Abstract
Background It is known that some children with intractable asthma do well when placed in residential treatment centers. Methods We retrospectively reviewed medical records of all patients referred to a residential facility (St. Mary's Hospital for Children, Brooklyn NY) from our large inner city hospital asthma clinic (King's County Hospital at Brooklyn) for intractable asthma for 12 years (1984-1995). Children with other underlying complicating factors such as bronchopulmonary dysplasia, congenital heart disease, congenital lung malformations, and cystic fibrosis were excluded. Total number of patients was 12 (M:F; 7:5), median age 12 years (range 5-13), median duration of stay 12 months (range 6 months-18 months). Number of hospital admissions, emergency room visits and pediatric intensive unit admissions were compared for 2 years, before placement and after discharge after residential treatment center. Results Median hospital admission/patient before placement at residential treatment center (9.0 ± SD 3.8) was significantly different than after discharge (1.0 ± SD 1.91) (p <.0002). Median emergency room visit/patient before placement at residential treatment center (20.50 ± SD 11.12) was significantly different than after discharge (3.00 ± SD 3.14) (p <.0002). Eight children had at least one pediatric intensive care unit (PICU) admission (2 received mechanical ventilation), before placement at residential treatment center whereas no one was admitted to PICU after discharge. Nine out of 12 children were on maintenance oral steroids before residential placement, mean dose (mg/every other day) 26.2 ± SD 15.3 as compared to only 3 children after discharge, mean dose (mg/every other day) 2.9 ± SD 6.0 (p <.02). Conclusion We conclude that inner city children with intractable asthma can benefit from placement at residential treatment center and improvement lasts for at least 2 years after discharge. This may be because of improved compliance and better asthma education.
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