Abstract
BackgroundPreschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years.The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center.MethodsThis is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at “Io e l’Asma center”, Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention.ResultsA total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage.ConclusionsThe results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.
Highlights
Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children
Since children aged less than 6 years with wheezing illnesses are at high risk of impaired lung growth and pulmonary function in childhood and adulthood [5], early diagnosis and treatment of wheezing is essential in preschool children mild persistent asthma of recent onset for reducing morbidity by decreasing the risk of severe exacerbations and improving control [10]
In a series of previous publications, we described the successful diagnostic and therapeutic outcomes of patient management of adolescent and teen-age patients with asthma using a pediatric self-management program that we developed in Italy referred to as the Diagnostic Therapeutic Educational Pathway (DTEP) [11,12,13,14,15]
Summary
Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center. Recurrent wheezing in children aged 5 years or younger is one of the most common chronic childhood symptoms and the main reason for consumption of pediatric health resources in Western countries, as measured by emergency department visits and hospitalizations [1]. Some studies showed that preschool children with clinically-diagnosed asthma have higher rates of emergency department visits and hospitalization and consume more resources for asthma management than those aged 6 years or older [7,8,9]. Since children aged less than 6 years with wheezing illnesses are at high risk of impaired lung growth and pulmonary function in childhood and adulthood [5], early diagnosis and treatment of wheezing is essential in preschool children mild persistent asthma of recent onset for reducing morbidity by decreasing the risk of severe exacerbations and improving control [10]
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