Hospitalization Prevention for Children With Asthma Requires Multimodal Approach

Randomized controlled trials on asthma hospitalization prevention are limited, but patient and caregiver education should be a top priority, investigators said.

Multimodal, individualized asthma care plans can help reduce the risk of hospitalizations among children with asthma, according to a new review article.

However, the authors of the review, published in Journal of Pediatrics and Child Health, also noted that more rigorous studies are warranted, given the “unexpected lack of randomised controlled trials of more regularly used medications in asthma such as corticosteroids, leukotriene antagonists, or biologics.”

Asthma is a common health problem for children worldwide and also a common driver of pediatric hospital admissions. About 1 in 5 children who are hospitalized due to asthma-related problems are readmitted to the hospital within a year, noted the investigators.

“A hospital admission for an asthma exacerbation suggests suboptimal control and is a strong independent predictor of future hospital admissions, with a small associated increase in asthma mortality,” they wrote.

The investigators sought to better understand what the existing literature says about preventing asthma-related hospitalizations in children. They found a range of studies evaluating a broad set of interventions and outcomes, and they focused on 12 studies that included 2719 participants, ranging in age from 2 to 16 years. Most of the participants in the studies had previously been admitted to the hospital.

The most common type of intervention among the selected studies was education-based programs, which took place in a variety of settings and were delivered by health care professionals or nonclinical staff. These educational programs included roles for parents or caregivers in the process, including tasks such as delivering medication or recording symptoms. The studies suggested that the most effective asthma-control education efforts were were tailored to the individual patient, culturally sensitive, and interactive.

Other interventions analyzed in the literature included reducing allergens at home and regular follow-up care after hospitalizations. The largest study, which had 937 participants, tested an intervention in which patient feedback, that summarized the patient’s symptoms and medication use, was provided to primary care providers. Doctors were also provided with guideline-based recommendations.

However, the authors noted this study’s intervention did not significantly affect hospitalization rates, in part because more than half of physicians involved in the study said they had difficulties implementing the recommendations.

The investigators limited their review to controlled randomized studies in order to ensure high scientific rigor. They said their analysis was limited by the thin availability of such trials, and they were unable to find sufficient evidence to draw conclusions for their secondary outcomes, which included the cost-effectiveness of different interventions and the impact of interventions on patient quality of life.

In their conclusion, the investigtors urged the scientific community to launch more studies into those questions. In the meantime, they said the available evidence suggests a holistic approach to asthma hospitalization prevention, particularly in the most vulnerable patient groups.

“​​The evidence for the clinical interventions to reduce asthma hospitalisations in at-risk children suggests multimodal interventions, delivered across care settings, can be effective in preventing future hospitalisations.”

Reference

Chen KYH, Saxon L, Robertson C, Hiscock H. Reducing asthma hospitalisations in at-risk children: a systematic review. J Paediatr Child Health. Published online August 5, 2021. doi:10.1111/jpc.15666