Asthma Education Reduces Hospitalization and Emergency Room Risk

 

Asthma is a complex respiratory disorder that significantly raises risk for ER visits and hospitalizations.  Despite it's complexity, there is a consistent knowledge gap that can put patients and parents at a significant disadvantage.  Following a consistent strategy grounded in evidenced based practice can make a difference in reducing chaos and preventing frequent sick visits.  This study demonstrated that a focused asthma education program consistently reduced these risks.

Background It remains unknown whether child-oriented asthma education is associated with better health outcomes. This meta-analysis investigated the effects of asthma education on hospitalisation and emergency department and clinic visits.

Methods We searched the Cochrane Library, PubMed and EMBASE for relevant studies from inception to 4 July 2021, and selected studies that reported hospitalisation or emergency department or clinic visits as outcomes. The participants were only children. Two authors independently selected the studies, assessed the quality of the included studies and retrieved the data. A third senior author was engaged to resolve disagreements. Fifteen longitudinal studies were included for the systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 was used as the standard of reporting (PRISMA registration ID is 284509).

Findings Compared with the control group, the asthma education group had 54% lower hospitalisation risk (95% CI 0.32 to 0.66), and 31% lower emergency department visit risk (95% CI 0.59 to 0.81). Sensitivity analysis showed that the asthma education group had a reduced clinic visit risk (risk ratio (RR)=0.80, 95% CI 0.67 to 0.97). Subgroup analysis showed that asthma education involving both children and parents/guardians was associated with fewer hospitalisations (RR=0.38, 95% CI 0.24 to 0.59) and emergency department visits (RR=0.69, 95% CI 0.57 to 0.83). Asthma education in hospitals or non-hospitals can reduce the risk of hospitalisation and emergency department visits. However, only education in the hospitals was associated with the reduction of clinical visits (RR=0.45, 95% CI 0.22 to 0.92).

Interpretation Education is effective for controlling asthma, especially for reducing hospitalisation and emergency department and clinic visits. Education involving both children and parents/guardians is more effective than that involving only children. The setting of asthma education does not impact its effect to a large extent.

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Antibiotics in Childhood Asthma

Most experts agree that there is little role in use of antibiotics in chronic or acute treatment of asthma.  In addition, antibiotic overuse may delay diagnosis and management of a chronic condition and undermine medical provider recommendations. 

After all, if an inflammatory lung condition is repeatedly conflated with an infectious process, families may lose faith in medical care and seek treatment options elsewhere.

Dr. Susarla

Children with asthma are prescribed antibiotics at a higher rate than those without asthma, according to a study published in BMJ Open. Furthermore, the diseases for which they are prescribed typically do not call for antibiotics.

This underscores the importance of measured distribution of antibiotics among physicians to avoid overprescribing and its consequences, which include further infection and microbial resistance.

This population-based retrospective cohort study included data from 26,750 participants with asthma and 330,916 without asthma, all of whom were aged 5 to 18 years old. Asthma was defined by ≥2 respiratory drug prescriptions within 1 year after receiving an asthma code. Data were collected from The Health Improvement Network (THIN) in the UK and Integrated Primary Care Information Database (IPCI) in the Netherlands. Rates of antibiotic prescriptions were compared using a Poisson regression model, and use indications were compared between individuals with and without asthma using Fisher's exact or chi-square tests.

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Welcome Dupixent!

When new anti-asthma biologics come to the door, always give them a welcome seat. Here is an anti- atopic dermatitis monoclonal antibody that also shuts down a key component of the allergy airway inflammation pathway, now a 12 and up asthma therapy.  Dr. Susarla

Dive Brief:

• Sanofi and Regneron have won an expanded U.S. approval for Dupixent in asthma, securing another indication for the biologic drug which the companies are counting on to deliver blockbuster sales. 
• On Friday, the Food and Drug Administration OK'd the drug for moderate-to-severe asthma patients with an eosinophilic phenotype, or with oral corticosteroid-dependent asthma regardless of phenotype, the companies said. The new indication adds to Dupixent's previously approved use for moderate-to-severe atopic dermatitis.
• Clinical results supporting the approval showed Dupixent cut severe asthma attacks by 67% compared to placebo in patients with high eosinophil counts. Among patients with lower levels of the inflammation marker, however, Dupixent did not separate from placebo in statistical comparison. 

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