Nurse-Led treatment strategy based on asthma score and oxygen requirement in children with acute reversible bronchoconstriction: A randomised controlled non-inferiority trial.

In 30 seconds

This multicentre, open-label, randomised non-inferiority trial compared nurse-led treatment guided by the oxygen-adjusted Childhood Asthma Score (CAS O2) with the standard CAS protocol in children aged 2–18 years hospitalised with acute reversible bronchoconstriction and requiring supplemental oxygen. Among 132 children, median length of stay was 40.0 hours with CAS O2 and 40.8 hours with CAS; the adjusted difference was -3.7 hours (95% CI -10.2 to 4.1), meeting the prespecified non-inferiority criterion. CAS O2 was also associated with fewer bronchodilator administrations, with no detected difference in reported safety outcomes.

Key findings

• Median length of stay was 40.0 hours (IQR 25.5-47.0) with CAS O2 and 40.8 hours (IQR 27.1-65.2) with CAS.
• The adjusted absolute difference in length of stay (CAS O2 - CAS) was -3.7 hours (95% CI -10.2 to 4.1), meeting non-inferiority.
• Mean bronchodilator administrations were 7.9 with CAS O2 versus 10.5 with CAS (rate ratio 0.75, 95% CI 0.64-0.88; p < 0.001).
• Physician assessments, intravenous magnesium sulphate or salbutamol, PICU transfer, and 7 day readmission did not differ between groups.

Why it matters

Oxygen requirement can affect assessment of children admitted with acute reversible bronchoconstriction. This trial suggests that incorporating oxygen use into a nurse-led scoring pathway can maintain non-inferior length of stay while reducing bronchodilator administrations. The findings are relevant to evaluating structured inpatient pathways for children receiving supplemental oxygen, while safety outcomes should be interpreted in the context of the trial population and setting.

What to keep in mind

The trial was open-label and conducted in two Dutch teaching hospitals, which may limit generalisability to other settings.