Association of Asthma With Treatments and Outcomes in Children With Critical Influenza

PALISI Pediatric Intensive Care Influenza Network Investigators

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Hospitalization for severe influenza infection in childhood may result in postdischarge sequelae. Objective: To evaluate inpatient management and postdischarge sequelae in children with critical respiratory illness owing to influenza with or without preexisting asthma. Methods: This was a prospective, observational multicenter study of children (aged 8 months to 17 years) admitted to a pediatric intensive care or high-acuity unit (in November 2019 to April 2020) for influenza. Results were stratified by preexisting asthma. Prehospital status, hospital treatments, and outcomes were collected. Surveys at approximately 90 days after discharge evaluated postdischarge health resource use, functional status, and respiratory symptoms. Results: A total of 165 children had influenza: 56 with preexisting asthma (33.9%) and 109 without it (66.1%; 41.1% and 39.4%, respectively, were fully vaccinated against influenza). Fifteen patients with preexisting asthma (26.7%) and 34 without it (31.1%) were intubated. More patients with versus without preexisting asthma received pharmacologic asthma treatments during hospitalization (76.7% vs 28.4%). Of 136 patients with 90-day survey data (82.4%; 46 with preexisting asthma [33.8%] and 90 without it [66.1%]), a similar proportion had an emergency department/urgent care visit (4.3% vs 6.6%) or hospital readmission (8.6% vs 3.3%) for a respiratory condition. Patients with preexisting asthma more frequently experienced asthma symptoms (78.2% vs 3.3%) and had respiratory specialist visits (52% vs 20%) after discharge. Of 109 patients without preexisting asthma, 10 reported receiving a new diagnosis of asthma (11.1%). Conclusions: Respiratory health resource use and symptoms are important postdischarge outcomes after influenza critical illness in children with and without preexisting asthma. Less than half of children were vaccinated for influenza, a tool that could mitigate critical illness and its sequelae.

Original languageEnglish (US)
Pages (from-to)836-843.e3
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number3
StatePublished - Mar 2023

Bibliographical note

Funding Information:
This study was supported in part by the Centers for Disease Control and Prevention (A.G. Randolph and PALISI Pediatric Intensive Care Influenza Network Investigators); Eunice Kennedy Shriver National Institute of Child Health and Human Development (A.B. Maddux, No. K23 HD096018), the National Heart, Lung, and Blood Institute (J.R. Grunwell, No. K23 HL151897), the National Institute of Nursing Research (A.M. Fitzpatrick, No. K24 NR018866), and the National Institutes of Allergy and Infectious Disease (A.G. Randolph and W. Phipatanakul, No. R01 AI 154470). The Centers for Disease Control and Prevention assisted with the collection, analysis, data interpretation and editing of the manuscript for important content, and in the decision to submit the article for publication. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Publisher Copyright:
© 2022 American Academy of Allergy, Asthma & Immunology


  • Acute respiratory viral infection
  • Asthma
  • Influenza
  • Outcomes
  • Pediatric intensive care unit
  • Reactive airway disease

PubMed: MeSH publication types

  • Observational Study
  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural


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