Daijiworld Media Network - Ontario

Ontario, Sep 1: Asthma-related intensive care unit (ICU) admissions remained largely stable among adults but increased significantly among children, according to a decade-long population-based study from Ontario, Canada.

The retrospective study analysed health administrative data of Ontario residents aged 0 to 59 with asthma between 2013 and 2022. After excluding people aged 60 and above and those with chronic obstructive pulmonary disease, the study included around 1.96 million people.

Among 52,919 patients hospitalised for asthma or an asthma-related condition, there were 71,258 hospital admissions, of which 7,870, or around 11 per cent, required ICU care. Despite advances in asthma treatment, the overall burden of ICU care did not decline during the study period.

The increase was particularly pronounced among children aged 0 to 18. The asthma-related ICU admission rate rose from 0.64 per 1,000 people with asthma in 2013 to 1.67 per 1,000 in 2022, representing an almost threefold increase.

The sharpest rise was recorded among children aged 0 to 5, particularly during 2021 and 2022. However, even after the pandemic years were excluded, researchers found a significant increase in paediatric ICU admissions between 2013 and 2019. More than 30 per cent of ICU admissions involved children younger than six.

The trend among adults aged 19 to 59 was different. Their asthma ICU admission rate remained relatively stable, declining slightly from 0.33 per 1,000 in 2013 to 0.28 per 1,000 in 2022. Researchers found no significant pre-pandemic change in adult ICU admissions or rates of invasive ventilation.

However, adult ICU stays lasting more than 10 days increased between 2013 and 2019, and around one-third of adult ICU admissions in 2022 lasted longer than 10 days.

Across all ICU admissions, 27 per cent required invasive ventilation. Among children, researchers observed a non-significant trend towards lower rates of invasive ventilation, along with fewer ICU stays lasting more than 10 days and an increase in stays of one to five days.

In-hospital mortality did not change significantly during the study period. Researchers cautioned that the rise in paediatric asthma ICU admissions should therefore not automatically be interpreted as evidence that asthma attacks have become physiologically more severe.

Greater use of non-invasive ventilation or changes in ICU admission practices may have contributed to the increase, although the available data could not establish either explanation.

Patients requiring ICU care were also more likely to have obesity, anxiety or depression, live in rural areas and have a history of asthma-related emergency department visits or hospitalisations compared with those who did not require intensive care.

The researchers said these associations require further investigation. They also noted limitations in the administrative data, which could not establish the specific reasons for ICU admission or reliably measure the use of non-invasive ventilation.

Asthma-related diagnoses may also have included other respiratory illnesses, particularly among children younger than six. While the Canadian setting limits direct application of the findings to US healthcare practice, the persistent burden of severe asthma among adults and rising ICU use among young children highlight the need for age-specific monitoring and healthcare planning.