Abstract
Introduction: The objectives of the study were to evaluate age-related differences in asthma diagnosis and management among children hospitalized for moderate-to-severe asthma exacerbations and to examine the relationship of regular follow-up and home-based exacerbation management with clinical outcomes. Methods: This retrospective observational study included children aged 25 months to <18 years who were hospitalized for moderate-to-severe asthma exacerbations. Patients were categorized as preschool-aged (25–60 months) or school-aged (61 months to <18 years). Asthma diagnosis before hospitalization, regular follow-up, controller therapy use, caregiver education, initiation of home-based treatment, exacerbation history, and healthcare utilization were compared. Results: A total of 104 children were included. Preschool children were less likely than school-aged children to have received an asthma diagnosis before hospitalization (56.5% vs. 83.3%, p = 0.008) and were more frequently managed with diagnoses such as bronchiolitis or bronchitis. Antibiotic use before asthma diagnosis was reported in 87.5% of the cohort. Patients attending regular follow-up had higher rates of controller therapy use, home-based exacerbation management education, and initiation of treatment at home (all p < 0.001). They also had fewer moderate-to-severe exacerbations (p < 0.001) and fewer emergency department visits (p = 0.036). Although children initiating home treatment had a greater previous exacerbation burden, they had fewer moderate-to-severe exacerbations during the preceding year than those who did not initiate treatment at home (p = 0.004). In multivariable analysis, regular follow-up remained independently associated with lower odds of recurrent moderate-to-severe exacerbations (aOR 0.03, 95% CI: 0.004–0.20; p < 0.001). Conclusion: Asthma was less often recognized before hospitalization in preschool children, and antibiotic use before diagnosis was common. Children attending regular follow-up more often received controller therapy and home-management education and had fewer moderate-to-severe exacerbations and emergency department visits. These findings highlight the importance of timely asthma recognition, regular follow-up, and practical caregiver education in children with recurrent wheezing or asthma, while the observational design precludes causal inference.