Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up, according to Janaki Paskaradevan, MD.

“Although asthma is one of the most common chronic childhood diseases, there is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission,” she wrote. For a paper published in Pediatric Pulmonology, Dr. Paskaradevan and colleagues evaluated the clinical care of children with critical asthma admitted to a single center PICU to determine whether pulmonary medicine consultation during admission

impacted outcomes. They conducted a retrospective chart review of 179 patients with known asthma who were aged 4-18 and had been admitted to a quaternary PICU between January 2013 and July 2019 for management of critical asthma. The median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. Among participants, 80 (44.7%) had a pulmonary medicine consultation.

 

Specialist Involvement Proved Beneficial

In the pulmonary medicine consultation group, versus the no‐pulmonary medicine consultation group, there were significant differences in hospital LOS (4.16 vs 2.86 days) and PICU LOS (2.00 v. 1.00), escalation of controller medication (66% vs 21%), scheduled outpatient pulmonology follow‐up (87.5% vs 45.4%), and receiving three or more courses of systemic steroids in the 12 months after discharge (32.2% vs 14.7%). There was no difference in attendance of scheduled follow up appointments or in having three or more ED visits or admissions in the 12 months after discharge.

“Fifty percent of patients in the no pulmonary medicine consultation group had moderate or severe persistent asthma and may have benefited from pulmonary consultation leading to escalation of therapy and scheduled follow up,” the study authors wrote. “Based on our results, we believe there is benefit to pulmonary specialist involvement in critical asthma in the PICU.

Ongoing studies will be needed, however, to determine best practices for treatment of severe asthma in the PICU, including specific criteria for pulmonary medicine or other asthma specialist consultation, and the impact of these best practices on short‐ and long‐term outcomes.”