High burden of asthma readmission seen in preschool children

Asthma readmission is highly prevalent among preschool children, reveals an Australia study, noting the need to identify modifiable factors such as asthma management after discharge to ease the burden of hospital readmission in this population.

“Our study highlights a significant burden of hospitalization and economic burden associated with paediatric asthma readmissions in Australia,” the investigators said. “In addition, most of the children readmitted for asthma lived in socioeconomically disadvantaged areas.”

This retrospective longitudinal cohort study used linked administrative data and identified children born from 2005 to 2015 with at least one asthma hospitalization after the age of 2 years. Eligible participants were followed up for 12 months from the asthma index hospitalization. Finally, the investigators calculated the incidence rates for first readmission within 12 months and related direct medical costs.

A total of 48,217 asthma hospitalizations in children were recorded from 2007 to 2022, with 28,177 identified as asthma index hospitalizations. Of these, 21.6 percent had first asthma readmissions within 12 months, including 80 percent from the 2‒4 years age group. A significant proportion of hospitalized children came from socioeconomically disadvantaged areas. [Respirology 2025;30:871-881]

The incidence rate of first asthma readmission was 23.8 per 100 person-years overall and 28.7 per 100 person-years for children aged 2‒4 years, with the highest rate (38.3 per 1,000 person-months) occurring within 1 month. Notably, the total direct cost of readmission was AU$ 15.6 million within 1 year.

Proper care

“Hospital discharge without proper disease management, guideline-discordant asthma care, lack of education including reviewing inhaler technique, and adequate counselling during discharge have been demonstrated to influence the risk of asthma readmission within the first few months of index hospitalization,” the investigators said. [J Asthma 2014;51:1055-1060; J Asthma 2018;55:695-704]

“Written asthma action plans and reviews of their inhaler technique are the cornerstones of asthma management,” they added.

Unfortunately, only two in three children have a written asthma action plan, while more than a third do not have a review of inhaler technique. This partially explains the high asthma readmission seen in the study, according to the investigators. [https://www.abs.gov.au/statistics/health/health-conditions-and-risks/asthma/2022; J Asthma 2022;60:1-10]

Previous studies have also shown how discharge periods attended by nurses, frequent outpatient follow-up, culturally tailored asthma education, psychosocial support services, and self-care plans can lower the rate of readmissions. [Thorax 1997;52:223-228; Arch Dis Childhood 1999;80:110-114; Am J Respir Crit Care Med 2003;168:1095-1099]

Follow-up for children in primary healthcare centres following discharge might also contribute to the reduction in asthma readmission. [J Asthma 2023;60:1-12]

“Given access to GPs is decreasing, community nurses play an increasingly important role. “Hence, a community-centred, clinically connected, and continuously collaborative comprehensive asthma programme is needed in the current scenario of asthma readmission,” the investigators said. [Ann Rev Pub Health 2012;33:193-208]

“[The current] study emphasizes the need to identify modifiable factors associated with asthma readmission and develop targeted interventions such as enhanced asthma discharge care and postdischarge follow-up within 30 days of discharge, which may help in lowering the high burden of paediatric asthma hospitalization,” they added.