Clinical features of moderate to severe asthma exacerbation in school-age children

Abstract

Objective To understand the clinical features and current therapies on asthma exacerbation, so as to provide practical evidence for managing asthma episodes. Methods Two hundred and fourteen school-age (≥6 years old) cases who were admitted for asthma exacerbation in Beijing Children's Hospital, from January 2005 to December 2013, were enrolled.All the cases were categorized into 2 groups: asthma with pneumonia group(group A, n=88) and asthma group(group B, n=126). Results There were 214 cases enrolled, the median age was 9(6-18) years old, and the male-female ratio was 1.5:1.0, 78.0%(167/214 cases) of the patients enrolled had moderate asthma exacerbation, and 22.0%(47/214 cases) were defined as severe episodes, 7.0% (15/214 cases) were on mechanical ventilation.Compared with group B, group A had more systemic corticosteroids use (53.4% vs 38.9%, χ2=4.416, P=0.036), higher proportion of cases needing mechanical ventilation (12.5% vs 3.3%, χ2=5.476, P=0.019), longer durations in hospital (9.0 d vs 8.0 d, Z=-3.063, P=0.002), and higher hospitalization expenses (10 000 yuan vs 9 000 yuan, Z=-2.058, P=0.000). The prescription of Aminophylline didn't help to shorten the duration of wheeze days (5.7 d vs 5.9 d, t=-0.233, P=0.817). Twenty-four cases received bronchial lavage through bronchoscope during wheezing days, in which 22 cases (91.7%) of wheezing disappeared within 3 days after the lavage.There were more sensitized allergens detected in those patients who showed hypersecretion status under bronchoscopy (3.3±1.4 vs 2.2±1.2, t=2.190, P=0.036), compared with those without such signs. Conclusions Pneumonia may increase the demand for systemic use of corticosteroids in asthma exacerbations.The early use of systemic corticosteroids may have an effect on reducing the severity of asthma attack, especially those with pneumonia.Multi-sensitization may contribute to the hypersecretion in bronchi.The bronchial lavage may help improve the bronchial ventilation caused by mucous plugin.The clinical usage of Aminophylline is still controversial, and it needs to be optimized. Key words: Asthma; Exacerbation; Pneumonia; Child