Childhood Asthma Management Pre- and Post-Incident Asthma Hospitalization

Abstract

Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6–17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004–2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient’s asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.

The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand?

“…drug prescription, hospital admission, specialist visits) permits the monitoring of diagnostic and therapeutic approaches in paediatric patients with chronic disorders (e.g. asthma, epilepsy) and the evaluation of compliance between daily clinical practice and guidelines [101,102].…”

Does routine spirometry impact on clinical decisions and patient-related outcome measures of children seen in respiratory clinics: an open-label randomised controlled trial

“…A study reported that only 32.4% of children aged 5–8 years with potential asthma had at least one spirometry undertaken either in the year before (6.4%) or the 2 years after (29.7%) the first asthma treatment 11. Moreover, only one-third of children with asthma were referred for spirometry,12 and only half of children hospitalised with asthma underwent spirometry during follow-up 13. Others found that only 10–21% of general practitioners and paediatricians used spirometry consistently in childhood asthma management 14 15…”

“… 11 Moreover, only one-third of children with asthma were referred for spirometry, 12 and only half of children hospitalised with asthma underwent spirometry during follow-up. 13 Others found that only 10–21% of general practitioners and paediatricians used spirometry consistently in childhood asthma management. 14 15 …”