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Inflammatory and Comorbid Features of Children Admitted to a PICU for Status Asthmaticus
Jocelyn R Grunwell1,2, Curtis Travers1, Anne M Fitzpatrick1,2
1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Insights
Certain factors increase the risk of pediatric intensive care unit (PICU) admission for asthma exacerbations, even in children with mild-to-moderate asthma. These risk factors for critical asthma require further investigation.
Area of Science:
- Pediatric Pulmonology
- Clinical Pediatrics
- Asthma Research
Background:
- Asthma exacerbations are a common cause of pediatric intensive care unit (PICU) admission.
- Identifying risk factors for severe asthma attacks, including those requiring mechanical ventilation, is crucial for timely intervention.
Purpose of the Study:
- To identify clinical features and risk factors associated with PICU admission for asthma exacerbations in children.
- To determine if children with critical or near-fatal asthma have distinct clinical features compared to those with less severe exacerbations.
Main Methods:
- Retrospective analysis of prospectively collected data from children aged 6-18 with confirmed asthma.
- Data were gathered between 2004 and 2015 at a quaternary care children's hospital.
- Multiple logistic regression was used to identify risk factors for PICU admission with or without intubation.
Main Results:
- Of 579 children, 170 (29.4%) were admitted to the PICU for asthma. Of these, 24.1% had mild-to-moderate asthma, and 48.8% required intubation.
- Risk factors for PICU admission included prior hospitalization, history of pneumonia, high-dose inhaled corticosteroid use, paternal asthma, poverty, and Black race.
- These factors were associated with increased odds of PICU admission, independent of chronic asthma severity.
Conclusions:
- Factors beyond standard asthma severity classifications are associated with critical and near-fatal asthma events.
- Further research should focus on these distinct clinical features to improve management strategies for severe pediatric asthma.
Objectives:
To determine risk factors associated with admission to a PICU with or without endotracheal intubation for an asthma exacerbation. We hypothesized that children with critical and near-fatal asthma would have distinguishing clinical features but varying degrees of asthma severity and measures of type 2 inflammation.
Design:
Retrospective analysis of prospectively collected data of children with asthma recruited into outpatient asthma clinical research studies at Emory University between 2004 and 2015.
Setting:
Large, free-standing academic quaternary care children's hospital in Atlanta, GA.
Patients:
Children 6-18 years old with physician-diagnosed and confirmed asthma.
Interventions:
None.
Measurements And Main Results:
A total of 579 children were analyzed with 170 children (29.4%) being admitted to the PICU for an asthma exacerbation in their lifetime. Of these 170 children with a history of critical asthma, 24.1% were classified as having mild-to-moderate asthma, and 83 of 170 children (48.8%) had been intubated and experienced near-fatal asthma. Multiple logistic regression was used to identify risk factors associated with increased odds of PICU admission with or without endotracheal intubation. Hospitalization within the prior 12 months of survey (odds ratio, 8.19; 95% CI, 4.83-13.89), a history of pneumonia (odds ratio, 2.56; 95% CI, 1.52-4.29), having a designation of increased chronic asthma severity on high-dose inhaled corticosteroids (odds ratio, 2.76; 95% CI, 1.62-4.70), having a father with asthma (odds ratio, 2.15; 95% CI, 1.23-3.76), living in a region with a higher burden of poverty (odds ratio, 1.28; 95% CI, 1.02-1.61), and being of black race (odds ratio, 2.01; 95% CI, 1.05-3.84) were all associated with increased odds of PICU admission with or without intubation.
Conclusions:
Our findings suggest that there are factors associated with critical and near-fatal asthma, distinct from the chronic asthma severity designations, that should be the focus of future investigation.
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