Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in the prevalence of asthma

Background: During the past 15 years, the prevalence of asthma in children in Sweeden has doubled. However, since, 1985, antiyinflammatory treatment with inhaled steroids has increased continuously. Objective: The aim of this study was to analyze the net effect of these changes in terms of hospitalization of children for treatment of asthma. Methods: The numbers of hospital days, admissions, and individual patients admitted to the Children's Hospital in Goteborg because of acute asthma were recorded from 1985 through 1993. All the in-patient treatment of children is centralized at this hospital (i.e., the study was population-based). Goteborg has half a million inhabitants. Hospitalization policies were not altered during the study period. Results: In children aged 2 to 18 years, the number of hospital days per year gradually decreased to less than a third (r = 0.9; p < 0.001), and admissions decreased by 45% (r = 0.7; p < 0.05). The decrease in hospitalization was most marked in the group older than the age of 5 years in which hospital days were reduced to one fifth (r = 0.9; p < 0.0001) and admissions were halved (r = 0.8; p < 0.05). A decreasing trend in number of hospital days was also seen in the 2- to 5-year-old group. The number of individual patients admitted did not show a statistically significant decreasing trend. In children under the age of 2 years, the number of hospital days fluctuated, and there was no clear-cut change with time. Conclusion: Although increased concentration on the education of patents and patients may have been a contributing factor, the major reason for the decrease in hospitalization in the group of children aged 2 to 18 years is most probably antiinflammatory treatment with inhaled steroids. The results suggest that this is a very cost-effective therapeutic approach.