Risk factors associated with severe asthma exacerbations in children attending Alexandria University Children’s Hospital, Egypt
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20184670Keywords:
Childhood asthma, Severe exacerbation, Pulmonary index scoring, Hypoxia, Silent chestAbstract
Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.
Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.
Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).
Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management.
References
Zahran HS, Bailey CM, Damon SA, Garbe PL, Breysse PN. Vital Signs: Asthma in Children — United States, 2001–2016. MMWR. 2018;67(5);149–55.
Sears MR. Epidemiology of asthma exacerbations. J Allergy Clin Immunol. 2008;122:662-8.
Hsu P, Lam LT, Browne G. The pulmonary index score as a clinical assessment tool for acute childhood asthma. Ann Allergy Asthma Immunol. 2010;105:425-7.
Forno E, Celedón JC. Predicting Asthma Exacerbations in Children. Curr Opin Pulm Med. 2012;18(1):63–9.
Carroll CL, Sekaran AK, Lerer TJ, Schramm CM. A modified pulmonary index score with predictive value for pediatric asthma exacerbations. Ann Allergy Asthma Immunol. 2005;94:355-9.
Amer Y, Elzalabany M, Omar T, Dowidar N, Badr-Eldin O, Elsawy I, et al. Treatment of Acute Asthma in Children: A Clinical Practice Guideline from the Alexandria University Hospitals, Center for Evidence-Based Clinical Practice Guidelines, Healthcare Quality Directorate and the Alexandria Faculty of Medicine, Department of Pediatrics, Pediatric Respiratory, Allergy & Immunology Unit and Alexandria University Children's Hospital. Conference Paper in GMS e-journal, 2012.
Wu AC, Tantisira K, Li L, Schuemann B, Weiss ST, Fuhlbrigge AL, et al. Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children. Chest. 2011;140(1):100–7.
Covar RA, Szefler SJ, Zeiger RS, Sorkness CA, Moss M, Mauger DT, et al. Factors associated with asthma exacerbations during a long-term clinical trial of controller medications in children. J Allergy Clin Immunol. 2008;122(4):741–7.
Schatz M, Clark S, Camargo CA, Jr. Sex Differences in the Presentation and Course of Asthma Hospitalizations. Chest. 2006;129:50-5.
Sears M. Epidemiology of asthma exacerbations. J Allergy Clin Immunol. 2008;122:662-8.
Engelsvold D, Øymar K. Hospital admissions for childhood asthma in Rogaland, Norway from 1984 to 2000. Acta Paediatrica. 2003;92:610-6.
Tsukioka K, Toyabe S, Akazawa K. Relationship between asthma severity and age at onset in Japanese adults. Nihon Kokyuki Gakkai Zasshi. 2010;48:898.
Haselkorn T, Zeiger RS, Chipps BE, Mink DR, Szefler SJ, Simons FE, et al. Recent asthma exacerbations predict future exacerbations in children with severe or difficult-to-treat asthma. J Allergy Clin Immunol. 2009;124(5):921-7.
Yavuz TS, Kartal O, Kaya G, Gulec M, Saldir M, Sener O. Risk factors associated with asthma exacerbations in school-age children. Clin Translational Allergy. 2015;5(2):6.
Scarfone RJ, Zorc JJ, Angsuco CJ. Emergency physicians’ prescribing of asthma controller medications. Pediatrics. 2006;117:821-7.
Johnston NW, Johnston SL, Duncan JM, Greene JM, Kabadze T, Keith PK, et al. The September epidemic of asthma exacerbations in children: a search for etiology. J Allergy Clin Immunol. 2005;115:132-8.
Guidelines is: From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015. Available at: http:// www.ginasthma.org/. Accessed December 15, 2015.
Gibson PG, Henry D, Francis L, Cruickshank D, Dupen F, Higginbotham N, et al. Association between availability of non-prescription beta 2 agonist inhalers and under treatment of asthma. British Medical J. 1993;306:1514-8.
Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, Soh JY, Le Souef P. The use of inhaled corticosteroids in pediatric asthma: update World Allergy Organ J. 2016;9:26.
Butz AM, Ogborn J, Mudd S, Ballreich J, Tsoukleris M, Kub J, et al. Factors Associated with High Short Acting B2 Agonist (SABA) Use In Urban Children with Asthma Ann Allergy Asthma Immunol. 2015;114(5):385-92.
Paris J, Peterson EL, Wells K, Pladevall M, Burchard EG, Choudhry S, Lanfear DE, Williams LK. Relationship between recent short-acting beta-agonist use and subsequent asthma exacerbations. Ann Allergy Asthma Immunol. 2008;101(5):482-7.
McFadden ER, Jr. Acute Severe Asthma. Am J Respiratory Critical Care Med. 2003;168:740-59.
Wu AC, Tantisira K, Li L, Schuemann B, Weiss ST, Fuhlbrigge AL. Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children Chest. 2011;140(1):100-7.
Alvarez GG, Schulzer M, Jung D, Fitz Gerald JM. A systematic review of risk factors associated with near-fatal and fatal asthma. Can Respir J. 2005;12:265-70.
Covar RA, Szefler SJ, Zeiger RS, Sorkness CA, Moss M, Mauger DT, Boehmer SJ, Strunk RC, Martinez FD, Taussig LM Factors associated with asthma exacerbations during a long-term clinical trial of controller medications in children.J Allergy Clin Immunol. 2008;122(4):741-7.
Renato Stein, Gerard J. Canny, Desmond J. Bohn, Joseph J. Reisman, Henry Levison. Severe Acute Asthma in a Pediatric Intensive Care Unit: Six Years' Experience. Pediatrics. 1989;83:1023-8.
Fábregas ML, de Diego Damiá A, MartínezFrancés M, Cordero Rodríguez P, PerpiñáTordera M. Relationship between peak expiratory flow and clinical exploration and arterial gas analysis in assessing the severity of an asthma attack. Arch Broncopneumol. 1996;32:4-9.
Brenner B, Corbridge T, Kazzi A. Intubation and Mechanical Ventilation of the Asthmatic Patient in Respiratory Failure, Proceedings of the American Thoracic Society. 2009;6:371-9.
Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo Jr. CA, Gern J, et al. Asthma outcomes: Exacerbations. J Allergy Clin Immunol. 2012;129:34-48.
Camargo CA Jr., Rachelefsky G, Schatz M. Managing Asthma Exacerbations in the Emergency Department. Proceedings of the American Thoracic Society. 2009;6:357-66.
Kelly AM, Kerr D, Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma? Respiratory Med. 2004;98:777-81.
Engelkes M, Janssens HM, de Ridder MA, Sturkenboom MC, de Jongste JC, Verhamme KM. Real life data on incidence and risk factors of severe asthma exacerbations in children in primary care Respir Med. 2016;119:48-54.
Sly RM. Continuing decreases in asthma mortality in the United States. Ann Allergy Asthma Immunol 2004;92:313-8.