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Risk factors for asthmatic patients requiring intubation. I. Observations in children
1Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine 95616, USA.
Insights
Secondhand smoke exposure and psychosocial issues significantly increase the risk of intubation in children with asthma. Identifying these factors is crucial for developing effective asthma management and prevention strategies.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Environmental Health
Background:
- Asthma mortality is a growing concern, despite advances in pharmacotherapy.
- The paradox of improved treatments but worsening prognosis necessitates research into risk factors.
- Understanding pediatric asthma admissions is key to identifying at-risk populations.
Purpose of the Study:
- To identify demographic and clinical risk factors for intubation in children admitted for asthma.
- To analyze data from a tertiary-care hospital to define predictors of severe asthma exacerbations requiring intubation.
Main Methods:
- Retrospective cohort study of 300 pediatric asthma admissions (ages 5-12) over a 10-year period (1984-1994).
- Exclusion of patients with cystic fibrosis.
- Analysis of demographic data, clinical history, and environmental factors to identify risk factors for intubation.
Main Results:
- Thirteen out of 300 children required intubation.
- Significant risk factors for intubation included secondhand smoke exposure (OR 22.4), psychosocial problems (OR 13.5), family dysfunction (OR 13.0), and upper respiratory infections (OR 10.2).
- Other significant factors included limited education, prior emergency room visits/hospitalizations, crowding, low socioeconomic status, steroid dependence, parental history of allergy/asthma, and language barriers.
Conclusions:
- Environmental and psychosocial factors are critical determinants of severe asthma exacerbations requiring intubation in children.
- Recognition of these risk factors can significantly impact preventive measures and improve asthma outcomes.
- Targeted interventions addressing socioeconomic and environmental factors are essential for reducing severe pediatric asthma events.
Abstract:
There are significant concerns regarding the increased mortality of patients with asthma. Indeed the paradox of improved pharmacotherapy but worsening prognosis has been explored in depth in several studies including observations in epidemiology, access to medical care, and drug toxicity. Because of our ability to track all admissions to a tertiary-care hospital, we attempted to define the demographic data from a population of asthmatic children admitted for asthma in order to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions excluding patients with cystic fibrosis. This study included all asthmatics aged 5-12 years admitted over a 10-year period (1984-1994) to the University of California at Davis Medical Center, Sacramento. A total of 300 such asthma admissions were reviewed, involving 135 girls and 165 boys, mean age 7.7 +/- 2.4 years. Of this group, 166 children were black, 70 were Caucasian, 49 were Hispanic, 14 were Asian, and 1 was an American Indian. By National Heart, Lung, and Blood Institute guidelines, this group included 147 mild, 117 moderate, and 36 severe cases. Thirteen children required intubation for their asthma. Significant risk factors identified for children requiring intubation, compared to those who did not require intubation, were secondhand smoke exposure [odds ratio (O.R.) 22.4; 95% confidence interval (C.I.) 7.4, 68.0], psychosocial problems (O.R. 13.5; 95% C.I. 5.1, 36.0), family dysfunction (O.R. 13.0; 95% C.I. 3.9, 43.9), upper respiratory infection (O.R. 10.2; 95% C.I. 3.4, 28.1), little formal education (O.R. 8.7; 95% C.I. 2.4, 31.6), prior asthma emergency room visit in past year (O.R. 7.2; 95% C.I. 1.9, 27.1), prior asthma hospitalization in past year (O.R. 7.1; 95% C.I. 2.2, 22.2), crowding (O.R. 6.9; 95% C.I. 2.5, 19.1), low socioeconomic status (O.R. 6.5; 95% C.I. 2.1, 20.8), steroid-dependent (O.R. 3.8; 95% C.I. 1.2, 12.1), parental history of allergy or asthma (O.R. 3.4; 95% C.I. 1.1, 10.0), and language barrier (O.R. 3.3; 95% C.I. 1.1, 10.6). Nonsignificant mild risk factors included inhaled cromolyn (O.R. 2.7; 95% C.I. 0.7, 10.0), atopy (O.R. 1.9; 95% C.I. 0.6, 5.9), and prior intubation (O.R. 1.6; 95% C.I. 0.2, 13.1). These risk parameters may be important determinants of baseline risk for asthma deaths and their recognition may have a significant impact on preventive measures.