Paediatric acute asthma management in Australia and New Zealand: Practice patterns in the context of clinical practice guidelines

Babl, Franz E; Sheriff, Nisa; Borland, Meredith L; Acworth, Jason; Neutze, Jocelyn; Krieser, David; Ngo, Peter; Schutz, Jacquie; Thomson, Fiona; Cotterell, Elizabeth; Jamison, Sarah; Francis, P.

doi:10.1136/adc.2007.125062

Cited by 30 publications

(46 citation statements)

References 43 publications

(51 reference statements)

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“…3 The use of MDIs with holding chambers offers several advantages, including potential cost efficiencies and improved patient health care experience (Table 1). Yet surveys of pediatric acute care settings in various Western countries continue to show that nebulization remains the dominant method for b-agonist inhalation administration, [11][12][13][14][15][16] despite convincing evidence and recommendations in national and international asthma care guidelines. 14,[17][18][19] In 2006, a qualitative study at our study site identified perceived barriers to changing the method of salbutamol inhalation delivery.…”

Section: Ré Sumémentioning

confidence: 99%

Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

Hill-Taylor

Hurley

Sketris

et al. 2013

CJEM

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Objective: The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention. Methods: PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained from the hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.Results: There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%, p , 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute 27.25%: 95% CI 28.31 to 26.19, p , 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map. Conclusions: A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere. RÉ SUMÉObjectif: L'é tude avait pour objectif principal de quantifier l'incidence d'une intervention clinique visant à promouvoir l'administration de salbutamol au moyen d'un aé rosoldoseur (AD) dans un service d'urgences pé diatriques (SUP) hautement spé cialisé . Mé thode: Les donné es sur le nombre de né bules de salbutamol en solution pour inhalation, d'AD, et de chambres d'inhalation au SUP ont é té obtenues du service de pharmacie. Les donné es sur les patients, elles, ont é té obtenues du service d'aide à la dé cision de l'hô pital. Nous avons eu recours à l'analyse de sé ries temporelles interrompues pour é valuer les tendances observé es dans les donné es sur la quantité de salbutamol, la gravité de l'é tat des patients au moment du triage, et les hospitalisations, du 1er janvier 2003 au 31 mai 2010. Des entrevues et des documents administratifs ont servi à la dé termination des composants de l'intervention, qui a commencé en 2006. Ré sultats: Une augmentation de 1,215 % de la proportion de salbutamol administré au moyen d'un AD comparativement à la quantité totale de salbutamol administré en inhalation (AD plus solution pour né bulisation) a é té relevé e à la suite de l'intervention (IC à 95 % 1,032 % à 1,396 %; p , 0.001). L'augmentation de l'utilisation du salbutamol en AD a é té associé e à...

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Section: Ré Sumémentioning

confidence: 99%

Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

Hill-Taylor

Hurley

Sketris

et al. 2013

CJEM

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“…Most gave the BTS/SIGN salbutamol MDI dose, though some tended towards lower doses in younger children. Ipratropium bromide use is more varied as in other healthcare systems, perhaps due to conflicting literature 13. However, in a recent systematic review, children treated with ipratropium bromide and salbutamol compared with salbutamol alone have lower rates of hospital admission, nausea and tremor and greater improvement in lung function 17…”

Section: Discussionmentioning

confidence: 99%

“…Many recommendations derive from high quality studies, but some are based on lesser evidence or expert consensus. Paucity of evidence results in guidance which cannot provide detail in some areas, potentially leading to individual interpretation and practice variation as in other systems 12 13. This may contribute to differences in admission rates, bed days and length of stay across English primary care trusts 5…”

Section: Introductionmentioning

confidence: 99%

Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice

et al. 2014

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Objective National clinical guidelines for childhood wheeze exist, yet despite being one of the most common reasons for childhood emergency department (ED) attendance, significant variation in practice occurs in other settings. We, therefore, evaluated practice variations of ED clinicians in the UK and Ireland. Conclusions Significant variation in ED consultant management of childhood wheeze exists despite the presence of national guidance. This reflects the lack of evidence in key areas of childhood wheeze and emphasises the need for further robust multicentre research studies.

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“…The huge differences in doses for adults and children are inconsistent with the predicted similarity in their salbutamol PK-PD relationship. More importantly, higher doses could translate to an increased risk of toxic reactions, and the inconsistencies in dosing regimens are liable to engender uncertainty and confusion among clinicians 25 26. For example, using dosing regimens recommended by the BNFc, a child weighing 20 kg and over 2 years of age will receive the same intravenous bolus dose as that recommended for a 70 kg adult 4 5.…”

Section: Intravenous Salbutamol Dosing Recommendations For Adultsmentioning

confidence: 99%

Intravenous salbutamol for childhood asthma: evidence-based medicine?

Starkey

Mulla

Sammons

et al. 2014

Archives of Disease in Childhood

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Intravenous salbutamol is commonly used to treat children with severe asthma unresponsive to inhaled β2-agonist therapy. However, in this setting, there is little clinical trial data demonstrating its effectiveness. Additionally, there are significant concerns that intravenous salbutamol-dosing recommendations for children with acute asthma are excessive, and unnecessarily raise the potential for adverse reactions, such as lactic acidosis and tachycardia which, by increasing respiratory workload, exacerbate respiratory failure. Here, we review salbutamol clinical pharmacology and toxicology, evidence relating to its use in acute asthma and highlight gaps in the evidence base.

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Paediatric acute asthma management in Australia and New Zealand: Practice patterns in the context of clinical practice guidelines

Cited by 30 publications

References 43 publications

Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice

Intravenous salbutamol for childhood asthma: evidence-based medicine?

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