Reassessment of Disease Severity in Patients Following Severe Acute Exacerbations of Asthma

Patients with asthma may have severe exacerbations. The impact of severe acute exacerbation on patient outcome has not been studied, however. The purpose of this study was to examine the long-term outcome of severe exacerbation of asthma on baseline disease severity in children. Data were collected retrospectively from all children with asthma older than 5 years who were admitted to the intensive care unit (ICU) with an acute exacerbation and were subsequently followed as outpatients. Patients were divided into 4 severity groups (intermittent, mild persistent, moderate persistent, and severe persistent) based on the severity of asthma prior to ICU admission, at the time of admission, and at 12-month follow-up. Thirty-nine patients were followed for 12 months after ICU admission. Pulmonology consultation was more likely to be obtained in patients with moderate and severe asthma at baseline as compared with those with intermittent or mild asthma (P = .004). On follow-up, 59% had a change in classification of their asthma severity. Changes in asthma severity were more likely to occur at the time of ICU admission rather than at 12-month follow-up. There was no difference in the gender, race, age, or body mass index at the time of ICU admission between the group who had a change in asthma severity and the group with no change in severity. There was no difference in Modified Pulmonary Index Score, duration of hospitalization, or length of stay in the ICU between the 2 groups. Prior inhaled steroid dose was lower in patients who had a change in severity as compared with those who had not (P = .018). Children with mild asthma were frequently reclassified to a more severe asthma category after an acute life-threatening episode of asthma. It is likely that this reclassification was due to underestimation of disease severity prior to the ICU admission, but the severe acute event itself may have contributed to increased severity classification.