Pre‐school wheeze hospital presentations: A demographic profile and review of clinical management

Abstract

Aim Pre‐school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre‐school wheeze. Methods Audit of children diagnosed with pre‐school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined. Results One hundred and ninety‐two children made 247 pre‐school wheeze hospital presentations. Pre‐school wheeze accounted for a larger proportion of acute hospital presentations for Māori versus non‐Māori children (rate ratio 1.76, 95% confidence intervals 1.32–2.31). Hospital representations with pre‐school wheeze occurred in 38/192 (20%) children. The proportion with a pre‐school wheeze representation was larger for Māori than non‐Māori (30% vs. 16%, P = 0.02). Pre‐school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre‐school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre‐school wheeze episode were NZ$1279 (NZ$774–2158). Conclusions In Auckland, pre‐school wheeze accounts for a larger proportion of acute hospital presentations for Māori compared with non‐Māori and Māori children have increased odds of pre‐school wheeze readmissions. Length of hospital stay for pre‐school wheeze episodes increased with household deprivation. In this audit pre‐school wheeze guideline adherence was poor.

Preventing progression of preschool wheezing to asthma: Opportunities for intervention

“…A factor that influences morbidity from recurrent preschool wheezing across the world is socioeconomic deprivation. Studies from Western Europe, 47 North America 48,49 and Australasia 50 consistently show a negative effect of deprivation on the prevalence of preschool wheeze. Indoor air quality is one factor that significantly impacts morbidity globally 51 .…”