Objectives: To describe the epidemiological, clinical and therapeutic aspects of asthma in children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville. Patients and methods: We reviewed the records of children hospitalized in the Pediatric Intensive Care Unit of University Hospital of Brazzaville from January 1 to December 31, 2015, and retained those from two months to 17 years hospitalized for asthma. The study variables were: age, sex, influence of seasons, history of atopy; the factors triggering the crisis, the type of follow-up, the degree of severity of asthma exacerbation, the type of treatment instituted and the course of the disease. In total, out of 2012 hospitalized children, 65 children met the inclusion criteria. Results: The hospital prevalence of asthma was 3.5%. Among 65 children of study, 42 (59.2%) were male and 29 (40.8%) female. The mean age was 3.9 ± 2.9 years (range from 2 months to 14 years). Children aged 30 months to 5 years were the most represented (40%). They were known as asthmatics, n = 18 (27.7%). Family atopy was found, n = 11 (16.9%). Acute Otorhinolaryngologic infections were in all cases the factors triggering the crisis. The peak frequency of hospitalizations for asthma occurred during the short rainy season. The crisis was moderate n = 46 (70%) and severe n = 19 (29%). Beta 2 mimetics were administered in all cases, by subcutaneous in 18 cases (27.7%) and inhaled in 47 cases (72.3%). The outcome was favorable in all cases with a mean hospital stay of 1.46 ± 0.92 days. Conclusion: Childhood asthma remains a public health challenge and severe asthma is the paradigm of uncontrolled and costly asthma. This first work suggests that a large-scale study be carried out for a better knowledge of it.
Asthma is the most common chronic respiratory disease in children [
We carried out a retrospective and descriptive study in the pediatric intensive care unit of the University Hospital of Brazzaville, covering the period from January 1st to December 31st, 2015. We reviewed all medical records of children aged from 2 Months to 17 years, hospitalized during the study period and included those whose exit diagnosis included the asthma item. The diagnosis of Asthma was retained in children over three years of age presenting cough episodes with or without sputum, wheezing, expiratory dyspnea, wheezes, and a reversibility of signs spontaneously or due to the effect of bronchodilators.
In children under three years of age, this diagnosis was retained when they had at least two previous episodes of bronchiolitis. Children who had obstructive upper airway malformation and/or other chronic diseases such as kidney failure, heart disease, or malnutrition, were excluded.
The variables studied were age, gender, influence of seasons, existence of a history of atopy and asthma, factors triggering the asthma attack, type of follow-up, pre-hospital background therapy, existence of prodromes, degree of severity of asthma exacerbation, radiological imaging, established treatment, progression and duration of hospitalization. The exacerbation of asthma was defined by the persistence of the crisis beyond 24 hours. As before, this exacerbation was classified as a mild, moderate and severe crisis [
During the study period, 2012 children were hospitalized in the service. Of these, 71 (3.5%) children as an exacerbated asthma attack, among which were 42/1089 (3.8%) of male and 29/923 (1.2%) of female. For this work, only 65 cases involving 42 male (59.2%) and 29 female (40.8%) were selected.
The data were entered and analyzed using the Epi Info 3.5.3 software. The statistical tests used were the chi-square and the Students t-test. For all tests, the significance level was set at 5%.
The 65 children selected for this study were aged of 3.9 ± 2.9 years (range: two months and 14 years). In 30 (46.1%) cases, they were under 30 months of age; in 18 (27.7%) cases, between 31 and 71 months; and in 15 (23.1%), cases between 6 and 10 years. Only two children, 3.1% aged 11 and 12 years. They were 42 (59.2%) male and 29 (40.8%) female, a sex ratio of 1.45.
Compared to the general population of the service, the frequency was 3.9 for 1089 male and 3.1 for 923 female, a sex ratio of 1.18.
