Asthma Exacerbation May Increase Pediatric Asthma Rehospitalization Rates

girl with asthma holding inhaler
Incidence rates of severe asthma exacerbation are highest in children with severe asthma and a history of exacerbations.

Incidence rates of severe asthma exacerbation (SAE) are highest in children with severe asthma and a history of exacerbations, underscoring the importance of enhanced care to reduce asthma burden in this patient population, according to study results published in Pediatric Allergy and Immunology.

International data on incidence rates of SAE in children with asthma are scarce, and researchers continue to lack reliable tools and biomarkers to predict SAE in children. The objective of this study was to evaluate incidence rates and risk factors for SAE, as well as incidence rates of asthma-related rehospitalization in children with asthma.

In this retrospective cohort study, researchers used data from 6 European electronic healthcare databases to identify patients aged 5 through 17 years with asthma and a minimum of 1-year database history. Asthma was defined as physician-diagnosed asthma in combination with the prescription or dispensing of asthma medications within 3 months of diagnosis. Severe asthma was defined as asthma treated with high-dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids for a minimum of 120 consecutive days. SAE was defined as the use of systemic corticosteroids, emergency department visit, and/or hospitalization for exacerbated asthma. Poisson regression analyses were used to assess risk factors of asthma exacerbations.

The final cohort consisted of 212,060 children with asthma contributing to 678,625 patient-years. Of the cohort, 14,283 children had severe asthma.

Overall rates of SAE ranged between 17-198/1000 patient-years and were higher in patients with severe asthma (46-375/1000 patient-years). In all databases, rates of SAE decreased with age, starting at 5 years. Atopy, gastroesophageal reflux disease, and obesity increased the risk for SAE in some databases after adjusting for age and gender. After stratifying for age, girls aged 5 through 11 years had a decreased risk for SAE, although the risk increased in girls aged 12 through 17 years. The incidence of rehospitalization within 1 year ranged between 17% and 29% in children with asthma, and between 33% to 79% in children with severe asthma.

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Limitations to this study included potential bias and confounding, potential underreporting of the asthma incidence rate, and potential differences in SAE rates because of international differences in the use of systemic steroids. Additional limitations included missing dosing information in some databases and potential misclassification of asthma and disease codes.

The researchers concluded that the most important risk factor for rehospitalization in children with severe asthma was a previous asthma exacerbation and that focusing on prevention of SAE in asthma management is critical to reducing asthma burden in children.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Engelkes M, Baan EJ, de Ridder MAJ, et al. Incidence, risk factors and re‐exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study [published online March 1, 2020]. Pediatr Allergy Immunol. doi:10.1111/pai.13237