ROLE OF RESIDENTIAL-TREATMENT CENTERS IN THE CARE OF INNER-CITY CHILDREN WITH INTRACTABLE ASTHMA

Background: It is known that some children with intractable asthma do well when placed in residential treatment centers. Methods: We retrosp ectively reviewed medical records of all patients referred to a reside ntial facility (St. Mary's Hospital for Children, Brooklyn NY) from ou r large inner city hospital asthma clinic (King's County Hospital at B rooklyn) for intractable asthma for 12 years (1984-1995). Children wit h other underlying complicating factors such as bronchopulmonary dyspl asia, congenital heart disease, congenital lung malformations, and cys tic fibrosis were excluded. Total number of patients was 12 (M:F; 7:5) , median age 12 years (range 5-13), median duration of stay 12 months (range 6 months-18 months). Number of hospital admissions, emergency r oom visits and pediatric intensive unit admissions were compared for 2 years, before placement and after discharge after residential treatme nt center. Results: Median hospital admission/patient before placement at residential treatment center (9.0 +/- SD 3.8) was significantly di fferent than after discharge (1.0 +/- SD 1.91) (p < .0002). Median eme rgency room visit/patient before placement at residential treatment ce nter (20.50 +/- SD 11.12) was significantly different than after disch arge (3.00 +/- SD 3.14) (p < .0002). Eight children had at least one p ediatric intensive care unit (PICU) admission (2 received mechanical v entilation), before placement at residential treatment center whereas no one was admitted to PICU after discharge. Nine out of 12 children w ere on maintenance oral steroids before residential placement, mean do se (mg/every other day) 26.2 +/- SD 15.3 as compared to only 3 childre n after discharge, mean dose (mg/every other day) 2.9 +/- SD 6.0 (p < .02). Conclusion: We conclude that inner city children with intractabl e asthma can benefit from placement at residential treatment center an d improvement lasts for at least 2 years after discharge. This may be because of improved compliance and better asthma education.