Hospital admissions and readmissions for asthma in the age group 0-4 years

Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0- 4-year-olds, 100 patien ts (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions. To examine factors that may play a role in admissions and readmissions. histories and laboratory tests for atopic status at initial presentation, and clinical data on admission were evaluat ed. Age groups 0-1 year (n = 54) and 2-4 years (n = 46) were analyzed separ ately, of whom 20 (37%) and 9 (20%) patients, respectively, had at least on e readmission. In the age group 2-4 years, patients with antibodies against inhalant aller gens, determined by radioallergosorbent test (RAST), had a significantly hi gher risk of readmission (RR = 1.54; 95% CI, 1.22-1.95). In the age group 0 -1, year prevalence of sensitization to inhalant allergens was low (20% vs. 72% in age group 2-4 years) and constituted only a slight risk (P = 0.097) for readmission. A history of eczema showed a negative association in the age group 0-1 year. Treatment of the first admission did not differ between children only admitted once and those requiring readmission. In both age g roups, clinical features at admission did not differ significantly between first and subsequent admissions, and neither did length of stay. Number of readmissions were higher in the age group 0-1 year than in the age group 2- 4 years (27/81 (33%) vs. 9/55 (16%), P; 0.028), with no indication of a low er threshold for admission. In the age group 0-1 year. 60% of the readmissi ons occurred within 2 months of first hospitalization. Moreover, in the age group 0-1 year a trend was observed that inhaled steroids were prescribed less frequently on discharge following first admission in those children wh o were readmitted than in the children who had a first admission only (4/20 (20%) vs. 15/34 (44%), P = 0.073). More "aggressive" therapy with anti-inflammatory drugs and close medical fo llow-up after discharge seem to be indicated. (C) 2001 Wiley-Liss, Inc.