New Australian research published recently in BMJ Open Respiratory Research has identified considerable inter-hospital differences in the frequency of treatment escalation, the choice of escalation treatments and hospital length of stay for children presenting to hospital with acute severe asthma.
The study found a wide variation in management with escalation of treatment strongly related to a higher, or more urgent, triage category.
The multicentre study of over 14,000 Australian and New Zealand children is the first large dataset reporting management beyond systemic corticosteroids and inhaled bronchodilators in the current era, where nasal high-flow (NHF) therapy has been increasingly used outside the ICU environment.
Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. Severe outcomes were rare, with 243 children admitted to intensive care; 22 received non-invasive ventilation and only four were intubated.
The research was led Dr Simon Craig as part of his 2020 Asthma and Airways Career Development Fellowship that was jointly funded by the National Asthma Council Australia and the Thoracic Society of Australia and New Zealand.
“We know that severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. However, to date, no large dataset has reported on both intravenous and respiratory support following first-line management for children presenting acutely to hospital with asthma.
“Remarkably, NHF was used in nearly all patients who received respiratory support and accounted for nearly one-third of all escalation of asthma treatment,” he said.
Paediatric respiratory physician and member of the National Asthma Council Australia Guidelines Committee Dr Louisa Owens said this is a critical study as children still die from acute asthma in Australia.
“The lack of evidence for some of these treatments is concerning and the study highlights areas which need more certainty and also some deviations from guidelines, for example, around nasal high-flow therapy.
“NHF therapy is widely used in the management of acute asthma, as was described in the study, and it likely has an important role, yet there is very little evidence behind this.
“Clearly the management of acute severe asthma in children should be a priority research area and the Australian Asthma Handbook guidelines are continually evolving to reflect the latest evidence regarding managing acute asthma in children,” said Dr Owens.
As the 2020 Asthma and Airways Career Development Fellowship recipient, Dr Craig is working to establish a set of global standards for the way outcomes are measured in clinical trials involving children with acute severe asthma.
“Thousands of children present to EDs with acute respiratory illnesses each year and that is the place where treatment is initiated, and where many decisions about ongoing management are made,” he said.
Dr Craig’s research was conducted in association with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network and its counterparts around the world.
Dr Simon Craig is an Emergency Physician, Monash Medical Centre and Adjunct Clinical Professor, School of Clinical Sciences at Monash Health, Monash University.
Study link here: https://bmjopenrespres.bmj.com/content/9/1/e001137.full
-- ENDS – For further information or an interview with Dr Craig or a National Asthma Council Australia spokesperson, please contact:
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