PURPOSE: This study was done to understand demographics of children with status asthmaticus treated in a tertiary care pediatric intensive care unit (PICU).
METHODS: The medical charts of all patients above 5 years of age admitted to the PICU with status asthmaticus, at Nationwide Children's hospital, Columbus, OH, between 2000-2007 were reviewed. Two hundred and forty seven (247) children were admitted on 281 occasions. Patients with significant co-morbidities were excluded. Final analysis was done using 222 encounters in 183 patients.
RESULTS: The mean age was 11 years (range, 5-20 years). The mean PICU stay was 2.1 days (range, 1-15 days) and mean hospital stay was 3.6 days. Male: Female 109:74. One hundred and sixty one (161) children had known history of asthma and for remaining 22 children this was their first asthma exacerbation. Mean age at diagnosis was 3.7 years and mean duration of symptoms was 8.2 years. Eighty nine (49%) children were on no daily controller asthma medications. Among those who were on daily controlled medications, 44 were on inhaled corticosteroids, 65 were receiving LTRA (singulair) and 38 were receiving combination medication (Advair). Among patients receiving MDI (n=88), only 29 were using it with spacer. Adherence to asthma medications was noted in 124, of whom only 41 (33%) claim that they were compliant to their daily asthma medications. Among 183 patients, 44 (24%) had previous PICU admission and 105 (57%) had previous hospital admission and 123 patients had previous multiple emergency department visits for acute asthma. Asthma severity noted in 75 patients revealed mild intermittent 22 (29%), mild persistent 23 (30%), moderate persistent 17 (23%) and severe persistent 13 (17%). Sixty seven (37%) patients had a positive family history of asthma diagnosed in either their parents or siblings. History of smoking exposure was available in 140 (76%) patients of whom 53 were exposed to smoking by their parents.
CONCLUSIONS: Asthmatic children with any level of severity are at risk for asthma exacerbations requiring PICU stay especially if they are not compliant with their controller asthma medications.
CLINICAL IMPLICATIONS: Asthma control and compliance to controller medications are important to prevent risk for asthma exacerbations requiring PICU stay.
DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Nadeem Khan, Melissa Frasure, Manual Cestari, Karen McCoy
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