In a critical look at pediatric asthma, scientists in Thailand have found that implementing standardized hospital guidelines can significantly improve how quickly and effectively children receive treatment during severe asthma attacks. But these recommendations may come at a cost, potentially resulting in longer hospital stays and higher healthcare costs.
That assessment was outlined in the paper, “Implementation of an Institutional Asthma Care Guideline in Hospitalized Children: Effects on Clinical Outcomes and Healthcare Resource Utilization,” recently published in the Journal of Asthma and Allergy.
The research was conducted at Songklanagarind Hospital in Songkhla, Thailand, between 2016 and 2024. Investigators analyzed 220 children hospitalized for asthma exacerbations, comparing outcomes before and after the introduction of formal inpatient asthma care guidelines in 2021 as well as a revised version in 2023.
After the guidelines were introduced, doctors and care teams delivered treatment more quickly and consistently, researchers noted in the study. Most notably, the time to administer the first bronchodilator (a critical medication for opening airways) dropped sharply from a median of 117 minutes before implementation to just 70 minutes after the revised protocol.
Researchers also reported that hospitals increased their use of evidence-based therapies, including nebulized steroids and high-flow nasal cannula (HFNC) oxygen support, reflecting stronger adherence to standardized care practices.
Children treated under the new guidelines showed modest but meaningful improvements in early respiratory health, the study’s authors noted. Researchers measured this using a clinical respiratory score (CRS) and found greater reductions in symptom severity within the first 24 hours of hospitalization after the guidelines were implemented.
Investigators said these findings suggest that standardizing care processes, such as when to escalate treatment or provide respiratory support, can help stabilize patients more quickly during acute asthma episodes.
The trade-off, however, could likely be higher healthcare costs via increased use of hospital resources, investigators noted. Key findings revealed:
- Length of stay increased from 47.5 hours before implementation to 67.3 hours after the revised guideline
- Hospitalization costs nearly doubled, increasing from about $249 to over $447 per admission
Researchers attributed these increases to more intensive care practices, including frequent monitoring, higher medication use and expanded reliance on advanced respiratory support like HFNC.
Importantly, the study’s authors found no significant differences in two key outcomes:
- ICU admission rates remained low across all phases
- 30-day readmissions or complications did not significantly change
This suggests that although care became more standardized and responsive, it did not necessarily reduce the likelihood of the most severe complications or short-term relapse rates, researchers noted.
To continue to refine asthma care, researchers said future efforts may focus on optimizing when and how advanced therapies are used as well as developing strategies to safely reduce hospital stays without compromising patient outcomes.
