The results of a study conducted by Dr. Francine Ducharme, Professor in the Departments of Pediatrics and Social and Preventive Medicine at the University of Montreal, published in the medical journal The Lancet Respiratory Medicine, confirm that respiratory viral detection, not child's age, explains the high rate of hospitalization for asthma attacks in children under six.
The management of asthma attacks in preschoolers has been the subject of much recent debate. The results of a study published in 2009 had shaken the pediatric world. The study reported that preschool children with viral-triggered flare-ups did not respond to standard treatment and, suggesting that this was due to their young age. Such finding was particularly worrisome as the majority of asthma-related emergency room visits and hospitalizations involve preschool children.
However, the results of Dr. Ducharme and her team show that age does not come into play. Independently of attack severity and symptoms between attacks, it is rather the presence of respiratory viral infection or fever triggering the attack that is more often associated with treatment failure, i.e., higher hospitalization rates, more returns to the emergency room, and reduced speed of recovery over the 10 days after discharge. Viral detection occurred more frequently in preschoolers (67%) than in older children (46%) with asthma. Still, the results confirm the overall effectiveness of standard treatment, when adjusted to the severity of the attack assessed by the PRAM score and administered early, in the vast majority of children, regardless of age and viral detection.
"With the new school upon us and September being the busiest month of the year for emergency room visits for asthma attacks, the good news for parents is that standard treatment works well for the majority of children, regardless of their age," said Dr. Ducharme, who is also Director of Clinical Research and Knowledge Translation at the Research Institute and Director of the Asthma Clinic of the Sainte-Justine University Health Centre.
The results of the study now open the door for exploring the best ways to prevent asthma attacks caused by viral infection in young children with asthma.
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Francine M Ducharme et al, Factors associated with failure of emergency department management in children with acute moderate or severe asthma: a prospective, multicentre, cohort study, The Lancet Respiratory Medicine (2016). DOI: 10.1016/S2213-2600(16)30160-6