Adherence to the asthma pathway, including pre-triage bronchodilator history, reduces hospitalizations.

Objective: To determine if adherence to an asthma treatment pathway is associated with a decrease in hospitalizations.Methods: A prospective cohort design was conducted of Thai children aged 2-15 years who visited the emergency department with severe asthma exacerbations, defined as a Buddhasothorn Asthma Severity Score ≥ 8. Patients who received systemic corticosteroids and nebulized short-acting beta-2 agonists combined with ipratropium bromides were classified as the adherence group. The timing of steroid and bronchodilator administration, length of hospital stay, and hospitalization rate were examined in relation to adherence to the asthma pathway. Multivariable logistic regression models and adjusted odds ratios were used to assess associations.Results: A total of 118 episodes of asthma exacerbations (EAEs) from 59 participants were included. Patients who adhered to the pathway had a significantly higher rate of systemic corticosteroid administration within 1 h of arrival at triage (88.6% vs. 41.9%, adjusted Odds Ratio: aOR 10.21; 95%CI 3.52-29.62). A higher proportion of the patients who adhered to the pathway also received inhaled ipratropium bromide ≥ 2 doses within 1 h of arrival at triage (72.7% vs. 12.2%, aOR 23.51; 95%CI 7.73-71.54) and it was administered significantly faster by 31 min (5 min vs. 36 min, p < 0.001) compared to non-adherence group. The hospitalization rate was significantly lower by almost half of EAEs for adherence group (36.4% vs. 63.5%, aOR 0.41; 95%CI 0.18-0.93).Conclusions: Accurate assessment of severity and adherence to the clinical pathway can reduce hospitalization in pediatric patients with severe asthma exacerbations.

The Buddhasothorn Asthma Severity Score (BASS): A practical screening tool for predicting severe asthma exacerbations for pediatric patients.

BACKGROUND AND AIM: A precise scaling system of acute asthma leads to an accurate assessment of disease severity. This study aimed to compare the accuracy of the Buddhasothorn Asthma Severity Score (BASS) with the Wood-Downes-Ferrés Scale (WDFS) to recognize the severity level of acute asthma. MATERIALS AND METHODS: A cross-sectional study was conducted comprising Thai children aged 2-15 years with acute asthma. The BASS and WFDS were rated once in the emergency department. The degree of severity was determined by frequency and type of nebulized bronchodilator administrations at the time of initial treatment. The optimum cutoff points for the area under the curve (AUC) were established to predict severe asthma exacerbations. RESULTS: All 73 episodes of asthma exacerbations (EAEs) in 35 participants were analyzed. Fifty-nine (80.8%) EAEs were classified as severe. Both scales had good significance to recognize the selection of nebulized bronchodilator treatments by AUC of 0.815 (95% Confidence Interval [CI]: 0.680-0.950) in case of BASS, and AUC of 0.822 (95% CI: 0.70-0.944) in case of WDFS. Cutoff points of BASS ≥ 8 had sensitivity 72.9%, specificity 64.3%, positive predictive value (PPV) 89.6%, negative predictive value (NPV) 36.0% at an AUC of 0.718 (95% CI: 0.563-0.873) for severe exacerbations. These results were consistent for cutoff points of WDFS ≥ 5 with sensitivity 78.0%, specificity 50.0%, PPV 86.8%, NPV 35.0% at an AUC of 0.768 (95% CI: 0.650-0.886) for predicting severe exacerbations. There was no significant difference between the AUCs of both scales. CONCLUSIONS: Both the BASS and WDFS were good and accurate scales and effective screening tools for predicting severe asthma exacerbations in pediatric patients by optimal cutoff points.

The implementation of pediatric asthma guidelines including self-assessment of the level of confidence and accessibility of medical supplies necessary for asthma management from the perspectives of multidisciplinary care teams.

BACKGROUND: Asthma control in Thai children is not yet satisfactory. Direct observation of the clinical practice for health care professionals (HCPs) in asthma clinic is essential. OBJECTIVE: To ascertain the implementation of asthma guidelines for Thai children, to assess the confidence level in general asthma management, and to determine the availability of medical supplies. METHODS: A cross-sectional study was conducted in which HCPs were surveyed by questionnaire. The selection of pediatric asthma guidelines and self-assessment of their confidence level of their own asthma practice were assessed by using a score range between 1 (the lowest) and 10 (the highest). Reasons for low confidence were identified. The necessity and availability of medical supplies for asthma and its comorbidities were investigated in government hospitals in Chachoengsao province. RESULTS: A total of 245 participants from 11 hospitals were enrolled. There were registered nurses (38.0%), medical and nursing students (31.4%), physicians (28.2%), and pharmacists (2.4%). The Global Initiative for Asthma has been the most frequently used guideline followed by the Thai Asthma Guideline for Children 2015-2016 (56.3% vs. 52.7%; p = 0.45). The pathway for assessment and stepwise approach for adjusting treatment was the most regularly applied (61.4%). The mean overall level of confidence was 5.72 & 1.70-a moderate level. Only 2 of 11 (18.2%) surveyed hospitals had nebulized corticosteroids, and less than half of them (45.5%) had an allergic rhinitis checklist. CONCLUSIONS: To perfectly implement the national asthma guidelines, HCPs should be able to increase the level of confidence and procure necessary medical supplies.