CAN BURST VENTOLIN THERAPY BE SAFELY GIVEN AT HOME TO REDUCE EMERGENCY AND HOSPITAL PRESENTATIONS WITH ASTHMA IN CHILDREN?

Abstract

Asthma is the most prevalent chronic illness for children in Australia,1 and there are limited treatment options at home to prevent an escalation of symptoms during an asthma exacerbation.2 The most commonly used treatment in emergency department (ED) is high-dose inhaled salbutamol with or without ipratropium.3 We investigated whether a novel use of burst Ventolin therapy (BVT) at home can be safely given during an exacerbation to prevent ED and hospital admissions in a pilot study. Thirty-two children and their care givers from the Complex Asthma Service at the Royal Children's Hospital Melbourne were given the BVT action plan (Fig. 1) between 2018 and 2019. Inclusion criteria were: five presentations to ED and/or hospital admissions, and the care giver has ability to administer medications during an asthma exacerbation. Exclusion criteria were: previous intensive care admission or a hospital admission exceeding 48 h. Ethics approval was granted by the hospital's Human Research Ethics Committee. The BVT action plan follows standard hospital management of high-dose inhaled salbutamol and ipratropium (Fig. 1). The BVT action plan was used whenever the care giver judged that an ED presentation was warranted. If there was no response to salbutamol or if the child was needing treatment more often than 2 hourly before the commencement of BVT, the care giver was instructed to attend the hospital or call an ambulance. The children were followed up regularly by a doctor and an asthma nurse for at least 12 months after implementation of BVT. The primary outcome was an adverse event defined as intensive care admission or intravenous asthma medication use due to a delay in presentation to ED following use of BVT at home. Paired t test was used to compare ED and hospital admission outcomes 12 months pre- and post-BVT use. The majority of children (27/32, 85%) were successfully given BVT at home; four children did not get BVT due to no severe exacerbations during the observation period, and one care giver forgot to use BVT (Fig. 1). There was one report of an extra dose of salbutamol given inadvertently but no reports of an adverse event. BVT was associated with preventing an ED presentation on average 54% of occasions and reduced ED presentations by −3.56 (95% confidence interval −4.94, −2.19) and hospital admissions by −2.88 (95% CI −4.06, −1.69). While we are unable to determine whether the reduction in ED and hospital use is in part due to the Complex Asthma Service and/or the natural history of asthma, this pilot study supports the safety and feasibility of BVT use at home with promising efficacy. Further evaluation with a randomised controlled trial is now warranted. Ethics approval was granted by the Royal Children's Hospital Human Research Ethics Committee (QA/57445/RCHM-2019).