Abstract:
:For patients whose asthma remains in poor control necessitating high utilization of medical services, a referral to a specialized "center of excellence" is often considered. A decade ago, we evaluated our pediatric asthma program of long-term hospitalization (median stay of 75 days) and found significant decreases in subjects' medical utilization following this intervention. In an effort to contain treatment costs, the former program was markedly altered to one of abbreviated stay with emphasis on family management of asthma. The purpose of the present study was to determine the outcome of children treated in the revised program with regard to disease severity, quality of life, and subsequent utilization of medical resources. Children with severe asthma who were admitted to the program and fulfilled study criteria were consecutively enrolled. Data was obtained concerning disease characteristics, treatment, and quality of life at admission, and at 1 and 2 years following discharge. Medical records for the year prior to program admission and for the 2 years following discharge were coded for medical care encounters. Ninety-eight children, aged 9 months to 18 years (mean age, 10.9 years), were enrolled. They participated in the program for a mean of 15.6 ( +/- 8 SD), median of 15.0, and range of 2-51 treatment days. The group showed significant improvement (P < 0.0001) from admission to 1- and 2-year follow-up in median corticosteroid use, asthma functional severity, perceived competence in asthma management, and quality of life for both caregiver and child. Medical record data showed significant improvement (P < 0.0001) at both 1- and 2-year follow-up in median number of corticosteroid bursts, emergency department visits, hospital days, and overall utilization of medical care encounters. A median total medical encounter cost/patient of $16,250 ($6,972-$25,714 interquartile range (IQR)) for the year prior to program participation was reduced to $1,902 ($505-$6,524 IQR) at 1-year and $690 ($185-$3,550 IQR) at 2- year follow-up (P < 0.0001). We conclude that multidisciplinary care in a short-term, outpatient, day treatment program can significantly contribute to improvement in asthma severity, quality of life, and reduction in healthcare costs.
journal_name
Pediatr Pulmonoljournal_title
Pediatric pulmonologyauthors
Bratton DL,Price M,Gavin L,Glenn K,Brenner M,Gelfand EW,Klinnert MDdoi
10.1002/ppul.1027subject
Has Abstractpub_date
2001-03-01 00:00:00pages
177-89issue
3eissn
8755-6863issn
1099-0496pii
10.1002/ppul.1027journal_volume
31pub_type
杂志文章abstract::Aspiration is common in the intubated human neonate. Thus, the ventilatory and blood gas responses to citric acid and saline instillation into different airway sites were studied in ten awake, unanesthetised lambs, breathing spontaneously via a tracheostomy tube. With a system of balloons, 1 ml of saline or citric aci...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.1950030112
更新日期:1987-01-01 00:00:00
abstract::Exercise challenge tests are helpful in the diagnosis and management of childhood asthma, but methodology is complex and time-consuming. The aim of this study was to investigate whether exercise-induced bronchoconstriction (EIB) can be predicted by the results of different surrogate tests in a pediatric population. Ei...
journal_title:Pediatric pulmonology
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doi:10.1002/ppul.20556
更新日期:2007-03-01 00:00:00
abstract::A potentially useful method to monitor respiratory mechanics in artificially ventilated patients consists of analyzing the relationship between tracheal pressure (P), lung volume (V), and gas flow (V) by multiple linear regression (MLR) using a suitable model. Contrary to other methods, it does not require any particu...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.1950130307
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:To describe the clinical course and treatment of an infant with acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation. DESIGN:Case report. SETTING:A tertiary care University-affiliated hospital. PATIENT, INTERVENTION, AND RESULTS:An 8-month-old girl de...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.21139
更新日期:2010-02-01 00:00:00
abstract::Congenital pulmonary venous stenosis (CPVS) has been previously described in older infants and children, typically manifesting as failure to thrive with congestive heart failure and subsequent respiratory deterioration. We report on 2 cases of CPVS which presented during the immediate newborn period as severe persiste...
