Children who have frequent emergency department (ED) visits because of asthma may be able to avoid hospitalisation by using ‘burst therapy’ with high dose inhaled salbutamol at home, Victorian clinicians have shown.
In a pilot study, doctors at the Royal Children’s Hospital in Melbourne have shown that the standard hospital management approach for acute asthma, ‘burst therapy’ can be safely delivered by carers of children in the home setting.
Burst therapy involves giving six puffs of a salbutamol puffer and four of ipratropium at twenty minute intervals for an hour during an exacerbation.
A ‘Burst Ventolin Therapy Action Plan’ was provided by the hospital’s Complex Asthma Service to 32 caregivers of children (mean age 3.8 years) who had asthma and a record of at least five ED presentations or hospital admissions for asthma. Caregivers were advised to provide burst therapy whenever they judged that the child would need to go to ED.
Almost all the children (85%) were able to receive burst therapy successfully, with four not needing it because they did not have a asthma exacerbation.
On more than half the occasions (54%) when it was used burst therapy prevented an ED presentation. In the 12 months after it was introduced, burst therapy reduced the number of ED presentations by an average of 3.56 compared to the previous 12 year, and reduced hospital admissions by an average of 2.88 compared to the pre-burst therapy period.
The use of burst therapy was not associated with any adverse events such as intensive care admission or intravenous asthma medication use due to a delay in presentation to ED.
“While we are unable to determine whether the reduction in ED and hospital use is in part due to the Complex Asthma Service and/or the natural history of asthma, this pilot study supports the safety and feasibility of [Burst Ventolin Therapy] use at home with promising efficacy,” the clinicians concluded in the Journal of Paediatrics and Child Health.