Abstract | OBJECTIVE: To compare the effectiveness of the administration of inhaled beta-agonists delivered via a metered-dose inhaler (MDI) with spacers--as part of an evidence-based asthma pathway developed to manage acute asthma exacerbations in children at the emergency room level and in inpatient management--against administration via nebulization. DESIGN: Case with historical control. SETTING: KK Women's and Children's Hospital (Singapore). PARTICIPANTS: A total of 19,951 children (infants to older children) aged 18 years and younger who attended the emergency room for asthma exacerbations. MAIN OUTCOME MEASURES: Average length of stay, proportion admitted to high dependency or intensive care, proportion readmitted for unresolved symptoms within 72 hr, cost per patient and overall. RESULTS: There was no increase in the mean proportion of emergency room attendances admitted to inpatient care with use of an MDI (mean difference 0.97%, 95% CI: -1.6-3.5%, P = 0.447), nor of children admitted to intensive care (0.21 vs. 0.20 pre- and post-pathway, P = 0.827) or to high dependency units (2.21 vs. 1.37 pre- and post-pathway, P = 0.200) but a significant reduction in the within 72 hr re-attendance rate (mean difference 1.4%, 95% CI: 0.78-2.0%, P < 0.001) with use of an MDI. The average length and cost per patient for an inpatient stay for acute asthma exacerbations was reduced with use of an MDI. CONCLUSIONS: The use of an MDI with spacer as part of an evidence-based asthma pathway was effective in the management of acute asthma exacerbations in the emergency room setting and for inpatient management.
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Authors | Anne Eng Neo Goh, Jenny Poh Lin Tang, Ho Ling, Teoh Oon Hoe, Ng Kee Chong, Chay Oh Moh, Chan Yiong Huak |
Journal | Pediatric pulmonology
(Pediatr Pulmonol)
Vol. 46
Issue 5
Pg. 421-7
(May 2011)
ISSN: 1099-0496 [Electronic] United States |
PMID | 21194171
(Publication Type: Journal Article)
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Copyright | Copyright © 2010 Wiley-Liss, Inc. |
Chemical References |
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Topics |
- Administration, Inhalation
- Adolescent
- Adrenergic beta-Agonists
(administration & dosage, therapeutic use)
- Asthma
(drug therapy)
- Child
- Child, Preschool
- Disease Management
- Emergency Service, Hospital
(statistics & numerical data)
- Female
- Hospitalization
- Humans
- Infant
- Infant, Newborn
- Length of Stay
- Metered Dose Inhalers
- Singapore
- Tertiary Care Centers
(statistics & numerical data)
- Treatment Outcome
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