Reduction in Asthma Related Emergency Department Visits and Hospitalizations Among Children Evaluated in a Specialty Asthma Clinic
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Mayuran Ravindran, David R. Stukus, MD FAAAAI
RATIONALE: In November 2011, our tertiary care pediatric academic center initiated a Complex Asthma Clinic (CAC) to provide comprehensive outpatient care by allergists to at-risk children with prior asthma-related Emergency Department (ED) visits/hospitalizations.

METHODS: A patient registry was created for children evaluated in the CAC between 2011 and June 30, 2017, followed by a retrospective review of asthma-related ED visits/hospitalizations in the year before and year after initial evaluation.

RESULTS: Two-hundred and sixty-two patients completed at least one CAC visit (mean=3.9+3.5 visits); mean age=6.3+4 years, 67% (N=176) male, 50% (N=132) African American, and 73% (N=190) receiving Medicaid. Prior to CAC evaluation, 85% (N=222) of children were prescribed asthma controller medication, 75% (N=166) of which were medium or higher dose inhaled corticosteroids. Previous to CAC evaluation, lung function testing had been performed in 23% (N=36) of children >5 years old and 10% (N=25) had previous allergy testing performed.

At initial CAC evaluation, 86% (N=226) were prescribed additional medications and/or higher dosages of existing therapy. While receiving care within the CAC, 75% (N=201) of children underwent skin prick testing, with 93% (N=186) being positive to at least one aeroallergen (57% any indoor, 51% any outdoor). Comparing the year before to the year after the initial visit, children evaluated in CAC had a 47% reduction in ED visits (mean=1.1 vs. 0.6; P<0.0001) and 44% reduction in hospitalizations (mean=0.4 vs. 0.2; P<0.01).

CONCLUSIONS: Children with a history of ED visits or hospitalizations for asthma benefited from specialty evaluation and management by allergists in an outpatient specialty asthma clinic.