Monthly variations in admissions of pediatric asthma versus respiratory infections during spring: A multicenter study

Asthma and acute lower respiratory tract infections (LRTI), including pneumonia and bronchiolitis, are leading causes of pediatric hospitalizations. In arid regions, environmental factors such as desert dust storms vary across spring months and may differentially influence asthma compared with infectious respiratory illnesses. Whether asthma hospitalizations demonstrate month-specific variation during spring remains unclear.

We conducted a multicenter retrospective study at four tertiary centers in Saudi Arabia. Pediatric patients aged ≤14 years admitted with asthma, pneumonia, or bronchiolitis during the spring months (March-May) of 2018 and 2019 were included. Admissions were categorized as asthma or LRTI. Demographic characteristics, clinical outcomes, respiratory viral detection, and monthly distribution were compared using nonparametric and Chi-square tests.

Among 729 admissions, 153 (21.0%) were for asthma and 576 (79.0%) for LRTI. Children with asthma were older (median: 48 [interquartile ranges 24-96] vs. 16 [6-34] months; P < 0.001) and had shorter hospital stays (3 [2-4] vs. 4 [3-7] days; P < 0.001). No significant differences were observed in sex distribution, intensive care unit admission, or ventilatory support. Respiratory viral detection was lower in asthma than LRTI (3.2% vs. 24.7%; P = 0.003). The monthly distribution of asthma relative to LRTI did not differ across March, April, and May.

Pediatric asthma hospitalizations during spring were characterized by older age, shorter stays, and lower viral detection compared with LRTI. Asthma did not demonstrate month-specific variation, suggesting that fluctuating environmental exposures did not generate population-level surges. These findings support diagnosis-specific interpretation of seasonal pediatric respiratory admissions and warrant investigation into nonviral asthma triggers.