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Seasonal and recurrent intensive care unit admissions for acute severe asthma in children
1Department of Paediatrics and Child Health, University of Cape Town.
Insights
Severe asthma attacks in children can be seasonal. This study identified a distinct subgroup of children with severe, persistent asthma and specific allergies, suggesting seasonality is a risk factor for life-threatening asthma.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Critical Care Medicine
Background:
- Life-threatening asthma exacerbations requiring intensive care unit (ICU) admission can exhibit seasonal patterns in some pediatric patients.
- Understanding these patterns may help identify children at higher risk for severe, intractable asthma.
Purpose of the Study:
- To investigate the characteristics of children experiencing seasonal, life-threatening asthma attacks requiring ICU management.
- To compare these 'seasonal' patients with those experiencing asthma attacks in random months.
Main Methods:
- Retrospective case-controlled study of 21 pediatric patients with seasonal ICU asthma admissions over 14 years.
- Comparison of demographic and clinical data between seasonal and non-seasonal (random) ICU asthma admission groups.
- Analysis included radioallergosorbent testing (RAST) results.
Main Results:
- Seasonal asthma admissions constituted 6.5% of all pediatric ICU asthma patients and 15.6% of ICU asthma admissions.
- Patients with seasonal admissions represented a distinct sub-population with severe asthma, often with a family history of fatal asthma.
- These children were less likely to outgrow asthma, more likely to need steroid therapy, and had higher rates of positive RAST to Aspergillus, Cladosporium, and grass pollen.
Conclusions:
- Individual seasonality in severe asthma attacks is a significant risk factor for life-threatening and intractable pediatric asthma.
- Identifying this seasonality can aid in managing severe asthma in children.
Abstract:
Life-threatening attacks of asthma requiring intensive care unit (ICU) management at Red Cross War Memorial Children's Hospital in Cape Town were noted to occur in some patients in the same or adjacent months of different years. A retrospective case-controlled study was performed of 21 such 'seasonal' patients who presented to the ICU over a 14-year period. The group made up 6.5% of all asthma patients admitted to the ICU and their 65 admissions made up 15.6% of all ICU asthma admissions during this period. The control group consisted of patients with recurrent admissions that occurred in 'random' months. The two groups were compared in respect of demographic and clinical data. Patients requiring seasonal admissions were shown to form a distinct sub-population of children with severe asthma, some with a family history of fatal asthma, who were less likely to 'outgrow' asthma in childhood, were more likely to require maintenance steroid therapy for asthma management, and significantly more often had positive radioallergosorbent tests to Aspergillus and Cladosporium sp. and to grass pollen. A retrospective analysis of dates of severe asthma attacks may identify individual seasonality, which is a risk factor for life-threatening and intractable asthma.