TOPLINE:

The implementation of a new integrated care pathway for paediatric acute asthma led to an increased use of metered-dose inhalers (MDIs) with a holding chamber and improved routine severity or control documentation across paediatric emergency departments (EDs) and primary care, without an increase in ward admissions, length of stay in the paediatric ED, or 72-hour revisits.

METHODOLOGY:

• Researchers conducted a quality improvement initiative to evaluate whether the implementation of a codesigned integrated care pathway leads to improved adherence to evidence-based paediatric acute asthma care across primary care and paediatric EDs in children aged 2-14 years.
• They included 7241 acute asthma episodes from two health districts and their referring paediatric ED in Spain between 2023 and 2025, of which 4150 episodes were in the paediatric ED and 3091 were in primary care centres. The mean age of children was approximately 6.0 years in both settings; overall, 58.8% of the patients were boys.
• Acute asthma was defined as an episode of acute wheezing in a child with a prior diagnosis of asthma or previous wheezing or a first episode in a child with a personal or family history of atopy and/or a documented bronchodilator response evaluated using the pulmonary score.
• The primary outcome was the proportion of acute asthma episodes treated with salbutamol using MDIs with a holding chamber; secondary outcomes included the documentation of the pulmonary score and the assessment of persistent asthma symptoms using the Paediatric Asthma Control Tool.
• The asthma integrated care pathway was codesigned and included inputs from families and clinicians, and interventions implemented across primary care and paediatric ED settings encompassed training, electronic decision support, family education, and regular audit and feedback.

TAKEAWAY:

• The proportion of acute asthma episodes treated with salbutamol using MDIs with a holding chamber significantly increased from 31.5% to 61.4% in the paediatric ED and from 9.0% to 26.7% in primary care centres (P < .001 for both).
• The documentation of the pulmonary score significantly increased from 48.4% to 78.7% in the paediatric ED and from 16.3% to 45.1% in primary care centres (P < .001 for both).
• The assessment of persistent asthma symptoms significantly increased from 32.9% to 67.4% in the paediatric ED and from 8.0% to 23.4% in primary care centres (P < .001 for both).
• No significant changes in ward admissions, length of stay in the paediatric ED, or 72-hour revisits were observed across the study period.

IN PRACTICE:

“This initiative demonstrates how engaging families, empowering clinicians and leveraging previous QI [quality improvement] cycles can yield sustainable improvements. The AICP [asthma integrated care pathway] builds directly on lessons learnt from successful bronchiolitis initiatives and provides a scalable model for closing implementation gaps in paediatric chronic disease management,” the authors wrote.

SOURCE:

This study was led by Marta Montejo, Primary Care Center, Basque Health Service, Barakaldo, Spain. It was published online on February 09, 2026, in BMJ Paediatrics Open.

LIMITATIONS:

The study was conducted within a single regional system, which may have limited generalisability. The absence of a control group may have limited causal inference, and the reliance on electronic health record data may have led to an underestimation or overestimation of certain indicators.

DISCLOSURES:

This study was funded by the 2021 Call of the Department of Health of the Basque Government for health research and development projects. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.