Emergency Admissions For Asthma Research Articles

Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England.

There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO2) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO2. We aimed to investigate how daily NO2 estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England. We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0-14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO2 levels were predicted at the patients' place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses. For each 10 µg/m³ increase in NO2 exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO2 average (mean lag 0-4) (OR 1.08, 95% CI 1.06-1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07-1.12) and during the cold season (OR 1.10, 95% CI 1.08-1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region. Short-term exposure to NO2 was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.

Using quality improvement to tackle the triple aim for children and young people with asthma: improving outcomes, experience and costs

Background/Aims Asthma in children and young people represents a substantial burden to the healthcare system, with these patients requiring frequent emergency care and having poorer health outcomes, leading to high system costs and poor patient experiences. This study used quality improvement methodology to achieve the triple aim of improved outcomes, better experience and reduced costs for those aged 0–16 years with asthma in north east London. Methods A multidisciplinary project team used quality improvement methods to implement and assess two interventions: a community high-risk asthma clinic and educational asthma-friendly school groups, both of which were delivered by a specialist asthma nurse. Population-level outcomes included asthma control test scores, accident and emergency department admissions and costs. Intervention-specific outcomes included number of clinic consultations delivered, did-not-attend rates and participant confidence ratings following the school sessions. Results Accident and emergency admissions for asthma reduced by 52%, with a 50% reduction in average monthly acute care costs. Asthma control test scores improved significantly, from an average of 18.56 to 22.34 out of a maximum score of 25 (P=0.000) following the interventions. Participants in the asthma-friendly school groups reported increased confidence in both day-to-day and emergency asthma management at the end of their sessions. Conclusions Having dedicated specialist asthma nurse input in the community and using school-based interventions can help to improve asthma care for children and young people, reducing the burden of frequent accident and emergency department admissions. Using quality improvement methods in pursuit of triple aim outcomes can help teams to work towards a shared goal.

Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data

In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. None.

Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

BackgroundThe COVID-19 pandemic’s impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading...

Household energy efficiency and health: Area-level analysis of hospital admissions in England

