Inpatient Childhood Asthma Controller Medication Escalation and Increased Time-to-Readmission

BACKGROUND Childhood asthma readmission rates are unacceptably high. Whether increasing asthma therapy during hospitalization prevents readmission is unknown. OBJECTIVE To determine if an asthma medication escalation in children hospitalized for an asthma exacerbation is associated with increased time-to-readmission for asthma. METHODS Retrospective cohort study of children aged 5 to 17 years admitted for an asthma exacerbation at our institution from 2021 to 2023. An escalation in asthma controller medication was defined as initiation of an asthma controller, increase in step therapy, or addition of a new controller class. The primary outcome was time-to-readmission for an asthma exacerbation. RESULTS Among 986 children admitted for an asthma exacerbation, asthma medication was escalated in 33%, not escalated in 47%, and undetermined in 20%; 25% were readmitted for asthma. Children who were readmitted were younger and more likely to live in a ZIP code with high asthma rates, have public insurance, a previous emergency department visit, identify as Black, and a higher therapy on discharge than those not readmitted. In adjusted analyses (n = 790), an escalation was associated with lower risk of readmission (hazard ratio [HR] = 0.65, 95% CI  0.46–0.91, P = 0.01). In stratified analyses, an escalation was associated with a reduced HR of readmission if discharged by the pulmonary (HR = 0.43, 95% CI 0.27–0.69) but not by hospital medicine (HR = 1.05, 95% CI 0.68–1.63) service. CONCLUSION Inpatient escalation of controller therapy is associated with reduced hazard of readmission for asthma. Further studies are needed to determine optimal discharge asthma therapy management.