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Risk factors for intensive care in children with acute asthma
Patricia J Lyell1, Elmer Villanueva, Debbie Burton
1Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia.
Insights
Very severe asthma in children is linked to factors like male gender and inhaled corticosteroid use. Understanding these risk factors can help prevent near-fatal asthma (NFA) events in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Clinical Epidemiology
Background:
- Severe asthma exacerbations requiring intensive care represent near-fatal asthma (NFA) events.
- Identifying risk factors for NFA in children is crucial for effective management and prevention.
Purpose of the Study:
- To identify risk factors associated with very severe asthma (near-fatal asthma) in pediatric patients.
- To compare risk factors between children with NFA and those with less severe asthma requiring only emergency department visits.
Main Methods:
- A retrospective case-control study was conducted at Monash Medical Centre.
- Cases were children admitted to the intensive care unit (ICU) for asthma (n=52), compared to controls admitted to the emergency department (n=53).
- Data were collected from patient files and structured telephone interviews, analyzed using univariate and multivariate logistic regression.
Main Results:
- Univariate analysis showed NFA patients were older, had longer asthma duration, hay fever, used inhaled corticosteroids and long-acting beta(2) agonists, had management plans, and saw respiratory specialists.
- Multivariate analysis identified male gender (OR, 5.7) and inhaled corticosteroid use (OR, 7.2) as potential predictors of NFA.
- Parental smoking was not a significant factor.
Conclusions:
- Several factors are associated with near-fatal asthma in children, some mirroring findings in adult asthma.
- While asthma severity plays a role, independent risk factors like male gender and asthma duration are suggested in pediatric NFA.
- These findings highlight potential targets for intervention and improved asthma management in children.
Objective:
A retrospective case-control study at Monash Medical Centre (MMC), a tertiary referral hospital in Melbourne, Australia, was conducted to identify risk factors associated with very severe asthma in paediatric patients.
Methodology:
Asthmatics admitted to an intensive care unit (ICU; n=52) were identified and considered to represent cases of very severe/near fatal asthma (NFA group). This group was compared to asthmatics who had been admitted on one occasion only to the emergency department at MMC (non-NFA controls, n=53). Patient files were examined and factors that may be linked to NFA were recorded. Information not on file was obtained from patients/parents during a structured telephone interview. Data for the two groups were compared, univariate and multivariate logistic regression analyses were performed, and odds ratios (OR) were calculated.
Results:
Univariate analysis indicated that asthmatics with NFA were more likely to be older (P=0.01) and have a longer duration of asthma (P=0.02). They were also more likely to have hay fever (P=0.002; OR, 7.6), use inhaled corticosteroids (P=0.001), long acting beta(2) agonists (P=0.02), have an asthma management plan (P=0.006), and see a respiratory specialist (P=0.001). Parental smoking habits were not different between the groups. Multivariate logistic regression analysis identified male gender (P=0.05; OR, 5.7) and use of inhaled corticosteroids (P=0.07; OR, 7.2) as factors that may be predictive of NFA.
Conclusions:
This study identifies a number of factors associated with NFA; many are similar to those reported in adult patients. Asthma severity explains some findings, but the data also suggest that additional independent risk factors such as gender and duration of asthma may operate in children.
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