Home Asthma Management Prior to Visiting an Inner City Pediatric Emergency Department

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Abstract 2084 Pulmonary: Reactive Airway Diseases I Poster Symposium, Monday, 5/3

Introduction: Home care for acute asthma could influence both the decision to come to the emergency department (ED) and the response to subsequent therapy given in the ED. We examined the home practices of inner city asthmatic children seen in our ED in 1997. Methods: A standardized interview containing questions regarding triggers, routine medications, pre-ED treatment, severity of chronic asthma, and healthcare utilization was prospectively administered for all acute asthma visits. Results: The sample consisted of 1,555 children, 87% non-caucasian, 64% male with a mean age of 6.3 (±4.4) years. Classification of chronic asthma severity (Resp Care 98:43(1);p 25) showed 36% mild, 15% moderate, 47% severe, and 2% undetermined. Among patients reporting chronic medication use, 89% used albuterol, 46% cromolyn, 16% inhaled steriods, and 6% other. There were 571 admissions (37%) and 984 discharges (63%). Admission rates by chronic asthma severity class were as follows: mild = 206(36%), moderate =105(18%) and severe =260(46%). Hospital admissions within the past year by chronic severity class were: O admissions = (mild -71%, moderate 68%, severe - 35%); 1 admission =(mild -21%, moderate -28%, severe -26%); > 2 admissions = (mild -0%, moderate - 0%, severe -36%) and unreported =(mild -8%, moderate -5%, severe -3%). Mean vital signs (±SD) at presentation were: respiratory rate 38 (±13.5) breaths/ min., SpO2 = 95(±3.3)%, and PEFR (n=155) 56(±18)% predicted. Only 19% had a written treatment plan, 25% currently had no medications at home, 34% of children (≥ 7 years of age) had a peak flow meter at home, and 7% had used oral steroids in the past 24 hours. The private physician was contacted by 26% prior to coming to the ED, and 22% of the patients received <2 aerosols at home, received <2 in ED and were discharged home. (Table) Conclusion: Most asthmatic patients' report having medications to treat asthma at home; however, few patients have written instructions for managing an acute episode. Although more patients with severe chronic asthma received aggressive beta-agonist aerosol treatment prior to coming to the ED, a minority of all patients institute aggressive self-management at home. Over 20% of visits probably could have been avoided with minimal home care (<3 aerosols). Many children are not adequately equipped with appropriate treatment plans or peak flow meters based on disease severity.

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