Short-Term Clinical Outcomes of Acute Treatment of Childhood
Purpose of Review: Acute exacerbations of asthma are the leading cause of emergency department visits in the pediatric patient. The present review is focused on the identification of those factors that may contribute to improving the short-term outcome of children after discharge from an emergency department visit for acute asthma.
Recent Findings: Several recent studies have documented that children treated at the emergency department because of an asthma-related event present a high morbidity at 7 and 15 days after discharge, mainly associated with symptom persistence, need for rescue bronchodilator medication, and absenteeism from school or day nursery. A better control of the disease, particularly adequate outpatient follow-up and maintenance treatment with inhaled steroids, could improve short-term clinical outcomes.
Summary: All efforts of emergency room management of children with asthma, identification of severity of the current exacerbation episode, and intensive treatment of the acute asthma attack have usually been directed at reducing the rates of hospitalization and the return for medical care. However, according to reported data on short-term morbidity, it is necessary to define therapeutic and follow-up strategies after treatment for acute asthma and emergency department discharge. Besides standard treatment for an acute asthma exacerbation in a pediatric emergency department, action plans should include a review of the maintenance treatment of asthma to improve underlying disease control and a strong recommendation for close follow-up by the primary care pediatrician.

Asthma is the most common chronic illness in childhood, with a prevalence estimated at 5-10% in developed countries. Acute asthma exacerbations account for 6% of children's visits to the emergency department, with 15-20% of patients requiring admission to the emergency department observation unit or to the hospital ward.

Although asthma morbidity and mortality have increased in recent years, childhood asthma hospitalization rates have remained stable, probably because of an increase in the severity of threshold for admission and intensive treatment of acute asthma attacks in the emergency department. This finding indicates that hospitalization rates may not be a reliable indicator of true asthma morbidity in children, given that these rates may be affected by changes in the criteria of hospital admission, modalities of treatment, and access to the health care system. Other parameters, such as measurement of the health-related quality of life, absenteeism from school, persistence of symptoms, or the need for prolonging treatment in the weeks after medical consultation have been shown to be more useful in the assessment of children with acute asthma exacerbations attended at the emergency department.