Analysis Of Clinical Characteristics And Factors Associated With The Severity Of Acute Asthma Attacks In Hospitalized Children

Objective:To summarize the clinical characteristics of children hospitalized with acute asthma attacks and to explore the factors associated with the severity of acute attacks,to provide a reference for the early identification and management of acute attacks in children with asthma,especially acute severe attacks.Methods:The clinical data of children admitted to our pediatric department for acute asthma attacks from 01 October 2017 to 01 October 2022 were retrospectively analyzed,and the cases enrolled were graded for the severity of acute asthma attacks according to the guideline severity grading criteria(<6 years old as mild and severe attacks,≥6 years old as mild,moderate,severe and critical attacks),and this study was divided into mild attacks(≥6years old(including mild and moderate exacerbations)and severe exacerbations(≥6 years old including severe and critical exacerbations).The clinical data of the children were collected through the electronic medical record system and telephone interviews to summarize the clinical characteristics of children hospitalized with acute asthma attacks.A dichotomous logistic regression model was constructed to analyze the factors associated with hospitalization for acute severe asthma attacks.Results:1.Epidemiological characteristics: The median age of onset was 4 years old(2.5 years old,6.0 years old).The proportion of infants,preschoolers and school-age children was 29.8%,38.0% and 32.2% respectively,with the highest proportion of acute attacks in preschool.The highest proportion of acute exacerbations occurred in preschool;the main cause of acute asthma hospitalization was respiratory infection,accounting for 49.1%;the season of onset was mainly autumn,accounting for 39.2%.Further analysis by age group showed that respiratory tract infections were still the main cause of acute asthma attacks in children<6 years old,accounting for 58.6%,and the onset season was mainly autumn;respiratory tract infections were the second cause in children≥6 years old,accounting for 29.1%,and the onset seasons were mainly autumn and spring.2.Pathogen detection: pathogens were detected in 89 out of 171 children,a detection rate of 52%.The detection rate of pathogens was higher in children <6 years old(54.3%)than in children ≥6 years old(47.3%),both with the highest detection rate of Mycoplasma pneumoniae.3.A higher proportion of children <6 years of age had an acute severe asthma attack,a trigger of respiratory infection,no previous diagnosis of asthma,and abnormal lung function than children ≥6 years of age,with a statistically significant difference(P<0.05).4.Univariate analysis: The differences in serum 25(OH)D level,whether ICS treatment was applied regularly,and lung function status were statistically significant between the mild and severe exacerbation groups in children <6 years old;the differences in EOS%,whether asthma had been diagnosed,whether ICS treatment was applied regularly,and whether Mycoplasma pneumoniae infection was statistically significant between the mild and severe exacerbation groups in children ≥6 years old.5.Multi-factor binary logistic regression analysis showed that increased serum 25(OH)D levels reduced the risk of acute severe asthma attacks in children <6 years of age with statistical significance(OR=0.936,95%CI0.877-0.998,P=0.043);regular ICS treatment reduced the risk of acute severe asthma attacks in children <6 years of age with statistical significance(OR=0.305,95%CI 0.322-0.730,P=0.007);abnormal lung function increased the risk of acute severe asthma attacks in children <6 years of age with statistical significance;and abnormal lung function increased the risk of acute severe asthma attacks in children <6 years of age with statistical significance.Regular ICS treatment would reduce the risk of acute severe asthma attacks in children <6 years of age,which was statistically significant(OR=0.305,95%CI 0.322-0.730,P=0.007);abnormal lung function would increase the risk of acute severe asthma attacks in children <6 years of age,which was statistically significant(OR=1.651,95%CI 1.129-2.413,P=0.010).Regular ICS treatment would reduce the risk of acute severe asthma exacerbation in children ≥6 years of age with statistical significance(OR=0.236,95%CI 0.059-0.941,P=0.041);Mycoplasma pneumoniae infection would increase the risk of acute severe asthma exacerbation in children ≥6 years of age with statistical significance(OR=5.803,95%CI1.418-23.757,P=0.014).Conclusions:1.The incidence of acute asthma attacks in children is relatively high in boys;children <6 years of age are more likely to be hospitalized for acute severe asthma attacks.2.The triggers for hospitalization for acute asthma attacks varied by age,with respiratory infections being the main trigger in children <6 years of age and less obvious in children ≥6 years of age,with respiratory infections being the 2nd trigger.3.The peak time of hospitalization for acute asthma attacks varies by age,with <6 years old predominantly in autumn and ≥6 years old predominantly in autumn and spring.4.Protective factors for hospitalization for acute severe asthma attacks in children <6 years of age were elevated serum 25(OH)D levels,regular ICS treatment and risk factors for abnormal lung function;protective factors for hospitalization for acute severe asthma attacks in children ≥6 years of age were regular ICS treatment and risk factors for Mycoplasma pneumoniae infection.