How are we treating severe childhood asthma in Australasia?

Grant ID: EMSS-273R27-2017

Project Summary

Most children with asthma presenting to an emergency department (ED) are managed with inhaled medications and oral steroids. Infrequently, those children that are very unwell may require assistance with their breathing, or intravenous medication. Currently, there is minimal information to guide clinicians on which treatment to choose for severe acute asthma. It is not known which is most effective and all have side-effects. Studies demonstrate significant variation in practice, while existing Australasian data is approximately 10 years old.

This project aims to determine current management practices for children with severe acute asthma and/or wheeze; how common the condition is, how frequently complications occur; and to understand differences in therapy between states and regions across Australia and New Zealand. When comparing treatments, it is important to determine the ability to reduce the risk of severe complications, or the difference in treatment outcomes. Once complete, this project will inform future research that will help to establish the best treatments for severe asthma.

This study is being run by the PREDICT network and its Chief Investigator is A/Prof Simon Craig. The EMF is funding Queensland sites taking part. The overall study will include 18,000 children aged between 1 and 18 years being treated for asthma in the ED.

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Outcomes

Each Queensland site was able to collect patient data to answer the study questions and identify the proportion of children receiving IV medications or respiratory support for asthma.

Early data still needs to be collated with the overall PREDICT Study, however researchers were able to determine that treatment escalation varied between hospitals, and that admission rates ranged considerably from as little as 1.1 per cent of patients to over 50.8 per cent.

Once data from all participating hospitals across Australia and New Zealand is interpreted, the results are expected to inform the way clinicians change clinical practice.

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Dissemination

Gray, C.S., Powell, C.V., Babl, F.E., Dalziel, S.R. and Craig, S., 2019. Variability of outcome measures in trials of intravenous therapy in acute severe paediatric asthma: a systematic review. Emergency Medicine Journal, 36(4), pp.225-230.

Craig, S., Powell, C.V., Nixon, G.M., Oakley, E., Hort, J., Armstrong, D.S., Ranganathan, S., Kochar, A., Wilson, C., George, S. and Phillips, N., 2022. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ Open Respiratory Research, 9(1), p.e001137.

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