Characteristics and Outcomes of Paediatric Patients With Severe Acute Asthma in Retrieval

To describe the characteristics, management, and outcomes of a paediatric cohort with severe acute asthma or wheeze retrieved to tertiary care.

A retrospective cohort study of children ≥ 1 year old with severe acute asthma or wheeze retrieved to tertiary paediatric centres by a statewide paediatric retrieval service, January 2017 to May 2023. Data of clinical characteristics, pharmacotherapy, respiratory support, and outcomes were collected.

We included 325 patients, median age 6.8 years (IQR 3.8-10.5) and 61% male. High rates of nebulised bronchodilators, systemic corticosteroids, intravenous magnesium sulphate, and adjunct aminophylline use were observed. Ketamine was the preferred sedative agent among cases managed with mechanical or non-invasive ventilation. Intravenous salbutamol use declined significantly during the study (p = 0.04). Intubation rates were low (6.8%), non-invasive ventilation was the most common respiratory support (37.2%), and high-flow nasal cannula use increased over the study (p < 0.01). Overall, 65.5% of patients were admitted to intensive care. We report two deaths (0.9%) following intensive care admission and infrequent complications, including air leak (2.2%) and haemodynamic instability (2.8%). Variables associated with intensive care admission include pre-existing asthma diagnosis, preventer prescription, and previous intensive care admission (p < 0.05).

Contemporary severe acute asthma management frequently includes adjunct aminophylline and non-invasive ventilation. Clinical outcomes were overall good with short intensive care and hospital stays, low mortality rates, and infrequent complications. Children with pre-existing asthma diagnosis, preventer prescription, or prior PICU admission for asthma were more likely to require PICU care.