Nocturnal attacks, emergency room visits and ICU admission of pediatric asthma: frequency and associated factors

ABSTRACT

Asthma is the most frequent cause of chronic illness in childhood and emergency department visits. This study aims to determine the frequency of emergency room [ER] visits, intensive care unit [ICU] admission, and nocturnal attacks among asthmatic children and to identify associated factors. Records of asthmatic children in the pediatric chest clinic, Ain Shams University during 1995-2004 were reviewed. Asthmatic children with documents of ER visits, ICU admission, or nocturnal attacks were compared with asthmatic children without previously mentioned events. Out of 691 asthmatic patients, 302 [43.7%] had nocturnal attacks, 258 [37.3%] had emergency room visits, 39 [5.6%] were admitted to ICU, and 249 [36%] had no reports of previous events. ER visits and nocturnal attacks were more in children above 4 years. ER visits and ICU admission were higher among those with positive family history of asthma [p< 0.01], those exposed to environmental tobacco smoke [ETS] [p< 0.01], and those who had previous respiratory infections [p< 0.05]. Attacks of nocturnal asthma were associated with the previous factors in addition to animal contact [p<0. 01] and living in bad housing conditions [p<0.05]. Logistic regression showed that family history [OR= 2.87, CI= 1.9-4.1] and bad housing conditions [OR= 2.65, CI= 1.3-5.3] were the significant factors for ER visits, while respiratory infections [OR= 5.24, CI= 2.1-12.0] and family history [OR= 3.48 CI, 1.3-9.2] were the significant factors for ICU admission. For nocturnal attacks, all factors were significant. Control of respiratory infections, limitation of ETS exposure and good housing conditions are needed to limit severe asthmatic attacks