IntroductionFuel poverty affects up to 35% of European homes, which represents a significant burden on society and healthcare systems. Draught proofing homes to prevent heat loss, improved glazing, insulation and heating (energy efficiency measures) can make more homes more affordable to heat. This has prompted significant investment in energy efficiency upgrades for around 40% of UK households to reduce the impact of fuel poverty. Despite some inconsistent evidence, household energy efficiency interventions can improve cardiovascular and respiratory health outcomes. However, the health benefits of these interventions have not been fully explored; this is the focus of this study. MethodsIn this cross sectional ecological study, we conducted two sets of analyses at different spatial resolution to explore population data on housing energy efficiency measures and hospital admissions at the area-level (counts grouped over a 3-year period). Housing data were obtained from three data sets covering housing across England (Household Energy Efficiency Database), Energy Performance Certificate (EPC) and, in the South West of England, the Devon Home Analytics Portal. These databases provided data aggregated to Lower Area Super Output Area and postcode level (Home Analytics Portal only). These datasets provided measures of both state (e.g. EPC ratings) and intervention (e.g. number of boiler replacements), aggregated spatially and temporally to enable cross-sectional analyses with health outcome data. Hospital admissions for adult (over 18 years) asthma, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) were obtained from the Hospital Episode Statistics database for the national (1st April 2011 to 31st March 2014) and Devon, South West of England (1st April 2014 to 31st March 2017) analyses. Descriptive statistics and regression models were used to describe the associations between small area household energy efficiency measures and hospital admissions. Three main analyses were undertaken to investigate the relationships between; 1) household energy efficiency improvements (i.e. improved glazing, insulation and boiler upgrades); 2) higher levels of energy efficiency ratings (measured by Energy Performance Certificate ratings); 3) energy efficiency improvements and ratings (i.e. physical improvements and rating assessed by the Standard Assessment Procedure) and hospital admissions. ResultsIn the national analyses, household energy performance certificate ratings ranged from 37 to 83 (mean 61.98; Standard Deviation 5.24). There were a total of 312,837 emergency admissions for asthma, 587,770 for COPD and 839,416 for CVD. While analyses for individual energy efficiency metrics (i.e. boiler upgrades, draught proofing, glazing, loft and wall insulation) were mixed; a unit increase in mean energy performance rating was associated with increases of around 0.5% in asthma and CVD admissions, and 1% higher COPD admission rates. Admission rates were also influenced by the type of dwelling, tenure status (e.g. home owner versus renting), living in a rural area, and minimum winter temperature. DiscussionDespite a range of limitations and some mixed and contrasting findings across the national and local analyses, there was some evidence that areas with more energy efficiency improvements resulted in higher admission rates for respiratory and cardiovascular diseases. This builds on existing evidence highlighting the complex relationships between health and housing. While energy efficiency measures can improve health outcomes (especially when targeting those with chronic respiratory illness), reduced household ventilation rates can impact indoor air quality for example and increase the risk of diseases such as asthma. Alternatively, these findings could be due to the ecological study design, reverse causality, or the non-detection of more vulnerable subpopulations, as well as the targeting of areas with poor housing stock, low income households, and the lack of “whole house approaches” when retrofitting the existing housing stock. ConclusionTo be sustainable, household energy efficiency policies and resulting interventions must account for whole house approaches (i.e. consideration of the whole house and occupant lifestyles). These must consider more alternative ‘greener’ and more sustainable measures, which are capable of accounting for variable lifestyles, as well as the need for adequate heating and ventilation. Larger natural experiments and more complex modelling are needed to further investigate the impact of ongoing dramatic changes in the housing stock and health. Study implicationsThis study supports the need for more holistic approaches to delivering healthier indoor environments, which must consider a dynamic and complex system with multiple interactions between a range of interrelated factors. These need to consider the drivers and pressures (e.g. quality of the built environment and resident behaviours) resulting in environmental exposures and adverse health outcomes.

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis.

Access to general practices may be an important determinant of emergency admissions for asthma, as early treatment of exacerbations has been shown to prevent deterioration. To determine whether access to primary care is associated with emergency admissions for asthma. Cross-sectional analysis of data from English practices in 2010-2011. Negative binomial regression was used to explore the associations between emergency admissions for asthma and seven measures of patient-reported access to general practice services taken from the GP Patient Survey, controlled for the characteristics of practice populations. Incidence rate ratios (IRR) were calculated for each association. In total 7806 (95%) of practices had data for all variables. There were 3 134 106 patients with asthma, and there were 55 570 emergency admissions with asthma. Admission rates were lower in practices with a higher composite access score (adjusted IRR for 10% change in variable 0.679, 95% CI = 0.665 to 0.708). Admissions were higher in those practices with higher proportions of the practice population who were white, and in practices with lower performance in the Quality and Outcomes Framework indicator 'asthma review in past 15 months' (Asthma 6). Assuming these associations were causal, a higher access score of 10% was associated with a decrease of 17 837 admissions per year for these practices. Practices with higher patient-reported access had lower rates of emergency admissions for asthma. Policymakers should consider improving access to primary care as one potential way to help prevent emergency hospital admissions for asthma.

Prediction of the impact of air pollution on rates of hospitalization for asthma in Shiraz based on air pollution indices in 2007-2012

Objectives: This study was designed to determine the effects of air pollutants on emergency admissions for asthma, and to forecast the disease burden in Shiraz, Iran. Methods: The average daily concentrations of fine particles (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (O3) were calculated from data reported by two air quality monitoring stations in Shiraz from the beginning of 2007 to mid-2012. Results: The numbers of patients admitted with asthma attack during this period were collected from four main university-affiliated hospitals. Admissions correlated strongly with the levels of PM10, SO2, CO and O3 during warm seasons (P<0.001), and with NO2 level during cold seasons (P<0.001). We forecast increasing trends in air pollutants and patient admissions in the year 2015. Conclusion: Our findings are further evidence of the effects of air pollutants on asthma exacerbations.

