AT THE 2017 AAAAI ANNUAL MEETING
ATLANTA (FRONTLINE MEDICAL NEWS) – The treatment of pediatric severe acute asthma has changed over the past 21 years, but interspecialty differences in the management of these patients persist, results from a national survey suggest.
“I think it’s good for every ER and ICU department to have a conversation with providers about what to do when these kinds of patients come in,” lead study author Roua Azmeh, MD, said in an interview at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “A lot of ERs are establishing protocols. I think that’s going to be the wave of the future.”
The National Heart, Blood, and Lung Institute Asthma Guidelines , first published in 1991, were most recently revised in 2007. In an effort to observe changes in asthma management in pediatric EDs and ICUs over the past 21 years, and to compare common management strategies, Dr. Azmeh and her associates distributed a 16-question online survey to 144 current program directors of U.S. training programs in pediatric emergency medicine and pediatric critical care. Results were compared to a similar survey that was sent by snail mail to program directors of U.S. training programs in pediatric emergency medicine and pediatric critical care in 1995.
Dr. Azmeh, a fellow in allergy and immunology at the Saint Louis University, reported results from 62 respondents who completed the 2016 questionnaire (43%). For initial management of pediatric acute severe asthma, a greater proportion of program directors in pediatric critical care reported using parenteral corticosteroids, compared with their counterparts in pediatric emergency medicine (85% vs. 32%, respectively; P less than .0001), as well as continuous beta 2-agonists (73% vs. 56%; P less than .05). A majority of overall respondents (98%) did not use theophylline for initial management, but more program directors in pediatric critical care reported using it for treatment failure, compared with their counterparts in pediatric emergency medicine (56% vs. 20%, respectively; P less than .0071). There was a trend among all respondents for more use of heliox for treatment failure than for initial management (13% vs. 6%).
When the researchers compared current survey responses to responses from the 1995 survey, they observed that program training directors across both specialties increased the use of nebulized ipratropium bromide in initial management and treatment failure (17% vs. 69%; P less than .0001 and 33% vs. 42%; P less than .05) and decreased use of theophylline for initial management of severe acute asthma (17% vs. 3%; P less than .05). However, theophylline is still used in treatment failure.
Among respondents to the 2016 survey, program directors in pediatric emergency medicine were less likely than were those in pediatric critical care to use continuous nebulized beta-2 agonists for initial management or to add parenteral selective beta-2 agonists (56% vs. 73% and 12% vs. 21%, respectively; P less than .05). They also were less likely to use theophylline in treatment failure (20% vs. 56%; P less than .05).
Dr. Azmeh reported having no relevant financial disclosures.