Chronic therapy with inhaled corticosteroids (ICS) is known to reverse and suppress airway inflammation and can also increase airway responsiveness to beta-adrenergic agonists. We theorized that the chronic use of ICS would be associated with shorter duration of hospitalization in severely ill children with status asthmaticus.
An eight-year retrospective chart review (April 1997 to May 2005) was conducted of all children greater than two years old admitted to the ICU with a primary diagnosis of status asthmaticus. Baseline demographics and outcome measures were compared between children receiving and not receiving ICS prior to admission.
During the study period, 241 children were admitted to the ICU for status asthmaticus, and 107 (44%) were receiving chronic ICS at the time of admission. Chronic ICS use was associated with asthma severity (NIH asthma classification), previous hospitalization for asthma (79% vs. 45%, p<0.01) and public insurance status (67% vs. 53%, p=0.03). However, ICS use had no effect on hospital or ICU length of stay, type and duration of treatments received, or the rate of recovery. When examining subsets of patients, including children with persistent asthma and those who received intravenous terbutaline, there was also no improvement in outcomes with the use of chronic ICS. However, children with persistent asthma were less likely to receive supplemental therapy with non-invasive positive pressure ventilation (5% vs. 15%, p=0.03) if they were receiving chronic ICS.
The chronic use of inhaled corticosteroids does not appear to reduce ICU length of stay or improve response to beta agonists in severely ill children with status asthmaticus.
Although useful preventively, the chronic use of ICS does not appear to affect the course of acute exacerbations in pediatric patients.
Christopher Carroll, None.