Asthma (Emergency Department and Inpatient)

Pathway Background and Objectives

In the United States, asthma affects 7 million children under 18 years. In 2010, 58.3% of children with asthma had at least one asthma attack in the previous twelve months. Nearly 20% of children diagnosed with asthma went to an ED for care in 2009. Asthma is the third¬ ranking cause of hospitalization for children and one of the leading causes of school absenteeism, approximately 12.8 million school days. Less than half of all children with asthma have an asthma action plan. Clinical pathways for asthma can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.

The objectives of this pathway are to:

• Standardize management of patients presenting with asthma exacerbation
• Ensure safe transfer of patients from the Emergency Department to Inpatient Unit
• Ensure all patients are discharged with a completed asthma home treatment plan
• Ensure that all eligible patients are started on a daily inhaled corticosteroid

Algorithm

• Asthma Emergency Department Pathway Algorithm – Updated March 14, 2023
• Asthma Inpatient Pathway Algorithm – Updated October 26, 2022

For management of this condition in primary care, see CLASP/Co-Management guideline

Quality Metrics

ED

• Percentage of eligible patients treated per pathway
• Percentage of patients treated for asthma in the ED who are admitted as inpatient or placed in observation status
• Average time from arrival to administration of systemic steroids
• LOS for patients discharged from the ED (hours)
• Number of transfers to the Pediatric Intensive Care Unit within 12 hours of admission
• Returns to the ED (treat and release) within 48 hours with asthma diagnosis
• Returns to the ED (treat and release) within 7 days with asthma diagnosis

Inpatient

• Percentage of eligible patients treated per pathway
• Percentage of patients with order set use
• Percentage of patients > 5 years of age discharged with a prescription for controller medication
• Percentage of patients who were given a complete asthma home treatment plan
• Mean length of stay (days)
• Readmissions within 7 days
• Readmissions within 30 days

Educational Module

Download Asthma Educational Module – Updated March 14, 2023

Key References:

• Miller AG, Breslin ME, Pineda LC, Fox JW. An asthma protocol improved adherence to evidence-based guidelines for pediatric subjects with status asthmaticus in the emergency department. Resp Care. 2015;60(12):1759–64.
• Carroll CL, Sekaran AK, Lerer TJ, Schramm CM. A modified pulmonary index score with predictive value for pediatric asthma exacerbations. Ann Allergy Asthma Immunol. 2005 Mar;94(3): 355-59.
• 2018 Global Initiative for Asthma Report, Global Strategy for Asthma Management and Prevention.
• Asthma Care Quick Reference: Diagnosing and Managing Asthma. National Institutes of Health and National Heart, Lung, and Blood Institute, 2011.
• 2020 Focused Updates to the Asthma Management Guidelines: Clinician’s Guide. NIH Publication No. 20-HL-8141, December 2020.

Pathway Contacts

Kristin Welch, MD
Eric Hoppa, MD
Anand Sekaran, MD
Christina Giudice, APRN
Alexander Hogan, MD

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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