CHARACTERISTICS OF CHILDREN HOSPITALIZED WITH MILD TO MODERATELY SEVERE ASTHMA

This retrospectively matched case-control study was conducted to ident ify historical and clinical characteristics of children admitted for h igh dependency asthma care (intravenous fluids and steroids, continuou s oxygen need, and frequent bronchodilator aerosols) and compare them with those requiring only oral steroids and infrequent bronchodilator aerosols. The study population consisted of patients with asthma admit ted to a pediatric hospital (providing primary through tertiary care). The health records of 112 children admitted (May 1994 to April 1996) for high dependency care (severe group) were compared with an equal nu mber of children admitted for standard care (mild group) of asthma and matched for age and sex (boys: n = 128; girls: n = 96; mean ages: 4.6 5 years and 4.9 years, respectively). Those in the severe group were a ssociated with a longer median length of stay (LOS)-4.0 days versus 2. 0 days (p < 0.00001). The duration of diagnosed asthma, previous admis sions, and environmental histories were similar in each group. Regular home bronchodilator use preceding the admission was associated with a severe episode (p < 0.001). Prehospital duration of symptoms or treat ment of the exacerbation did not predict severity. Logistic regression (controlling for sex and age) indicated regular bronchodilator use or low oxygen saturation (less than or equal to 90%) prior to treatment was strongly associated with intensive therapy. Many historical featur es, such as the duration of diagnosed asthma, previous admissions, and environmental histories (smokers, presence of animals), do not reliab ly predict the need for, nor duration of, intensive therapy for asthma . Some children with mild disease on presentation may become very ill. However, a history of regular, monthly bronchodilator use is importan t as a marker for severe disease or inappropriate management. A low ox ygen saturation at presentation is a useful predictor of the need for intensive asthma management.