journal_title:Pediatric pulmonology
pub_type: 杂志文章,评审
doi:10.1002/(sici)1099-0496(199910)28:4<301::aid-ppul1
更新日期:1999-10-01 00:00:00
abstract:INTRODUCTION:Chest impedance (CI) is the current standard for cardio-respiratory monitoring in preterm infants but fails to provide direct and quantitative information on diaphragmatic activity. Transcutaneous electromyography (dEMG) is able to measure diaphragmatic activity, but its feasibility and repeatability to mo...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.23116
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Treatment of bronchopulmonary dysplasia (BPD) remains as yet an unmet clinical need and recently stem cells have been proposed as a therapeutic tool in animal models. We investigated the role of amniotic fluid stem cells (AFS) in an adult rat model of hyperoxia lung injury. METHODS:Fifty Sprague-Dawley rats...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.22791
更新日期:2013-11-01 00:00:00
abstract::SUMMARY. Patients with idiopathic scoliosis are reported to have a restrictive pattern on pulmonary function tests. A case is presented of a teenage girl with juvenile idiopathic scoliosis who had evidence of airways obstruction in addition to restriction on pulmonary function tests (PFT). Examination of flow-volume l...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/1099-0496(200101)31:1<86::aid-ppul1012>3.0
更新日期:2001-01-01 00:00:00
abstract::Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior,...
journal_title:Pediatric pulmonology
pub_type: 杂志文章,多中心研究
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更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnograp...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.21451
更新日期:2011-09-01 00:00:00
abstract::Glucocorticoids are given antenatally to promote pulmonary epithelial maturation and prevent respiratory distress syndrome in premature newborns. In contrast to airway changes, effects on vessels are less documented. We hypothesized that antenatal betamethasone (BM) administration promotes vascular development. Does r...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.20870
更新日期:2008-08-01 00:00:00
abstract::Ten infants with evidence of impending respiratory failure from severe bronchiolitis were successfully treated with continuous positive airway pressure (NCPAP) with double nasal prongs. Their mean (SD) age was 6.7 (3.8) months and mean (SD) body weight was 7.1 (2.1) kg. Respiratory assessments were made immediately be...
journal_title:Pediatric pulmonology
pub_type: 临床试验,杂志文章
doi:10.1002/ppul.1950160305
更新日期:1993-09-01 00:00:00
abstract::Mucus plugging constitutes a nutrient-rich nidus for a bacterial infection that has long been recognized as a potent stimulus for neutrophilic airway inflammation driving progressive lung damage in people with cystic fibrosis (CF). However, mucus plugging and neutrophilic inflammation are already present in many infan...
journal_title:Pediatric pulmonology
pub_type: 杂志文章,评审
doi:10.1002/ppul.24462
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Juvenile dermatomyositis (JDM) is the main cause of chronic idiopathic inflammatory myopathy of autoimmune origin in children. The aim of this multicenter prospective study was to describe respiratory status and treatment of children followed for JDM. METHODS AND PATIENTS:Clinical manifestations, pulmonary ...
journal_title:Pediatric pulmonology
pub_type: 杂志文章,多中心研究
doi:10.1002/ppul.22742
更新日期:2013-10-01 00:00:00
abstract::Electronic compensation to overcome thermal artifacts during plethysmographic estimations of airway resistance is now used routinely in adults and school-age children, and was shown to be a valuable means of discriminating airway function between preschool children with and without lung disease. A similar system is no...
journal_title:Pediatric pulmonology
pub_type: 临床试验,杂志文章
doi:10.1002/ppul.20217
更新日期:2005-07-01 00:00:00
abstract::The purpose of the study was to analyze the respiratory-dependent intraarterial blood pressure variations (pulsus paradoxus, PP) in intensive care unit patients with obstructive and restrictive pulmonary disease, and to evaluate the usefulness of PP for assessment of disease severity. One-minute paper recordings of ar...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/1099-0496(200102)31:2<138::aid-ppul1022>3.
