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Severe Asthma Exacerbations in the Pediatric Intensive Care Unit: Clinical Profile, Management, and
Amal H Aljohani1, Hamdi Ahmed Alsufiani2, Abeer Musaibieh AlSaadi2
1Division of Allergy and Clinical Immunology, Pediatric Department, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia.
Insights
Severe pediatric asthma admissions to the pediatric intensive care unit (PICU) are linked to early symptoms and nutritional issues. Improving outpatient asthma management and nutritional support can help prevent severe exacerbations.
Area of Science:
- Pediatric pulmonology
- Critical care medicine
- Public health
Background:
- Severe asthma exacerbations are a significant cause of pediatric intensive care unit (PICU) admissions, especially in young children.
- Understanding the characteristics of these admissions is crucial for developing targeted interventions.
Purpose of the Study:
- To characterize demographic factors, clinical presentations, management approaches, and outcomes of children admitted to the PICU for severe acute asthma exacerbations.
- To identify risk factors and patterns associated with severe pediatric asthma requiring intensive care.
Main Methods:
- A retrospective descriptive study analyzed 73 pediatric patients (aged 1-14 years) admitted to King Salman Medical City, Madinah, Saudi Arabia, between January 2023 and October 2024.
- Data collected included demographics, medical history, clinical features, management strategies, and PICU/hospital outcomes.
Main Results:
- The average age was 4.6 years, with a bimodal nutritional distribution (underweight and overweight/obese).
- Common factors included family history of asthma (54.8%), prior COVID-19 (16.4%), poor asthma control (60.3%), and delayed diagnosis.
- Management involved standard therapies; mean PICU and hospital stays were 3.1 and 8.1 days, respectively, with high recovery rates (93.2%) and no mortality.
Conclusions:
- Severe pediatric asthma requiring PICU admission is associated with early symptom onset, dual nutritional risks (undernutrition and obesity), family history, and suboptimal outpatient care.
- Recommendations include age-adjusted nutritional screening, improved medication adherence support, and enhanced outpatient education to decrease PICU admissions.
Background:
Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood.
Objective:
To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations.
Methods:
A retrospective descriptive study was conducted of pediatric patients aged 1-14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023-October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes.
Results:
The mean patient age was 4.6 years, with most (57.5%) aged 1-5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1-5-year age group, whereas obesity predominated in the 6-10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health.
Conclusions:
Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions.
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