Pediatric Dyspnea Scale for use in hospitalized patients with asthma

Background

Asthma is a leading cause of pediatric hospitalizations across the country, yet no clinical instrument exists that incorporates the child's perception of dyspnea in determining discharge readiness.

Objective

We sought to develop the Pediatric Dyspnea Scale (PDS) to support discharge decision making in hospitalized asthmatic patients and to compare the performance of the PDS with traditional markers of asthma control in predicting outcomes after discharge.

Methods

Asthmatic children aged 6 to 18 years hospitalized for an exacerbation were included in the study. The PDS score, demographics, asthma severity, spirometric results, peak expiratory flow rate, and fraction of exhaled nitric oxide were assessed at the time of discharge. A telephone call 14 days after discharge determined relapse, activity limitation, asthma control, and asthma-related quality-of-life outcomes.

Results

Eighty-nine patients were enrolled, of whom 70 completed the telephone follow-up. Eight patients had a relapse, and 29 complained of limited activity. A PDS score of greater than 2 on the 7-point scale was a significant predictor of these poor outcomes, with each additional point of the PDS doubling the risk. A higher score on the PDS also correlated with worse asthma control and poor asthma-specific quality of life. The PDS performed better than FEV₁, peak expiratory flow rate, or fraction of exhaled nitric oxide in predicting the outcomes of interest.

Conclusion

The PDS, which is easy to use in children as young as 6 years of age, might be able to predict adverse outcomes after hospitalization for an asthma exacerbation and should be used as a tool to help guide inpatient discharge decisions.

Key words: Asthma, discharge, dyspnea, hospitalized, outcome, pediatric, scale, spirometry, symptoms, exhaled nitric oxide

Abbreviations used: ACT, Asthma Control Test, ATS, American Thoracic Society, CHOM, Children's Hospital of Michigan, ED, Emergency department, FeNO, Fraction of exhaled nitric oxide, ICU, Intensive care unit, ITG-CASF, Integrated Therapeutics Group–Child Asthma Short Form, NIH, National Institutes of Health, OR, Odds ratio, PDS, Pediatric Dyspnea Scale, PEFR, Peak expiratory flow rate