Long-term effects of multidisciplinary inpatient asthma treatment

Abstract

Background: For children with refractory difficult asthma achieving adequate control can be challenging. Previously we have shown that multidisciplinary inpatient treatment improves short-term asthma control and quality of life for patients that remain uncontrolled despite optimal outpatient treatment by paediatric pulmonologists.

Objective: To evaluate the long-term effects of multidisciplinary inpatient treatment in paediatric patients with refractory difficult asthma.

Methods: In this prospective observational study, 10 children (mean age 12.3 ± 2.3 years) hospitalised in Asthma Centre Merem, Netherlands (mean treatment duration 4.4 ± 0.5 weeks) were followed up for 12-24 months (mean 17.6 ± 4.3). Treatment focused on optimizing basic management by addressing four modules; asthma specific, physical health, chronical illness and system therapy. Evaluations were taken prior admission and post treatment. Statistical significance on intra-individual change in outcome variables was assessed using the Wilcoxon signed rank test.

Results: Overall there was a significant reduction in hospital admissions (p. 0.018), emergency room visits (p. 0.021) and oral corticosteroid use (p. 0.007) comparing 12 months prior and post treatment. In addition treatment had positive effect on school attendance; children with < 1 month of school absenteeism increased from 10% (pre-treatment) to 90% (post-treatment). Improvements in asthma related quality of life (PAQLQ) exceeded the clinically minimal important difference; mean pre-treatment 5.5 ± 0.8 vs post treatment 6.5 ± 0.5.

Conclusion: This small observational study shows that multidisciplinary inpatient treatment can have long-term effects in several aspects of asthma control and quality of life.