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVE:To determine the interpretative consequences of adopting the Global Lungs 2012 (GLI-2012) spirometric prediction equations in a pediatric hospital population. MATERIAL:Spirometric records from 2,192 white boys and 1,842 white girls, and 412 and 334 African-American boys and girls, respectively, aged 6.0-18.0...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.22876
更新日期:2014-02-01 00:00:00
abstract::Pneumogram (PG) recordings were performed in 87 very low birthweight (VLBW) asymptomatic infants just prior to hospital discharge to determine the relationships between: 1) a prior history of apnea of prematurity (AOP) and cardiorespiratory pattern; and 2) cardiorespiratory pattern at hospital discharge and postconcep...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.1950040204
更新日期:1988-01-01 00:00:00
abstract::Inhaled corticosteroids are commonly used in cystic fibrosis (CF), but there are few studies evaluating their safety in young children. We, therefore, prospectively administered beclomethasone diproprionate (BDP) to 12 clinically stable young children with CF to examine the safety of this therapy with respect to adren...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.1122
更新日期:2001-10-01 00:00:00
abstract::A 14-year-old Korean boy was admitted with cough, hemoptysis, and fever. A chest X-ray showed a solitary pulmonary mass and pneumonitis. Bronchial biopsy by fiberoptic bronchoscopy revealed a poorly differentiated small cell carcinoma. All of the staging information indicated that the patient had limited disease. Duri...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/(sici)1099-0496(200004)29:4<317::aid-ppul1
更新日期:2000-04-01 00:00:00
abstract::With dual energy X-ray absorptiometry (DEXA), it is possible to quantitate important aspects of growth in children with cystic fibrosis (CF), supplementing the usual measures of height and weight. Of particular concern during growth is the accumulation of bone mineral, since osteoporosis and fractures are well-recogni...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/(sici)1099-0496(199902)27:2<80::aid-ppul3>
更新日期:1999-02-01 00:00:00
abstract::Previous research has demonstrated the potential benefit derived from the combination of high frequency oscillatory ventilation and volume guarantee mode (HFOV-VG), a procedure that allows us to explore and control very low tidal volumes. We hypothesized that secondary spontaneous change in oscillation pressure amplit...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.25084
更新日期:2020-12-01 00:00:00
abstract::During the final prenatal period of fetal lung development in humans, important maturational processes occur, including the production of surfactant necessary to decrease surface tension at the air-liquid interface of the alveoli. During early gestation, the glucocorticoid receptor is expressed in the fetal lung, and ...
journal_title:Pediatric pulmonology
pub_type: 杂志文章,评审
doi:10.1002/ppul.1092
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Treatment regimens for patients with cystic fibrosis (CF) are time-consuming and complex, resulting in consistently low adherence rates. To date, few studies have evaluated innovative technologies to improve adherence in this population. Current infection control guidelines for patients with CF seek to minim...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.21164
更新日期:2010-02-01 00:00:00
abstract::In order to better understand the regulation of lung maturation by glucocorticoid-glucocorticoid receptor signaling, we studied glucocorticoid receptor (GR) hypomorphic mice with a mixed C57Bl6/129 sv background, in which disruption of exon 2 of the GR gene produces an N-terminal truncated GR protein. Four groups of m...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.20746
更新日期:2008-02-01 00:00:00
abstract::Dysfunctional swallowing is an uncommon, but important cause of bronchiectasis. We describe a child with a brainstem tumor, who developed bronchiectasis caused by chronic aspiration secondary to a dysfunctional swallow. The case highlights the importance of thorough and repeated evaluation before a diagnosis of idiopa...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.21152
更新日期:2010-02-01 00:00:00
abstract::We report the case of a 4-year-old child with an atypical presentation of an aspirated unwitnessed foreign body in the airway. During an attempt to obtain a biopsy of what appeared to be a mucosal growth, the foreign body was removed. This may be the first report of foreign body removal in a child this young, using a ...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.1950180113
更新日期:1994-07-01 00:00:00
abstract:RATIONALE OF THE STUDY:Increased neonatal fraction of exhaled nitric oxide (FeNO) is associated with lung symptoms early in life, while predictors of neonatal FeNO levels are unknown. The objective of this study was to investigate perinatal and genetic predictors of FeNO in healthy at-risk neonates. METHODS:FeNO was m...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.22958
更新日期:2015-02-01 00:00:00
abstract::Few data are known about the effects of sleep-related breathing disorders (SRBD) on the cardiovascular system in adolescents. Forty healthy adolescents (mean age, 13.7 +/- 1.6 years) answered a questionnaire regarding symptoms of sleep-related breathing disorders (SRBD) and underwent a cardiorespiratory polygraphy and...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.10303
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Our objective was to determine those characteristics associated with reversibility of airflow obstruction and response to maximal bronchodilation in children with severe asthma through the Severe Asthma Research Program (SARP). METHODS:We performed a cross-sectional analysis evaluating children ages 6 to 17...
journal_title:Pediatric pulmonology
pub_type: 杂志文章
doi:10.1002/ppul.24473
更新日期:2019-11-01 00:00:00