Multidisciplinary Care in Pediatric Severe Asthma: A Comparative Outcomes Analysis

The purpose of the study was to compare asthma outcomes in children with severe asthma who were treated in multidisciplinary severe asthma clinics (SACs) vs single-discipline clinics (SDCs). Longitudinal health outcomes were also evaluated in children who followed with SAC.The study population included children aged between 5 and 18 years with severe asthma. Patients with significant underlying respiratory disease other than asthma were excluded. The comparative cohort included 280 children. Fifty-six children were part of the SAC group, and 224 children were part of the SDC group. There were statistically significant differences identified for ethnicity and race. Notably, 79% of SAC patients identified as Black compared with 52% in the SCD group. There were no patients that identified as Hispanic in the SAC group compared with 10% in the SDC group.This was a retrospective cohort study that looked at health outcomes over a 12-month period. Pediatric patients that had a minimum of 2 visits to their respective clinics were included. A comprehensive analysis was performed that analyzed health care utilization, including hospitalizations and emergency department (ED) visits, in the SAC and SDC groups. Secondary outcomes were also analyzed, including systemic corticosteroids and controller prescriptions. Descriptive statistics were used to characterize the data.Most participants did not have ED visits or hospitalizations during the duration of the study. There was a significant difference between hospitalizations among the 2 groups, but not ED visits. Specifically, 21.4% of the SAC group experienced hospitalization compared with 10.3% of the SDC group; 19.6% of the SAC group had ED visits compared with 11.6% of the SDC group. Similarly, the number of ambulatory visits (4+) was greater in the SAC group (55.4%) compared with the SDC group (37.1%). There was also a higher utilization of systemic corticosteroid prescriptions in the SAC group (34%) compared with the SDC group (17%). Likewise, long-acting muscarinic antagonists, leukotriene receptor agonists, and biologic therapies were used more in the SAC patient group. In a longitudinal analysis comparing the 12-month period before participants enrolled in SAC, there was a statistically significant reduction of acute exacerbations (from 35 to 5 [P < .001], number of hospitalizations (from 21 to 1 [P < .001]), intensive care unit (ICU) admission rates (from 8 to 1 [P = .2]), and median reduction of 2 systemic corticosteroids prescribed per patient.The results highlight the importance of addressing psychosocial factors with medical care in pediatric patients with severe asthma. Despite the higher rate of health care utilization in SAC patients, benefits of multidisciplinary care were best seen over time with significant reductions in asthma exacerbations, hospitalizations, ICU admissions, and corticosteroid use.The study suggests that multidisciplinary asthma care is effective in improving long-term outcomes in pediatric patients with severe asthma. Additionally, the study demonstrates asthma disparities among different racial and ethnic groups, highlighting the need for comprehensive asthma management for equitable care. Clinicians and health systems should consider active referral of these patients to centers with these resources.