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

Dondi, Arianna; Calamelli, Elisabetta; Piccinno, Valentina; Ricci, Giampaolo; Corsini, Ilaria; Biagi, Carlotta; Lanari, Marcello

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.