Children with asthma who had been hospitalized earlier for acute exacerbations of asthma are more likely to be rehospitalized in the PICU or pediatric ward in their current visit to the emergency department (ED), according to a recent study, the findings of which were presented at 2023 annual meeting of the American Academy of Allergy, Asthma and Immunology held in February in San Antonio, Texas and published in the Journal of Allergy and Clinical Immunology.¹

To examine the factors influencing the chances of hospitalization in asthma patients, researchers included 240 patients, with ages ranging between 1 and 21 years who presented to the ED for acute exacerbations of asthma. Each patient admitted to pediatric intensive care (PICU) in this retrospective case control study was matched with two consecutive patients admitted to the pediatric floor and three patients who were discharged from the ED. These patients acted as controls.

The median age of patients admitted to PICU and that of floor-admitted patients was 5 years, whereas patients discharged from the ED had a median age of 9 years. Patients older than 5 years were at higher risk of inpatient admission during their present visit to the ED (odds ratio 0.21).

Patients who had moderate persistent asthma in the last one year were six times more likely to be hospitalized during their present visit to the ED with OR of 6.0 compared to patients with intermittent asthma. Patients who required treatment in the ED for acute exacerbation in the previous year were nearly 9 times more at risk of inpatient admission with OR of 8.7 in the current visit. And those who had been hospitalized in the last 12 months were at risk of being hospitalized again during their current visit (OR 8.7). No such associations were observed for gender, race, parental availability, English fluency and health insurance.

This study has identified age, type of asthma, prior ED admission as factors that increased the likelihood of hospitalization in the current visit among patients with acute exacerbations of asthma.

Identification of these risk factors may enable clinicians to anticipate the chances of hospitalization in patients visiting the ED for acute exacerbations of asthma and manage them accordingly to reduce hospitalizations. At-risk patients should also be educated about the signs and symptoms of acute exacerbation and seek immediate emergency care.  

Reference

1. Armen Sanosyan, et al. Assessment of pre-hospitalization factors predicting pediatric inpatient admission in acute asthma exacerbation. J Allergy Clin Immunol. 2023 Feb.;151(2 Suppl): AB74. DOI:https://doi.org/10.1016/j.jaci.2022.12.23.