Understanding Clinical Outcomes in Children With Atopic Versus Nonatopic Asthma in the Pediatric Intensive Care Unit (PICU)

Introduction Asthma is a common chronic disease in children, affecting milions of children worldwide [1]. Asthma is divided into two main types: atopic asthma (AA) and non-atopic asthma (NAA). Children admitted to the PICU for asthma exacerbations (AE) can follow varied clinical courses, making it difficult to predict outcomes such as the need of intubation, length of stay (LOS) or the necessity for mechanical ventilation. Aim To compare the differences of outcomes between asthma exacerbation in AA and NAA in children admitted to PICU. Methods This study utilized a retrospective cohort design involving a chart review conducted at the Kaunas Clinics Children’s Department PICU. It was approved by Bioethics center (2024-BEC2-006). The cohort consisted of children (aged 1month to 18 years) admitted to the PICU for an acute AE from 2015-01-01 to 2022-12-31, identified by the following ICD-10-AM codes: J45 - asthma, J45.0 - predominantly allergic asthma, J45.1 - non-allergic asthma, J45.9 - unspecified asthma, J46 - status asthmaticus. Patients were categorized into two groups based on their diagnoses recorded in medical files. Those whose primary reason for hospitalization was unrelated to an AE were excluded from the study. Data were analyzed using IBM SPSS Statistics Version 29.0.2.0 (20) (IBM Corp., Armonk, NY, USA). Categorical variables were reported as frequencies and percentages. Continuous variables were summarized using medians and interquartile ranges (IQR). Differences in distributions between groups were assessed using the Mann-Whitney U test and ChiSquare test. Differences in the compared groups were assumed as statistically significant if p-value < 0.05. Results Out of 121 patients 33 met the criteria (n=13 (39.4%) NAA and n=20 (60.6%) AA). Among the patients, 7 (21%) had a family history of asthma, 1 (3%) personal history of eczema, 8 (24%) – allergic rhinitis. Statistically significantly more patients in AA group had a history of rhinitis (X2= 6,864, p=0.012). The LOS in the PICU was not significantly different between the groups (U=125.000, p=0.784). The median hospital LOS were 6 days (IQR 3.5-7.0) for NAA patients and 4 days (IQR 2.25-7.5) for AA patients (U=103.500, p=0.077). 1 (5%) AA patient required intubation, while none of the NAA patients did. However, this difference was not statistically significant (p=0.420). Conclusions Patients with AA are more likely to have a history of allergic rhinitis (AR). While AR is more prevalent in AA patients, the type of asthma does not significantly impact PICU outcomes such as LOS or the need for intubation.