ABSTRACT
Asthma is the most prevalent chronic disease in childhood with 2.7 million under the age of 18 affected (1). It is a frequent cause of emergency department (ED) visits that often result in hospitalizations. It is estimated that there are 200,000 hospitalizations per year for asthma in the pediatric population (1). In the last few decades, hospitalization rates from asthma among children have increased from 112 per 100,000 in the early 1970s to 279 per 100,000 in the 1980s (2). Children under 4 years of age are disproportionately affected, with an average increase in hospitalization of 5.0% per year compared to 4.5% for all children age 0-17 years (3). Mortality from asthma in children under age 15 years has doubled over the same time period from an all-time low of 54 deaths in 1977 to 125 deaths in 1985 (3). These increases have occurred despite advancements in the understanding of disease pathophysiology and in the number of therapeutic modalities available (47). The reasons for these increases are still unclear (6-9). In addition to increasing hospitalization rates, relapse or return unscheduled visits by pediatric asthma patients to the ED or other health care facilities have been reported to be as high as 30% (2). From the third Multicenter Asthma Research Collaboration (MARC3), nationally representative rates for admission for approximately 750 asthmatic children from 30 states in 1997 for children ages 2-17 are 22% [20-25 confidence interval (CI)] with relapse rates of 17% in two weeks for acute asthma that presented to the ED. Neither admission nor relapse rates varied significantly with age (personal communication, C. Camargo, principal investigator for MARC3, May 1998).
