CLINICAL PROFILE AND RISK FACTORS OF ACUTE ASTHMA EXACERBATIONS IN CHILDREN

Background: Acute asthma exacerbations are an important cause of morbidity and emergency healthcare utilization among children. Identification of clinical characteristics and modifiable risk factors associated with severe exacerbations may facilitate early recognition and improve asthma management. Objectives: To assess the clinical profile and identify potential risk factors associated with acute asthma exacerbations and their severity among children presenting to Al-Khansaa Teaching Hospital, Nineveh Governorate, Iraq. Patients and methods: A hospital-based cross-sectional study was conducted among 102 children with acute asthma exacerbations at Al-Khansaa Teaching Hospital during the period from April 2025 to May 2026. Demographic characteristics, asthma history, previous exacerbations and healthcare utilization, treatment adherence, inhaler technique, allergic comorbidities, and potential environmental and infectious triggers were assessed using a structured questionnaire. Clinical parameters, including respiratory rate, heart rate, peripheral oxygen saturation, chest retractions, and accessory muscle use, were recorded at presentation. Associations between potential risk factors and exacerbation severity were evaluated using appropriate statistical tests, and multivariable logistic regression was performed to identify independent predictors of severe exacerbations. Results: Among the 102 children, 59 (57.8%) were males and 43 (42.2%) were females, with the largest proportion aged 2–5 years (42.2%). Wheezing was the most frequent presenting symptom (94.1%), followed by cough (86.3%) and dyspnea (80.4%). Exacerbations were classified as mild in 39 (38.2%), moderate in 43 (42.2%), and severe in 20 (19.6%) children. Previous asthma exacerbation during the preceding 12 months was reported in 71 (69.6%) children, while 43 (42.2%) had experienced two or more exacerbations. Poor treatment adherence was present in 38 (37.3%), frequent rescue medication use in 44 (43.1%), and incorrect inhaler technique in 29 (28.4%). Recent respiratory tract infection was the most frequently reported potential trigger (56.9%), followed by household dust exposure (51.0%) and passive cigarette smoke exposure (33.3%). Previous exacerbation, poor adherence, frequent rescue medication use, recent respiratory tract infection, and passive cigarette smoke exposure were independently associated with severe exacerbations. Severe cases also demonstrated significantly higher respiratory and heart rates, lower oxygen saturation, and more frequent chest retractions and accessory muscle use. Conclusions: Acute asthma exacerbations in this pediatric hospital population were associated with a substantial burden of recurrent disease and potentially modifiable treatment and environmental factors. Previous exacerbations, frequent rescue medication use, poor treatment adherence, recent respiratory tract infection, and passive cigarette smoke exposure were important predictors of severe exacerbations. Early identification of high-risk children, optimization of controller therapy, improvement of treatment adherence and inhaler technique, avoidance of tobacco smoke and other relevant triggers, and regular follow-up are recommended to reduce the frequency and severity of acute asthma exacerbations.