262 - Clinical Outcomes of Patients with Acute Asthma Exacerbation Treated with Nebulizer versus Metered-Dose Inhalers in the Pediatric Emergency Department after the Emergence of the COVID-19 Pandemic
Resident NYU Grossman School of Medicine Bellevue Hospital Center New York, New York, United States
Background: While nebulizers have historically been the preferred treatment modality for acute asthma exacerbation in the Pediatric Emergency Department (PED), studies have shown that medications given by nebulizers and metered-dose inhalers (MDI) with spacers are equally effective. However, since the onset of the COVID-19 pandemic, there has been an increase in MDI use to avoid viral aersolization and airborne transmission. Symptoms of acute asthma exacerbation and SARS-CoV-2 infection may overlap and may be difficult to differentiate.
Objective: We aim to identify changes in clinical outcome in pediatric patients with symptoms of acute asthma exacerbation treated with nebulized medications versus MDI before and after the onset of the COVID-19 pandemic.
Design/Methods: This study is a retrospective chart review from two urban, inner-city, public hospitals. Patients under 21 years-old who presented to the PED between February 1 and June 30, 2020 with the following ICD-10 codes were identified: asthma, wheezing, reactive airway disease, shortness of breath, or difficulty breathing. Patients must have a documented asthma diagnosis, and received treatment via nebulizer, MDI, or both while in the PED. Patients were divided into two groups: those who presented between February 1 and February 29, 2020 (Pre-COVID), and those between March 1 and June 30, 2020 (During-COVID). Primary outcome is patient disposition after treatment. Secondary outcomes include medication delivery modality, PED length of stay, presenting symptoms, and PED return visits within 7 days. Mann-Whitney and Chi-square tests were used for statistical comparison.
Results: 160 charts were reviewed. No significant differences were detected in PED length of stay (157 hours to 153 hours, p = 0.70), 7-day PED return rates (13.4% to 8.6%, p = 0.03), or hospital admission rates (3% to 3.2%, p = 0.93), but there was a significant increase in MDI use (1.5% to 35.5%, p = <0.01) and decrease in nebulizer use (97% to 57%, p = <0.01) between the Pre- and During-COVID groups. This indicates that, while there was increased use of MDI over nebulizers since the emergence of COVID-19, there were no significant differences in clinical outcome. Conclusion(s): Despite the increased use of MDIs over nebulizers for management of acute asthma exacerbation in the PED, we did not identify significant differences in clinical outcomes in these pediatric patients since the emergence of COVID-19.
Patient Characteristics, Treatments, and Disposition
Authors/Institutions: Gabrielle Pyronneau, Bellevue Hospital Center, New York, New York, United States; Erin Alpert Rathauser, Bellevue Hospital Center, New York, New York, United States; Motoki Yasuda, Harlem Hospital Center, New York, New York, United States; Xinming Wu, Harlem Hospital Center, New York, New York, United States; David Mortel, Harlem Hospital Center, New York, New York, United States; Ee T. Tay, Bellevue Hospital Center, New York, New York, United States