Acute asthma exacerbation and management of Hispanic patients admitted to hospital

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.366-366
• Main Authors: Oliver, Lara S., Rosado-Barreras, Lymarie, López-Ortiz, Bryan, Gorbea-Fuxench, Gabriela, Merced-Román, Jesus, Mendez-González, Gabriela, Puig, Anabel
• Format: Article
• Language: English
• Subjects: Asthma; Children; Cystic fibrosis; Demographics; Disease management; Dysplasia; Fibrosis; Immunosuppression; Males; Mechanical ventilation; Medical personnel; Metropolitan areas; Patient admissions; Patients; Pediatrics; Risk factors; Steroid hormones; Steroids
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA4.366

Introduction Asthma is the third most common cause for hospitalization among the pediatric population under 15 years old. Studies report a higher prevalence of asthmatic children and hospital admissions due to asthma attacks among Puerto Rican children living in the island, than those living in the United States. This study assessed the profile of patients admitted to PICU and Ward due to asthma exacerbations. Methods This retrospective case-control study evaluated all admissions to a pediatric children's hospital in the San Juan metropolitan area of Puerto Rico from July 2016 to July 2017 due to asthma. Patients between the ages of 4 and 21 years old admitted with an official diagnosis of asthma were evaluated. Patients under mechanical ventilation at home, history of any neuromuscular disorder, history of cystic fibrosis, history of bronchopulmonary dysplasia, history of NICU admission, history of immunosuppression, and history of less than 48 hours with symptoms were excluded. The following data was collected: demographic, origin (PICU or Ward), clinical, previous hospital admissions, and relevant past medical history and management. Severity of asthma was assigned using the Asthma Clinical Respiratory Score (CRS) on admission. Data was expressed as means, medians ± SD, frequencies and percentages as appropriate. An un-paired Mann-Whitney test was used to compare continuous variables from patients from PICU vs Ward. A Fisher's Exact Test was used for proportions and categorical data. Results A total of 254 admissions were evaluated, of which 34% were from PICU. PICU admissions were 51% female with an average age of 8.9 years. Ward had 52% males with a mean age of 9 years. Hospital LOS of admissions to PICU were longer than admissions to Ward (9.2 vs 5.4 days). Average PICU LOS was 4.8 ± 2.4 days and average Ward LOS was 5.4 ± 3.3 days. PICU patients had 65% moderate and 35% mild asthma. Ward patients had 48% moderate and 52% mild asthma. A 95% of patients received IV steroids in the first 24 hours, whereas only 28% used Ipatropium for asthma management. Conclusions Patients with asthma are at risk for life-threatening exacerbations requiring PICU admissions, especially those not receiving or adherent to long-term control medication. Physicians and parents should be aware of risk factors, and efforts should be made to counteract them. It is possible to use findings from this study to define guidelines for admission of asthmatic patients to Ward or PICU a