{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:53:31Z","timestamp":1747151611725,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Project Aim<\/jats:title><jats:p>To retrospectively evaluate a clinical management algorithm for acute wheezers in a UK Pediatric Emergency Department (PED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Overview and Rationale<\/jats:title><jats:p>Acute wheezing attacks are a leading cause of PED attendances and inpatient admissions. Prednisolone, a routine treatment, is intolerable in almost one\u2010third of children, requiring repeated dosing, which may prolong length of stay (LOS). To address this problem, we: (1) developed an acute management algorithm (concise, single\u2010sided flow\u2010chart, instructing immediate management); (2) modified the OCS regime from prednisolone (1\u2009mg\/kg, 3\u2010day course) to dexamethasone (600 then 300\u2009mcg\/kg); (3) and disseminated guidance regionally. Written information\u2014handouts, e\u2010mails, and posters\u2014were followed\u2010up with verbal reinforcement. We implemented the algorithm in 2017 and revised it further in 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evaluation<\/jats:title><jats:p>In 2019, we retrospectively collected data on 100 acute wheeze attendances (those requiring OCS, aged 2\u201314), between October and December in 2016, 2017, and 2018 (<jats:italic>n<\/jats:italic>\u2009=\u2009300), and assessed outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a 48\u2010month period, we reduced OCS intolerability by 67.2% and OCS drug costs by 85.8% (saving \u00a341,470.14), while not significantly influencing the other outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Reduced intolerability and substantial cost savings can be achieved by implementing a structured acute pediatric wheeze algorithm and modifying the OCS to single\u2010dose dexamethasone 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