Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Mar;11(3):836-843.e3.
doi: 10.1016/j.jaip.2022.10.045. Epub 2022 Nov 12.

Association of Asthma With Treatments and Outcomes in Children With Critical Influenza

Aline B Maddux  1 , Jocelyn R Grunwell  2 , Margaret M Newhams  3 , Sabrina R Chen  3 , Samantha M Olson  4 , Natasha B Halasa  5 , Scott L Weiss  6 , Bria M Coates  7 , Jennifer E Schuster  8 , Mark W Hall  9 , Ryan A Nofziger  10 , Heidi R Flori  11 , Shira J Gertz  12 , Michele Kong  13 , Ronald C Sanders Jr  14 , Katherine Irby  14 , Janet R Hume  15 , Melissa L Cullimore  16 , Steven L Shein  17 , Neal J Thomas  18 , Kristen Miller  1 , Manish Patel  4 , Anne M Fitzpatrick  19 , Wanda Phipatanakul  20 , Adrienne G Randolph  21 ; PALISI Pediatric Intensive Care Influenza Network Investigators
Collaborators, Affiliations
Observational Study

Association of Asthma With Treatments and Outcomes in Children With Critical Influenza

Aline B Maddux et al. J Allergy Clin Immunol Pract. 2023 Mar.

Abstract

Background: Hospitalization for severe influenza infection in childhood may result in postdischarge sequelae.

Objective: To evaluate inpatient management and postdischarge sequelae in children with critical respiratory illness owing to influenza with or without preexisting asthma.

Methods: This was a prospective, observational multicenter study of children (aged 8 months to 17 years) admitted to a pediatric intensive care or high-acuity unit (in November 2019 to April 2020) for influenza. Results were stratified by preexisting asthma. Prehospital status, hospital treatments, and outcomes were collected. Surveys at approximately 90 days after discharge evaluated postdischarge health resource use, functional status, and respiratory symptoms.

Results: A total of 165 children had influenza: 56 with preexisting asthma (33.9%) and 109 without it (66.1%; 41.1% and 39.4%, respectively, were fully vaccinated against influenza). Fifteen patients with preexisting asthma (26.7%) and 34 without it (31.1%) were intubated. More patients with versus without preexisting asthma received pharmacologic asthma treatments during hospitalization (76.7% vs 28.4%). Of 136 patients with 90-day survey data (82.4%; 46 with preexisting asthma [33.8%] and 90 without it [66.1%]), a similar proportion had an emergency department/urgent care visit (4.3% vs 6.6%) or hospital readmission (8.6% vs 3.3%) for a respiratory condition. Patients with preexisting asthma more frequently experienced asthma symptoms (78.2% vs 3.3%) and had respiratory specialist visits (52% vs 20%) after discharge. Of 109 patients without preexisting asthma, 10 reported receiving a new diagnosis of asthma (11.1%).

Conclusions: Respiratory health resource use and symptoms are important postdischarge outcomes after influenza critical illness in children with and without preexisting asthma. Less than half of children were vaccinated for influenza, a tool that could mitigate critical illness and its sequelae.

Keywords: Acute respiratory viral infection; Asthma; Influenza; Outcomes; Pediatric intensive care unit; Reactive airway disease.

PubMed Disclaimer

Conflict of interest statement

Competing Interests Statement: The author(s) declare no competing interests.

Figures

Figure 1.
Figure 1.
Enrollment Diagram. Flow diagram of patients with influenza enrolled in PICFlu with and without a pre-existing diagnosis of asthma.
Figure 2.
Figure 2.
Pediatric intensive care unit (PICU) treatments received by influenza-infected children with and without a pre-existing diagnosis of asthma. NIV = non-invasive mechanical ventilation. IMV = invasive mechanical ventilation. PARDS = pediatric acute respiratory distress syndrome. *p < 0.0001.
Figure 3.
Figure 3.
Pharmacologic asthma treatments received in the pediatric intensive care unit (PICU). IV = intravenous. *p < 0.0001.
Figure 4.
Figure 4.
Post-discharge outcomes for influenza-infected children with and without a pre-existing diagnosis of asthma. The dashed line separates the follow-up (above the line) from the candidate respiratory outcomes (below the line). *p < 0.001
See this image and copyright information in PMC

Comment in

References

    1. Campbell AP, Ogokeh C, Lively JY, Staat MA, Selvarangan R, Halasa NB, et al. Vaccine Effectiveness Against Pediatric Influenza Hospitalizations and Emergency Visits. Pediatrics 2020; 146. - PubMed
    1. Past seasons estimated influenza disease burden. National Center for Immunization and Respiratory Diseases (NCIRD); 2020.] Available from https://www.cdc.gov/flu/about/burden/2019-2020.html.
    1. Olson SM, Newhams MM, Halasa NB, Feldstein LR, Novak T, Weiss SL, et al. Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children. Clin Infect Dis 2022. - PubMed
    1. Ferdinands JM, Olsho LE, Agan AA, Bhat N, Sullivan RM, Hall M, et al. Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010–2012. J Infect Dis 2014; 210:674–83. - PubMed
    1. Randolph AG, Vaughn F, Sullivan R, Rubinson L, Thompson BT, Yoon G, et al. Critically ill children during the 2009–2010 influenza pandemic in the United States. Pediatrics 2011; 128:e1450–8. - PMC - PubMed

Publication types