Analysis of risk factors for severe acute pediatric asthma exacerbation in Quanzhou, Southern China

Objective: To investigate risk factors associated with severe acute asthma attacks in children with asthma over six years of age. Methods: This retrospective study enrolled children aged over six years diagnosed with acute asthma exacerbation at the Department of Pulmonology, Quanzhou Children's Hospital, from January 2012 to September 2024. Data on the patients' clinical manifestations were compared between the mild to moderate and severe asthma attack groups. Results: The average age of the 261 patients was 8.03 +/- 1.88 years. The patients were categorized into two groups based on attack severity: mild to moderate (n = 209) and severe (n = 52). Univariate analysis revealed significant differences between the two groups in terms of malnutrition, breastfeeding duration (over three and six months), eosinophil and neutrophil percentages, human rhinovirus (HRV) infection, mediastinal emphysema, and subcutaneous emphysema (p < 0.05). Logistic regression analysis revealed that children over six years of age hospitalized for asthma attacks were more likely to experience severe exacerbations if they had an elevated neutrophil % (OR = 1.040), HRV infection (OR = 5.655), malnutrition (OR = 5.051), or mediastinal emphysema (OR = 9.205). ROC analysis revealed that a neutrophil percentage threshold of 69.35 (the threshold value of neutrophil count over 6 years old is 1.6-8.3 x 109/L) was diagnostically useful for severe asthma, with a sensitivity of 0.750, specificity of 0.617, and an area under the curve of 0.73. Conclusion: The level of neutrophils, history of HRV infection, malnutrition, and mediastinal emphysema are all independent risk factors for a severe acute asthma attack in children aged over six years. Management strategies for asthma should be expanded to focus on high-risk children in order to avoid severe attacks.