trial and error with her treatment. Ventolin does not help because it treats inflammation and not secretions and this was very much misunderstood during our first few visits to the hospital. But ever since it was followed up by the hospital’s ventilator, things have improved.”
Chen, KYH, et al. (2022) Modifiable factors associated with childhood asthma readmissions: a multicenter linked cohort study. Diary of Asthma† doi.org/10.1080/02770903.2022.2089996†
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