aeolos Sens CLINICAL STUDY Aepo8dfapos Eicnvowv aeolos KAINIKH MEAETH Allergologia et immunopathologia Sociedad Espafola de Inmunologia Clinica, Alergologia y Asma Pediatrica SEICA\P ‘wwwalkimm com SHORT COMMUNICATION OPENACCESS Assessment and management of asthma exacerbations in an emergency department unit Konstantinos Douros:*, Dafni Morikis, Olympia Sardelis, Barbara Boutopoulous», Angeliki Galanis, Vasiliki Papaevangelous, Kostas N. Priftiss.s" “ard Department of Pediatrics, “Attton” University Hostel, National and Kapodistrian Unversity of Athens, Schoo! of Meine, Athens, Greece *pedlatrce Center of Athens, Marcus), Athen, Greece Received 4 July 2022; Accepted 21 Aust 2022 ane kerworos ste fedacheprtry semen Hear ath re seta resent athena; asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in chiléren, childrens Bssessed with the PRAM Score as having mild-moderate asthma exacerbation, who were treated With salbutamol falbutamal delivered via. a metered-dose inhaler andspacer (MDI/S) PRAM; Methods: The suey. population consisted of children aged 3-16 years with mild-mederate asthma metered-dose inhaler; exacerbation. All children received tmg/kg preérisolone pc. (max 40 mg) and 46 putts f salbutamol via spacer DUS. Results: Fifty patients participated in the study. Admission was associated positively with the initial Pha score (OR: 18.91, Cl: 2.42-123.12, P= 0.005) and negatively with the Improvement in PRAM score (OR: 0.52, CI: 0.01-0.78, P= 0.032) Conclusion: PRAM ia reliable tool that can be used effectively to estimate the asthma exacerbation every. 152023 Codon Pubcatons. Published by Codon Pubications Introduction salbutamal va nebulzers remained the prevailing method in majority of the Clea astern of asta exacerbations x baseé mayan signs and SETEENEY partments (ED in Greece ard many aver prs af the werd Sink Theta espratn/aeesent esse PRdaveeencal However, he SARSCOV? pandemic athe eon of reutaton defo Oe Sim wor developed fo guide the management of eraceoasionsn the shat aibore transmission of the rus ese rendered MDS the {hiro age 217 years consts of te estimation af five components, 17 Svblablerethed or proving albtnal inthe amely wisesng, wren. conacton shrine muses, supraerma’ ‘Ts sty aimed to estate te rik of hospitalization for ci between guideline recommendations and thelr implementation tn clinical “The study population consisted of children, 3-16 years old, who visited the ED Practice affecting the actual management of exacerbations ‘STAttka Hospital trom Oclober 2020 to Februa'y 2022, with ié-maderate ‘Although salbutamol used to be delivered via nebulization, it new Ssthma,exacerbatlons defined as. an acute or subacute worsening I(9 pulse oxmety saturation (80) <9; (having receved salbucalo {he previous 6h, ee system cortasterls wi te preeus 24) throne respratary rsa ter than sta) care, mmunlope, fr metabolic eserders Al patents who Wsed te ED wih Fespratory amiaies were evaluates for inclusion and exclusion enter and Aleiere ecelved g/g pedicle po. (ax Omg) ae puts of salbutamol va WO! ands ove waiesgiing chamber fe 7, Secor Kousumtas WE Co, Theeloni Cesc eqvipped wih Both ‘Moutigiece anda Ui tears face at eaues ow presse [Sha {Sachlve an Avg sal. Each pu wat followed wih 23 dow and eso) ‘Seep nfs Westnet win elbvaral was repestec, a€70: "025m Intervals, up to three times ane according to each chide Improvement The ciel arent of enren was performed with ne Phas scare, bear the commencement ofweatmant ard then 20 min ater ‘Th study was pprore byte tkon Hospital ties Caries. mston asthe respons arate. Age, PRAM score a presentation, athe preci varabes The number of sbitanal wentent wad uted a prong forthe tne to compete remain of the exacerbation PRAM score = Bvanattwas anayaed with a Cxpropetnal azardmoael alas were ‘ipressadas medians wth 2th a 73 percentlas@25p73}andress as ‘terraos (08) orhazadrato twin corience eras ee pears, median GIST) Tea, Fai htory of asthma 8) nue Duration of symptoms fours), medan (25975) 11 6-22) 80, at presentation, median (525-975) 503,36) Number of previous epsoces 60,10) Previous adisons 20,5) Prophyactic treatment Tralee sors 8) 5 308) onteucat 08) #68) RAM (esi, 925-975) at praseotaion 335 xt measures PRAM (median, 625-975) 104 avs Petri resatoryaeeament measure score S20; Plsaoxmetry saturation Results Fite patient were asked to partcate nthe sud, anal but vee greed: Patents cincal characteris are sown #5 Ege 19) ‘here nance he facemask or erectve celery ot albtmol Twenty rine caer (G83) were clarifies av mid ane 21428) ar madera bancrsatione Seven {148 paints wore amited al of whom had 3 Iocerte exacerbation Admenon wae srosted potty wy the i Seven (9-14) mil ana four (19.0%) moderate cases ataned complete FemaionPRAM=0) wihthe weatment nthe. The tal PRAM score was oghivey esseclated with achieving complete erin nthe (HR: O.9, Cistzrd.s6, 90.005) Thee (eh) dilaren experienced a arial Sigieant ero Discussion ‘orgy rece cone eison after eset inthe ED othe need for osptalzaton, ab was shown previously. Te neatve reatinsip between te improveet fo Pah score an hespialzton i coraltent wth he observed ably ofthe PRAM sare fo detect cnialy Important Changes overtime betwoan thas tne diferent madaiies Neyerteteg ny ssungchres Seuotable(epeforms lait seul wundihe nouiece sede ae? {aeeran the ony svalale opin, Oreo he connie t characteristic sy on he Yace of very ha Salbutarol has Deen Uadlonalycevered wa nebulizer during asthna exacerbations. However, the benef of the ‘rag eingdelvereg a MOUS hve Dean long and dey recognize. Nore {pecttealy, nar bean shown ratte aomnstaton of sabutael Novis scarrelatewth sie improvements hesptataton ats fevth of say" eical saveny scares, ane eax pumoray sprzaetc Seether an tacyeard Adin oe Hs ister Honea cept he apiece rg HOS tretumert of pedarc astra exacerbations in any ED” Tis appuent ‘scotnect between evidence bases fldeneeconmmercatios ab eal brace ly to lead to poorer terapeutc resus, and ceased se of Fescurces” Tha feasons tht lina the ED sl prefer the use of ‘ebaltaers tend of H/S fore aeminstraton of alata are ot ear But prebablyretet ata ner namay an unlingnes to charge {he tenement with which they are fears Hawever wht he scene ‘Senco has fe to change wan aly impaee fom the SARS Cod ‘hua fom a convenience samp an neta randem td representative Bopulation sane are bus cant be generalize. sg, because he Study \rasconductetn an sein, we were urableto perfor ay ung uncon {estsand sea onal cefnitno asta, ‘oncisivaly, PRA Sa reable too hat canbe uses effectively inthe ED to ‘stnate asta eracerbaton sever. Funding Thistuycidnat receive ay spect tung. CConficts of Interest References