Design: Multicentre, open-label, randomised non-inferiority trial
Population: 132 children aged 2–18 admitted with acute reversible bronchoconstriction needing oxygen
Primary outcome: Length of hospital stay (non-inferiority margin 8 hours)
Effect: −3.7 hours (−10.2 to 4.1); bronchodilator rate ratio 0.75 (0.64–0.88)

A multicentre, open-label non-inferiority trial at two Dutch hospitals, published in PLOS One on 30 October, compared two nurse-led protocols for children aged 2 to 18 admitted with acute wheeze who needed oxygen. One used the standard Childhood Asthma Score to guide bronchodilator dosing and reassessment; the other used a version adapted for children on oxygen.

In 132 children, median length of stay was about 40 hours in both groups, meeting non-inferiority. The adapted score led to about a quarter fewer bronchodilator doses. Escalations, intensive care transfers and seven-day readmissions did not differ.

The point is less the specific score than the principle: a structured, nurse-led protocol lets bronchodilator frequency fall as the child improves, rather than continuing on a fixed schedule. Fewer doses mean less tachycardia and less nursing time.

The trial was small and in two hospitals, so local adaptation is needed.

Use a structured asthma score to guide bronchodilator frequency on the ward.
Let trained nurses space out bronchodilators as the score improves.
Include oxygen requirement in the assessment, not only work of breathing.
Escalation, PICU transfer and readmission did not rise with the nurse-led approach.

Why it matters

Fixed-interval bronchodilators in recovering children add side effects and workload without shortening stay.

The statistics, in plain English

The stay difference was −3.7 hours (95% CI −10.2 to 4.1). The upper limit stays below the pre-set 8-hour margin, so the adapted score was not meaningfully worse. Bronchodilator use fell by 25% (rate ratio 0.75, 0.64 to 0.88).