Evaluation if Risk Factors, Resource Utilization and Outcome of Critical Acute Asthma in PICU

Abstract

Background: Childhood asthma is the most common chronic illness in children, affecting approximately 10% of the pediatric population worldwide. Critical asthma, defined as acute severe asthma requiring PICU admission due to deteriorating clinical status and inadequate response to initial therapy, is a life-threatening condition.

Aim: To evaluate risk factors, resource utilization, and outcomes of critical acute asthma in pediatric patients who are admitted to intensive care units.

Methods: This case-control study was conducted in the Pediatric Intensive Care Units of Cairo University Children's Hospital (Abou El-Reesh) between April 2024 and August 2025. The study included 82 children aged 1-14 years with confirmed asthma diagnosis, divided into two groups: 41 children with critical acute asthma requiring PICU admission (cases) and 41 children with well-controlled asthma attending outpatient clinics (controls). Comprehensive data collection included demographic information, asthma history, medication adherence, environmental exposures, clinical examination, laboratory investigations, and virological screening. Asthma control was assessed using the validated Asthma Control Questionnaire (ACQ-6). Healthcare resource utilization and outcomes were documented for PICU patients.

Results: Cases and controls were comparable regarding age, sex, disease duration, and age at asthma onset (p>0.05). Critical acute asthma was significantly associated with family history of asthma/allergy (p=0.046), previous PICU admissions (p=0.007), frequent emergency room visits (p<0.001), poor controller therapy adherence (p=0.036), inadequate inhalation technique (p=0.034), lower leukotriene receptor antagonist use (p<0.001), obesity (p=0.023), eczema (p=0.019), allergic rhinitis (p=0.023), and poorer asthma control (ACQ-6 score; p<0.001). Environmental factors including allergy, air pollution, passive smoking, animal exposure, and seasonal symptom variation were also significantly associated with critical acute asthma (p<0.05). Among PICU patients, 43.9% had positive viral screening, predominantly respiratory syncytial virus. High-flow nasal cannula was the most commonly used respiratory support modality (51.2%). Clinical improvement occurred in 92.7% of cases, while mortality was 4.9%. 

Conclusion: Critical acute asthma in children is strongly associated with poor asthma control, inadequate treatment adherence, allergic comorbidities, recurrent healthcare utilization, and environmental exposures. Despite generally favorable outcomes, significant healthcare resources are required for management. Early optimization of asthma control, adherence, and trigger avoidance may reduce the risk of severe exacerbations requiring PICU admission.