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

Abstract

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 (NO 2 , PM 10 , 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 NO 2 0.58 (95%CI, 0.02-0.87) and PM 10 0.75 (95%CI, 0.31-0.93) (P<.05). Conclusion: Environmental factors such as grass pollen counts and pollution (NO 2 and PM 10 ) are associated with a higher frequency of admission to the ED.

Impact of Air Pollution on Asthma Outcomes

“…Many studies have demonstrated so far a clear association between short-term exposure to outdoor air pollutants and different asthma outcomes including asthma control [ 87 ], lung function [ 92 ], consumption of asthma medications [ 93 , 94 ], outpatient visits [ 95 , 96 ], asthma exacerbations [ 97 , 98 ], emergency room visits [ 99 ], hospitalizations [ 100 , 101 ], length of stay in the hospital [ 102 ] and deaths [ 2 ]. Several air pollutants have been implicated in the loss of asthma control.…”

Effects of Air Pollutants on Airway Diseases

“…However, there was insufficient evidence to draw a similar conclusion regarding adult asthma [65]. Many studies have described correlations between short-term exposure to outdoor air pollutants and various aspects of asthma, including symptom control [66], lung function [67], medication dose [68,69], outpatient visits [70,71], asthma exacerbations [72,73], emergency room visits [74], hospitalizations [75,76], length of hospital stay [77], and mortality rate [78] (Figure 1). COPD is a disease characterized by exhaustion that frequently affects smokers and involves progressive respiratory symptoms, such as dyspnea and cough with sputum.…”

Impact of the State of Emergency during the COVID-19 Pandemic in 2020 on Asthma Exacerbations among Children in Kobe City, Japan

“…Asthma exacerbation (AE), the temporary worsening of asthma symptoms, is multifactorial in etiology. Numerous studies have reported environmental factors for AE and such contributing factors include infections (e.g., a recent study in children reported that rhinovirus (RV) species were most frequently detected, followed by respiratory syncytial virus (RSV), influenza virus, human parainfluenza viruses, and human metapneumovirus) [2], meteorological factors (e.g., temperature, humidity, wind speed, and thunderstorms), and exposure to allergens (e.g., pollen, Asian dust) or pollutants (e.g., sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), particulate matters (PMs), carbon monoxide (CO), and ozone (O 3 )) [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Therefore, environmental factors are very important causes of AEs.…”