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. 2023 Oct 14;4(2):209-215.
doi: 10.1016/j.jointm.2023.08.008. eCollection 2024 Apr.

Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Romy Younan  1 , Jean Loup Augy  1 , Bertrand Hermann  1 , Bertrand Guidet  2   3 , Philippe Aegerter  4 , Emmanuel Guerot  1 , Ana Novara  1 , Caroline Hauw-Berlemont  1 , Amer Hamdan  5 , Clotilde Bailleul  1 , Francesca Santi  1 , Jean-Luc Diehl  1   6   7 , Nicolas Peron  1 , Nadia Aissaoui  1   8
Affiliations

Severe asthma exacerbation: Changes in patient characteristics, management, and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Romy Younan et al. J Intensive Med. .

Abstract

Background: Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.

Methods: In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality.

Results: A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (n=2841) between 1997 and 2001, 1.76% (n=1717) between 2002 and 2006, 1.05% (n=965) between 2007 and 2011, and 1.05% (n=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32-59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13-28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV.

Conclusion: ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.

Keywords: Epidemiology; Intensive care unit; Mechanical ventilation; Severe asthma exacerbation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Flowchart representing the current population-based study investigating admissions for SAE or status asthmaticus without associated COPD diagnosis in the 40 CUB-Réa ICUs, divided into four 5-year periods. COPD: Chronic obstructive pulmonary disease; ICUs: Intensive care units; SAE: Severe asthma exacerbation.
Figure 2
Figure 2
Changes in SAE admissions, ICU mortality, and hospital mortality, and the use of IMV, NIV, and catecholamine over the study period. The proportion of admissions to the ICU for SAE decreased over time, as did ICU mortality and hospital mortality. The use of catecholamine almost disappeared from 2005. The use of mechanical ventilation remained infrequent. ICU: Intensive care unit; IMV: Invasive mechanical ventilation; NIV: Non-invasive mechanical ventilation; SAE: Severe asthma exacerbation.
Figure 3
Figure 3
Forest plot of results of multivariate analysis of factors associated with mortality. ARDS: Acute respiratory distress syndrome; IMV: Invasive mechanical ventilation; OR: Odds ratio; RRT: Renal replacement therapy; SAPS II: Simplified Acute Physiology Score II.
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