Admissions for asthma occurred in 36 (55.38%) cases between March and June, while in other months, only an average of four children were admitted per month (
All 65 children were born at term. They had a history of bronchiolitis in 25 (38.5%) cases. They were known to have asthma in 18 (27.7%) cases, 8 (12.5%) of which were followed by a pediatrician. In follow up children, treatment consisted to the administration of beta 2 mimetics in spray as a background treat-
ment. These patients were aged 5.4 ± 3.5 years versus 3.2 ± 2.9 years for those who did not know asthma (p = 0.006). The history of familial atopy was found in 11 (16.9%) children, in all cases it was a history of asthma. No case of passive smoking was found.
The triggers of the asthma attack were an otorhinolaryngologic infection in all cases.
Patients came directly from home (n = 50; 79.4%) or referred by a secondary health center (n = 15; 20.6%). The mean time between onset of symptoms and consultation was 2.28 ± 1.72 days with extremes of 12 hours to 7 days. Dyspnea was the main reason for hospitalization in all cases.
The functional and general signs are given in
Signs of pulmonary auscultation, some associated in the same patient, were observed in the following proportions: wheezes alone 58 cases (89.2%), wheezes associated with ronchi 5 cases (7.7%), and with crackles 17 cases (26.1%). Seizures were considered moderate in 46 (70.8%) patients and severe in 19 (29.2%) patients.
The chest X-ray, performed in 45 patients (69.2%), was normal in 25 cases (55.6%), showed thoracic distension in 18 cases (40.0%), atelectasis and alveolar image in one case each (2.2%).
The treatment consisted in all cases of administration of beta 2 mimetics, subcutaneously (n = 5; 7.7%) or inhaled (n = 60; 92.3%) by spray (n = 39; 60%) or in nebulization (n = 21; 32.30%). In combination with oxygen therapy in all cases, corticosteroids were administered in 52 (80.0%) cases, as slow intravenous methylprednisolone to 50 children (76.9%), and betametasone per os 2 (3.1%). Antibiotic therapy was administered in 16 (24.6%) cases. It was a beta-lactam in 5
N | (%) | |
---|---|---|
Asthenia | 15 | 4.0 |
Fever | 43 | 66.1 |
Cough | 53 | 81.5 |
Rhinorrhea | 44 | 67.6 |
Expectoration | 7 | 10.7 |
Sneeze | 2 | 3.0 |
Difficulties feeding | 17 | 26.1 |
(31.0%) cases, a macrolide in 1 (6.0%) case, and a combination of beta-lactam and macrolide in 10 (63.0%) cases. There was no significant difference between the type of antibiotic prescribed and the age groups (p = 0.64).
The outcome was favorable in all cases. The mean hospital stay was 1.46 ± 0.92 days (range= 12 hours - 6 days). For severe seizures, and 1.7 ± 1.4 days (range 1 - 6 days) for seizures: significant difference (p = 0.04).
Asthma occurs in various forms: mild or intermittent asthma, moderate, and severe [
In a hospital and pediatric population, frequencies of 0.51% have been reported in Ouagadougou [
The mean age of onset reported in our work (3.5 years) is comparable to the French [
Our study covered only 12 months. It reported a higher frequency of admissions from March to June, a period corresponding to the small rainy season, whereas this recrudescence was observed during the Great dry seasons in Togo [
The clinical expression of asthma attacks included, in our work, the usual signs reported elsewhere [
We used β-mimetics in 39 children (60%), as in the Burkinabe study of OUADRAOGO et al. [
The daily administration of inhaled corticosteroids, in combination with long- acting β-mimetics if necessary, is the background treatment of childhood asthma to prevent exacerbations and achieve daily symptom control [
The importance and frequency of asthma in the Pediatric Intensive Care Unit in Brazzaville require that preventive measures be implemented. These go through the education of patients and parents of the asthmatic child, the use of written instructions that proved beneficial, and compliance with the coding of its care.
Moyen, E., Bemba, E.L.P., Kambourou, J., Ekouya-Bowassa, G., Nika, E.R., Nkounkou, G., Bomelefa-Bomel, V., Okoko, A.R., Moyen, G. and Nkoua, J.-L. (2017) Asthma in Children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville (Congo). Open Journal of Pediatrics, 7, 140-148. https://doi.org/10.4236/ojped.2017.73017