Refraining Aminophylline Use Increases Hospitalization Among Children with Acute Asthma: A 10-Years Retrospective Cohort Study

Asthma is a leading cause of emergency department (ED) visits and hospitalizations for children in developed countries. The study was to determine which variables and treatment protocols were associated with hospitalization among children with asthma-related ED visits. We retrospectively collected data from the clinical records of children aged 2 to 18 years who were diagnosed with asthma and treated in the ED of a referral tertiary center in southern Taiwan from June 2004 to May 2014. Regression-based analyses were performed to determine factors associated with hospital admissions, and to investigate whether administering intravenous aminophylline was associated with hospital admissions from asthma-related ED visits. A total of 2,375 patients were included in the analysis. Body weight (adjusted odds ratio [AOR]=0.97; 95% confidence interval [CI]=0.95-0.99), fever episode (AOR=1.96; 95% CI=1.47-2.60), pulse rate (AOR=1.02; 95% CI=1.02-1.03) and previous hospitalization due to asthma episode (AOR=1.39; 95% CI=1.03-1.88) were significantly associated with hospital admission among children with asthma-related ED visits during the whole study period. Hospital admission rates sharply increased from 9.9% + 3.2% in 2004-2008 to 24.3% + 2.8 % in 2009-2013. Children with a hospital admission during the second 5-year time period (2009-2013) received significantly less aminophylline treatment than those without a hospital admission in the first 5-year time period (2004-2008) (AOR=0.30; 95% CI=0.17-0.51). In conclusion, we found body weight, fever episode, pulse rate and previous hospitalization were predictive factors of hospitalization in children with asthma exacerbation at ED visits. Refrain intravenous aminophylline use may increase hospital admission among children with acute asthma.