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Factors Associated with Failure of Intermittent Nebulization with Short-Acting Beta-Agonists in Children with Severe

Prapasri Kulalert1, Phichayut Phinyo2,3, Jayanton Patumanond3

  • 1Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

Journal of Asthma and Allergy
|September 9, 2020
PubMed

Insights

Children with severe asthma exacerbation (SAE) may not respond to initial SABA treatment. Predictors of treatment failure include prior intubation, low oxygen saturation, and pneumonia triggers.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Medicine
  • Clinical Research

Background:

  • Short-acting beta-agonists (SABA) are the first-line treatment for pediatric asthma exacerbations.
  • Children with severe asthma exacerbations (SAE) may require advanced treatment strategies due to inadequate response to initial therapy.

Purpose of the Study:

  • To identify factors predicting poor response to intermittent nebulized SABA in children experiencing SAE.
  • To inform clinical decision-making for managing severe pediatric asthma.

Main Methods:

  • Retrospective cohort study of children with SAE admitted between 2015-2017.
  • Treatment failure was defined as the need for escalated therapy.
  • Logistic regression analysis was employed to determine predictors of treatment failure.

Main Results:

  • Previous intubation history was significantly associated with treatment failure (aOR 6.46).
  • Receiving fewer than 3 doses of nebulized salbutamol in the ER predicted failure (aOR 3.21).
  • Low emergency room oxygen saturation (SpO2 <92%) and pneumonia as a trigger were also significant predictors (aOR 3.02 and 2.67, respectively).

Conclusions:

  • Four key prognostic factors for treatment failure in pediatric SAE were identified: prior intubation, insufficient initial SABA dosage, low SpO2, and pneumonia.
  • These findings highlight critical indicators for closer monitoring and potential escalation of care in severe pediatric asthma cases.
Abstract

Keywords:
hospitalizationnebulizationprognosisstatus asthmaticustreatment failure

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