Long-term outcome after pediatric intensive care unit asthma admissions.

ABSTRACT

BACKGROUND: Patients with asthma admitted to the pediatric intensive care unit (PICU) are often found to have had previous severe asthma exacerbations. OBJECTIVE: To prospectively evaluate the outcome of children after PICU admission. METHODS: Patients, ages 218 years, admitted to the PICU at Assaf Harofeh Medical Center over a 10-year period were assessed at a mean of 10 years after their admission and compared with matched patients admitted to the pediatric ward. Each patient filled out a questionnaire on subsequent hospitalizations and current asthma treatment and control. Pulmonary function studies and allergy skin tests were performed. RESULTS: Compared with patients admitted to the pediatric ward, those admitted to the PICU had more hospitalization and ICU admissions after their index admission (p = 0.022 and p = 0.021, respectively). Most patients in both groups (6070%) had uncontrolled asthma, and 47% of those (PICU) and 33% (ward) were not receiving controller therapy. Patients in the PICU group had more recent asthma exacerbations (p = 0.014), weekly wheezing (p = 0.017), and bronchodilator use (p = 0.007). Lung function tests were comparable between the two groups, but 3045% in each group had airflow obstruction. No significant differences were found between preschool and school-age children in any of the parameters. CONCLUSION: Compared with patients admitted to the pediatric ward, those admitted to the PICU with asthma exacerbations, experienced more asthma-related hospitalizations and their asthma was less controlled even years later. The lack of regular follow-up and controller therapy in most patients after asthma hospitalization indicated that this increased morbidity might be prevented.