Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Acad Emerg Med. 2012 Sep;19(9):E1019-26. doi: 10.1111/j.1553-2712.2012.01433.x.
The objective was to examine utilization of β2 agonists via metered dose inhalers with oral and inhaled corticosteroids (ICS) at discharge in children with acute asthma.
This was a retrospective medical record review at six pediatric emergency departments (EDs) of otherwise healthy children 2 to 17 years of age discharged with acute asthma. Data were extracted on history, disease severity, and pharmacotherapy used in the ED and at discharge. The primary outcome was the proportion of children prescribed "comprehensive therapy," i.e., albuterol via metered dose inhaler (MDI) with oral and ICS.
The overall rate of comprehensive therapy was 382 of 654 (58%), which varied from 30% to 84% (p < 0.0001). A total of 570 of 575 children discharged on albuterol received MDIs. Although the rates of prescriptions for oral and ICS were both 80%, only 58% of patients without ICS on arrival were offered ICS at discharge. There was significant variation in the rates of all discharge pharmacotherapies across centers. The independent predictors of comprehensive therapy were daytime presentation (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.05 to 2.67) and "intensive stabilization" (OR = 2.33, 95% CI = 1.29 to 2.67). Seventeen patients (2.6%) were prescribed antibiotics. Children were more likely to receive antibiotics if they had moderate to severe exacerbations (OR = 2.8) or received a chest radiograph (OR = 8.4).
The overwhelming majority of children discharged from Canadian pediatric EDs with acute asthma are prescribed inhaled albuterol via MDIs. Although the corticosteroid use at discharge is higher than previously reported, utilization of new prescriptions for ICS may not be optimal. Children presenting during daytime to EDs receiving intensive stabilization are more likely to receive the albuterol/oral steroid/ICS combination.
本研究旨在调查患有急性哮喘的儿童在出院时使用β2 受体激动剂（通过计量吸入器给药）联合口服和吸入皮质类固醇（ICS）的情况。
这是一项在 6 家儿科急诊部（ED）进行的回顾性病历回顾研究，入组对象为年龄在 2 至 17 岁之间、患有急性哮喘且情况稳定的儿童。研究人员提取了这些儿童在 ED 就诊和出院时的病史、疾病严重程度和药物治疗情况等数据。主要结局是使用通过计量吸入器（MDI）给药的沙丁胺醇联合口服和 ICS 治疗的儿童比例（即“综合治疗”）。
共有 654 名儿童出院，其中 382 名（58%）接受了综合治疗，比例范围为 30%至 84%（p<0.0001）。在接受沙丁胺醇治疗的 570 名儿童中，575 名均接受了 MDI。尽管口服和 ICS 的处方率均为 80%，但在到达时未接受 ICS 治疗的患者中，仅有 58%在出院时接受了 ICS 治疗。各中心之间的所有出院药物治疗方案的使用率存在显著差异。综合治疗的独立预测因素是日间就诊（优势比[OR] = 1.67，95%置信区间[CI] = 1.05 至 2.67）和“强化稳定化治疗”（OR = 2.33，95% CI = 1.29 至 2.67）。有 17 名儿童（2.6%）被处方了抗生素。中度至重度加重的儿童（OR = 2.8）或接受了胸部 X 线检查的儿童（OR = 8.4）更有可能接受抗生素治疗。
在加拿大儿科 ED 出院的患有急性哮喘的儿童中，绝大多数都接受了沙丁胺醇通过 MDI 吸入治疗。尽管与之前的报告相比，皮质类固醇的使用率更高，但 ICS 的新处方使用率可能并不理想。日间到 ED 就诊并接受强化稳定化治疗的儿童更有可能接受沙丁胺醇/口服皮质类固醇/ICS 联合治疗。
