Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study

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A.M. Herrera
P. Brand
G. Cavada
A. Koppmann
M. Rivas
J. Mackenney
H. Sepúlveda
M.E. Wevar
L. Cruzat
S. Soto
M.A. Pérez
A. León
I. Contreras
C. Alvarez
B. Walker
C. Flores
V. Lezana
C. Garrido
M.E. Herrera
A. Rojas
C. Andrades
E. Chala
R.A. Martínez
M. Vega
J.A. Perillán
H. Seguel
I. Przybyzsweski


Children, Asthma exacerbation, Asthma hospitalization


Background: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this.

Objective: Describe clinical characteristics of children hospitalized for asthma exacerbation.

Methods: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist.

Results: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist.

Conclusions: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

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1. Bousquet J, Bousquet PJ, Godard P, Daures JP. The public health implications of asthma. Bull World Health Organ. 2005;83:548-54.

2. Mallol J, Aguirre V, Aguliar P, Calvo M, Amarales L, Arellano P, et al. Cambios en la prevalencia del asma en escolares chilenos entre 1994 y 2002. Rev Méd Chile. 2007;135:580-6.

3. The global asthma report 2014. Asthma Report 2014.pdf [accessed January 2018].

4. Herrera AM, Cavada G, Manalich ˜ J. Hospitalizaciones por asma infantil en Chile: 2001-2014. Rev Chil Pediatr. 2017;88.

5. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1.

6. Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, et al. Economic burden of asthma: a systematic review. BMC Pulm Med. 2009;9:24.

7. Vicuna˜ P, Loza C, Munoz ˜ P, Sanchez I. Características clínicas de los ninos ˜ asmáticos hospitalizados en un servicio de pediatría. Rev Chil Pediatr. 2007;78:29-34.

8. Herrera AM, Escobar AM, Saavedra M, Medina ME, Salgado E, Palavecino T, et al. Exacerbación de asma infantil en unidad de paciente crítico: caracterización clínica. Rev Chil Enferm Respir. 2011;27:26-30.

9. Lozano J, Yanez ˜ L, Lapadula M, Fernández C, Alcántara A, Rodriguez P, et al. Asma severo en ninos: ˜ ¿fenotipo diferente? Rev Chil Enferm Respir. 2012;28:272-6.

10. GINA 2016. [accessed January 2017].

11. Vega JM, Badia X, Badiola C, López-Vina˜ A, Olaguíbel JM, Picado C, et al. Validation of the Spanish version of the asthma control test (ACT). J Asthma. 2007;44:867-72.

12. Pérez-Yarza EG, Castro-Rodríguez JA, Villa JR, Garde J, Hidalgo FJ. Validation of a Spanish version of the childhood asthma control test (SC-SCT) for use in Spain. An Pediatr (Barc). 2015;83:94-103.

13. AL-Jahdali H, Ahmed A, AL-Harbi A, Khan M, Baharoon S, Salih SB, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visit. Allergy Asthma Clin Immunol. 2013;9:8.

14. BMI-for-age (5---19 years). World Health Organization. bmi for age/en/ [accessed July 2016].

15. Bush A, Saglani S. Management of severe asthma in children. Lancet. 2010;376:814-25.

16. de Groot EP, Kreggemeijer WJ, Brand PL. Getting the basics right resolves most cases of uncontrolled and problematic asthma. Acta Paediatr. 2015;104:916-21.

17. Bracken M, Fleming L, Hall P, Van Stiphout N, Bossley C, Biggart E, et al. The importance of nurse-led home visits in the assessment of children with problematic asthma. Arch Dis Child. 2009;94:780-4.

18. de Groot EP, Nijkamp A, Duiverman EJ, Brand PL. Allergic rhinitis is associated with poor asthma control in children with asthma. Thorax. 2012;67:582-7.

19. Deliu M, Belgrave D, Simpson A, Murray CS, Kerry G, Custovic A. Impact of rhinitis on asthma severity in school-aged children. Allergy. 2014;69:1515-21.

20. Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Effect of smoke-free legislation of perinatal and child health: a systematic review and meta-analysis. Lancet. 2014;383:1549-60.

21. Desai M, Oppenheimer JJ. Medication adherence in the asthmatic child and adolescent. Curr Allergy Asthma Rep. 2011;11:454-64.

22. Bourdin A, Halimi L, Vachier I, Paganin F, Lamouroux A, Gouitaa M, et al. Adherence in severe asthma. Clin Exp Allergy. 2012;42:1566-74.

23. Bender BG, Rand C. Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004;4:191-5.

24. Jentzsch NS, Camargos PA, Colosimo EA, Bousquet J. Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods. Allergy. 2009;64:1458-62.

25. Klok T, Kaptein AA, Brand PL. Non-adherence in children with asthma reviewed: the need for improvement of asthma care and medical education. Pediatr Allergy Immunol. 2015;26:197-205.

26. Haahtela T, Valovirta E, Bousquet J, Mäkelä M. The Finnish Allergy Programme 2008---2018 works. Eur Respir J. 2017;49.

27. Lasmar L, Fontes MJ, Mohallen MT, Fonseca AC, Camargos P. Wheeze child program: the experience of the Belo Horizonte pediatric asthma management program. World Allergy Organ J. 2009;2:285-9.

28. Klok T, Kaptein AA, Brand P. Improving adherence in paediatric respiratory disease. Breath. 2013;9:269-77.

29. Zemek RL, Bhogal SK, Ducharme F. Systematic review of randomized controlled trials examining written action plans in children: what is the plan? Arch Pediatr Adolesc Med. 2008;162:157-63.