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Asthma Exacerbations in the Pediatric Emergency Department at a Tertiary Hospital: Association With Environmental Factors

Marques-Mejías MA1, Tomás-Pérez M1,2, Hernández I1, López I1, Quirce S1,2,3

1Department of Allergy, Hospital Universitario La Paz, Madrid, Spain
2Department of Allergy, Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
3CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain

J Investig Allergol Clin Immunol 2019; Vol 29(5) : 365-370
doi: 10.18176/jiaci.0364

Introduction: Children with asthma experience recurrent respiratory symptoms and exacerbations due to multiple environmental factors. The aim of this study was to describe the prevalence and triggers of asthma exacerbations and their management in a cohort of pediatric patients attended in an emergency department (ED).
Methods: We performed an observational, retrospective, single-center study in the pediatric ED of Hospital Universitario La Paz, Madrid, Spain in 2015. Children with asthma exacerbations attending the ED were included after a thorough search using our institutional computer database. Pollen and atmospheric mold spore counts and pollution data were collected for that period from official websites. Multiple logistic regression was used to assess the association between daily pollution (NO2, PM10, ozone, pollen, and molds) and admissions to the ED because of asthma.
Results: During 2015, a total of 50 619 patients were attended in the ED of our hospital. Of these, 2609 (5%) were diagnosed with asthma exacerbation/bronchospasm. The patient had to be admitted to hospital in 21.7% of cases. The main triggers of asthma exacerbations were respiratory infection in 1841 cases (70.6%). A significant correlation was found between grass pollen counts and ED admissions (P<.0001). A positive correlation was also found between ED admissions and NO2 0.58 (95%CI, 0.02-0.87) and PM10 0.75 (95%CI, 0.31-0.93) (P<.05).
Conclusion: Environmental factors such as grass pollen counts and pollution (NO2 and PM10) are associated with a higher frequency of admission to the ED.

Key words: Pediatric asthma, Asthma exacerbations, Air pollutants, Asthma management