Risk factors for hospitalization in subspecialty patients with severe persistent asthma

Background and objectives: Children with severe persistent asthma managed by subspecialists represent a unique patient population. The factors predisposing these children to hospital admission are poorly understood. This study aimed to identify factors associated with future emergency department (ED) visits and hospitalization in this group.

Methods: A chart review was conducted for children with severe persistent asthma evaluated by a pulmonologist between January 1, 2021 and June 30, 2022. Asthma-related ED visits and hospitalizations were recorded from electronic medical records. Chi-square testing, mixed effects modeling, and logistic regression were used to analyze associations between patient characteristics and hospitalization. A secondary analysis evaluated factors contributing to ED visits.

Results: We identified 244 unique patients with 487 pulmonary clinic visits. Of these, 56 % were black, 58 % had public insurance, and 32 % had a history of ICU admission for asthma. In the 12 months following a clinic visit, 84 (34 %) patients had an ED visit, and 46 (19 %) had at least one hospitalization. Secondhand smoke exposure (OR 2.74, 95 % CI 1.16-6.45), public insurance (OR 3.37, 95 % CI 1.46-7.82), and prior ICU admission (OR 2.29, 95 % CI 1.09-4.79) were positively associated with hospitalization for asthma exacerbation. Among hospitalized patients, bronchopulmonary dysplasia (BPD) and gastroesophageal reflux disease (GERD) were linked to shorter time to admission.

Conclusions: Despite subspecialty care, children with severe persistent asthma exposed to cigarette smoke, with prior ICU admission, or with public insurance are at higher risk of subsequent ED visits and hospitalization. These findings will inform targeted interventions to prevent hospitalization in this patient population.