Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations

Abstract

Background . Asthma exacerbations are a common reason for Emergency Department (ED) visits in children. Aim . To analyze differences among age groups in terms of triggering factors and seasonality and to identify those with higher risk of severe exacerbations. Methods . We retrospectively revised the files of children admitted for acute asthma in 2016 in our Pediatric ED. Results . Visits for acute asthma were 603/23197 (2.6%). 76% of the patients were &lt;6 years old and 24% ≥6. Infections were the main trigger of exacerbations in both groups; 33% of the school-aged children had a triggering allergic condition (versus 3% in &lt;6 years; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mo>.</mml:mo><mml:mn fontstyle="italic">01</mml:mn></mml:math>). 191 patients had a previous history of asthma; among them, 95 were ≥6 years, 67% of whom were not using any controller medication, showing a higher risk of a moderate-to-severe exacerbation than those under long-term therapy (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>p</mml:mi><mml:mo>&lt;</mml:mo><mml:mo>.</mml:mo><mml:mn fontstyle="italic">01</mml:mn></mml:math>). Exacerbations peaked in autumn and winter in preschoolers and in spring and early autumn in the school-aged children. Conclusions . Infections are the main trigger of acute asthma in children of any age, followed by allergy in the school-aged children. Efforts for an improved management of patients affected by chronic asthma might go through individualized action plans and possibly vaccinations and allergen-avoidance measures.