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. 2017:2017:9687061.
doi: 10.1155/2017/9687061. Epub 2017 Oct 12.

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

Arianna Dondi  1 , Elisabetta Calamelli  2 , Valentina Piccinno  1 , Giampaolo Ricci  3 , Ilaria Corsini  1 , Carlotta Biagi  1 , Marcello Lanari  1
Affiliations

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

Arianna Dondi et al. Biomed Res Int. 2017.

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 <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 <6 years; p < .01). 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 (p < .01). 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.

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Figures

Figure 1
Figure 1
Colour tag at triage of 603 patients aged 0–14 years who were visited for acute asthma from 1 January to 31 December 2016 in the Pediatric ED of S. Orsola-Malpighi University Hospital of Bologna.
Figure 2
Figure 2
Etiologies of asthma exacerbations in 603 patients aged 0–14 years who were visited for acute asthma in 2016 in the Pediatric ED of the Pediatric Department of S. Orsola-Malpighi University Hospital of Bologna and divided into 2 subgroups: patients younger than 6 years (n = 459; 76%) and those aged 6 years and older (n = 144; 24%).
Figure 3
Figure 3
The severity of the exacerbations in patients ≥6 years with a previous diagnosis of asthma (n = 95) who were visited for acute asthma in 2016 in the Pediatric ED of the Pediatric Department of S. Orsola-Malpighi University Hospital of Bologna and divided into two subgroups (“controller therapy” and “no controller therapy”).
Figure 4
Figure 4
The seasonal trend of the asthmatic exacerbations in 603 patients who were visited for acute asthma in 2016 in the Pediatric ED of the Pediatric Department of S. Orsola-Malpighi University Hospital of Bologna and divided into 2 subgroups: patients younger than 6 years (n = 459; 76%) and those aged 6 years and older (n = 144; 24%).
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