G138(P) Designing a Behavioural-Educational Intervention Using Intervention Mapping to Reduce the High Rates of Paediatric Asthma Hospital Admissions in an Inner-City Area of Birmingham

AimTo develop asthma self-management programme working with children and families to prevent paediatric asthma emergency admissions in order to provide effective care and promote behaviour change (BC) towards effective management.MethodAn...

Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults: a population-based study

BackgroundComprehensive smokefree laws have now been introduced in several jurisdictions. Few studies have examined the association between smokefree laws and asthma in adults and these have limitations, such as lacking...

OP54 Short-Term Impact of the Smokefree Legislation in England on Hospital Admissions for Asthma Among Adults

BackgroundComprehensive smokefree laws prohibiting smoking in enclosed public places and workplaces have now been introduced in several jurisdictions and there is a growing body of evidence documenting the immediate health...

Acute effects of air pollution on pediatric asthma exacerbation: Evidence of association and effect modification

We investigated the short-term effects of particulate matter with aerodynamic diameter <10 μg/m 3 (PM 10), sulfur dioxide (SO 2), nitrogen dioxide (NO 2) and ozone (O 3) on pediatric asthma emergency admissions in Athens, Greece over the period 2001–2004. We explored effect modification patterns by season, sex, age and by the presence of desert dust transported mainly from the Sahara area. We used daily time-series data provided by the children's hospitals and the fixed monitoring stations. The associations were investigated using Poisson regression models controlling for seasonality, weather, influenza episodes, day of the week and holiday effects. A 10 μg/m 3 increase in PM 10 was associated with a 2.54% increase (95% confidence interval (CI): 0.06%, 5.08%) in the number of pediatric asthma hospital admissions, while the same increase in SO 2 was associated with a 5.98% (95% CI: 0.88%, 11.33%) increase. O 3 was associated with a statistically significant increase in asthma admissions among older children in the summer. Our findings provide limited evidence of an association between NO 2 exposure and asthma exacerbation. Statistically significant PM 10 effects were higher during winter and during desert dust days, while SO 2 effects occurred mainly during spring. Our study confirms previously reported PM 10 effects on emergency hospital admissions for pediatric asthma and further provides evidence of stronger effects during desert dust days. We additionally report severe effects of SO 2, even at today's low concentration levels.

Short-term effect of pollen exposure on antiallergic drug consumption

Several studies have investigated the association between pollen exposure and asthma emergency admissions, but only 2 have investigated the effect of airborne allergens on consultations for rhinitis or conjunctivitis and none has used drug consumption as the health indicator. To analyze the short-term association between pollen exposure and antiallergic drug consumption in the urban area of Clermont-Ferrand, France, taking into account the potentially confounding effect of air pollution and meteorological factors. We used the French health insurance database to select all individuals from the Clermont-Ferrand urban area having benefited from reimbursement for antiallergic treatment from January 1, 2000, through December 31, 2001, and from January 1, 2003, through December 31, 2004. An episode of treated allergic rhinitis, rhinosinusitus, or conjunctivitis (ARC) was defined as the association of an oral antihistamine and a local antiallergic drug on the same prescription. The relations between daily changes in pollen concentrations and daily changes in the number of treated ARC cases were analyzed using a Poisson regression model with penalized spline functions. The risk of treated ARC associated with an interquartile increase in pollen concentration increased significantly for Poaceae (5%, P < .001), Fraxinus (7%, P < .001), Betula (7%, P < .001), and Corylus (2%, P < .02). This increase was significant in all age groups for Poaceae and Fraxinus pollen and in people younger than 65 years for Betula pollen. The effect was mainly concentrated on the present day, except for Poaceae pollens, for which the risk remained significantly (P < .001) increased until 3 days lag time. This study showed a significant increase in treated ARC cases related to Poaceae, Fraxinus, and Betula. Specific risks are difficult to evaluate for species that share the same pollination period. Time-series studies based on drug consumption are useful to highlight and to supervise pollen-related diseases requiring ambulatory care.

