Risk factors for intensive care admission in children with severe acute asthma in the Netherlands: a prospective multicentre study.

Rationale: Severe acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS).
Objectives: To determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections.
Methods: A prospective, nationwide multicentre study of children with SAA (2-18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses.
Measurements and Main Results: 110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission.
Conclusions: Children with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors.
Competing Interests: Conflict of interest: S.A. Boeschoten has nothing to disclose. Conflict of interest: A.L. Boehmer has nothing to disclose. Conflict of interest: P.J. Merkus reports grants from Chiesi Netherlands BV and Novartis Netherlands BV during the conduct of the study. Conflict of interest: J. van Rosmalen has nothing to disclose. Conflict of interest: J.C. de Jongste has nothing to disclose. Conflict of interest: P.L.A. Fraaij reports grants from EU FP7 PREPARE (#602525). Conflict of interest: R. Molenkamp has nothing to disclose. Conflict of interest: S.G. Heisterkamp has nothing to disclose. Conflict of interest: J.B. van Woensel has nothing to disclose. Conflict of interest: B. Kapitein has nothing to disclose. Conflict of interest: E.G. Haarman has nothing to disclose. Conflict of interest: R.M. Wösten-van Asperen has nothing to disclose. Conflict of interest: M.C. Kneyber has nothing to disclose. Conflict of interest: J. Lemson has nothing to disclose. Conflict of interest: S. Hartman has nothing to disclose. Conflict of interest: D.A. van Waardenburg has nothing to disclose. Conflict of interest: H.E. Bunker-Wiersma has nothing to disclose. Conflict of interest: C.M. Brouwer has nothing to disclose. Conflict of interest: B.E. van Ewijk has nothing to disclose. Conflict of interest: A.M. Landstra has nothing to disclose. Conflict of interest: M. Verwaal has nothing to disclose. Conflict of interest: A.A. Vaessen-Verberne has nothing to disclose. Conflict of interest: S. Hammer has nothing to disclose. Conflict of interest: C.M. Buysse reports grants from the AMMODO and SAB foundations outside the submitted work. Conflict of interest: M. de Hoog reports grants from the AMMODO and SAB foundations outside the submitted work.
(Copyright ©ERS 2020.)