Children with Asthmatic Exacerbation Influences of Different Phenotypes

Asthma exacerbations are defined as an acute or subacute worsening of symptoms and lung function with respect to the usual conditions of the patient. Asthma is a heterogeneous disease and different phenotypes have been identified.

Objective: To know the epidemiological and clinical profile of pediatric patients hospitalized for asthmatic exacerbations in a highly complex metropolitan hospital.

Methods: A retrospective descriptive study that included all children aged between 4 to 14 years with a diagnosis of exacerbation or asthmatic crisis hospitalized in one year period was performed. The clinical records were reviewed, and demographic and clinical history specifically directed to identified different phenotypes and comorbidities were analyzed.

Results: Fifty asthmatic children met the inclusion criteria. Prior to hospitalization, 66% had moderate asthma, and 10% had severe asthma. Persistent rhinitis was found in 66%, and 40% had a history of at least one previous hospitalization for asthma attacks, where 20% had been hospitalized for this reason in the last year and 18% had at least one previous hospitalization in the ICU or CPU. Only 70% of the patients had a prior established diagnosis of asthma and 28% had adequate compliance with both treatment and attendance at medical controls. On admission, 20% were obese. In 54% of the cases, one or both parents reported smoking during the research period. Symptoms duration prior to admission was less than 24 hours in 40% of the patients, and 34% could be defined with unstable asthma. Twenty two percent of the patients were admitted to the ICU or CPU, of which 45% began their symptoms in less than 24 hours and 36% also can be defined as having unstable asthma.

Conclusions: We found a group of patients who, despite not presenting symptoms and apparent clinical signs of severe asthma, some of them with a history of previous hospitalizations, suddenly presented an asthmatic exacerbation that evolved in a few hours with respiratory failure and requiredadmission to hospital ICU or CPU. Further characterization is necessary for the education, management, and personalized treatment of this group because they resemble a different phenotype previously described as type II labile asthma in adults.