Traffic air pollution and hospital admission for asthma: a case–control approach in a Turin (Italy) population

This study investigated the relationship between traffic air pollution and asthma, using a case-control design applied to routinely collected data. Subjects resident in Turin during the period 1997-1999 and admitted for asthma were defined as cases; patients admitted for causes other than respiratory diseases or heart diseases were defined as controls. Nitrogen dioxide and total suspended particulate were considered as indicators of traffic air pollution. Statistical analysis were performed, separately for young (0-14 years), adult (15-64 years) and elderly (>64 years) patients, with a logistic regression model; results are expressed as percentage of risk modification for a 10 g/m(3) increase in exposure to pollutants. The risk of emergency admissions for asthma rose significantly with increased exposure to nitrogen dioxide [2.4%, 95% Confidence Interval: 0.5%; 4.3%], and total suspended particulate [2.3%, 95% Confidence Interval: 1.1%-3.6%]. The significant association was evident, in particular, among young and elderly patients for both pollutants. Using a case-control design both easy to use and manage, the study confirms the significant association between hospital emergency admissions for asthma and exposure to nitrogen dioxide and total suspended particulate pollutants.

Case-control study of hospital admission with asthma in children aged 5–14 years: relation with road traffic in north west London

BACKGROUNDEvidence for an association between road traffic pollution and asthma is inconclusive. We report a case-control study of hospital admissions for asthma and respiratory illness among children aged 5–14 in...

Long‐Term Home Jejunostomy Feeding of Young Children

Gastroesophageal reflux disease (GERD) is a motility disorder that occurs more frequently in children with neurological disease and in children with congenital esophageal anomalies or diaphragmatic hernia. Feeding difficulties and asthma may be caused by GER. Pharmacological and surgical treatment are successful in most cases. The authors describe 6 children with severe GER and asthma, who were treated with long‐term jejunostomy feeding. Median length of treatment was 6 months (range, 5–12), for a total of 44 months. The parents were trained to replace dislodged jejunostomy tubes. All replacements of tubes at home by the parents were successfully carried out. Vomiting and emergency admissions for asthma were decreased in all children.

Analysis of the relationships between environmental factors (aeroallergens, air pollution, and weather) and asthma emergency admissions to a hospital in Mexico City.

There have been several studies of the relationships between environmental factors, particularly air pollution, and attacks of asthma. Most of these studies have ignored the potential confounding effects of aeroallergens such as pollens and fungal spores. We report a statistical analysis of the relationships between emergency admissions for asthma to a hospital in Mexico City and daily average airborne concentrations of pollen, fungal spores, air pollutants (O3, NO2, SO2, and particulates) and weather factors. Asthma admissions had a seasonal pattern with more during the wet season (May-October) than the dry season (November-April). There were few statistical associations between asthma admissions and air pollutants for the three age groups studied (children under 15 years, adults, and seniors [adults over 59 years]) in either season. Grass pollen was associated with child and adult admissions for both the wet and dry seasons, and fungal spores were associated with child admissions during both the wet and dry seasons. The analysis was done with environmental data averaged over the day of admission and the 2 previous days. Our results suggest that aeroallergens may be statistically associated more strongly with asthma hospital admissions than air pollutants and may act as confounding factors in epidemiologic studies.

Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project.

BACKGROUND: A study was undertaken to assess the combined association between urban air pollution and emergency admissions for asthma during the years 1986-92 in Barcelona, Helsinki, Paris and London. METHODS:...