The first multi-centre study of paediatric intensive care units (PICU) in England has found that children from more deprived neighbourhoods represent the majority of asthma admissions, invasive ventilation and deaths.
The study, involving BREATHE Director, Professor Aziz Sheikh, calls for enhanced asthma support in the community for children from poorer backgrounds.
Despite asthma being more common in children in the UK compared to our European neighbours, data on asthma admissions in paediatric intensive care units had not been reported before this study.
Using electronic data from the Paediatric Intensive Care Audit Network (PICANet) between April 2006 and March 2013, researchers from the Asthma UK Centre for Applied Research and BREATHE investigated admissions of children in England aged 0-14 who had been given an asthma diagnosis.
Statistics on asthma deaths for children aged 0-14 in England during the study period were sourced from the Office for National Statistics.
Linking these data to the National Statistics Postcode Directory, which has information on the English Index of Multiple Deprivation (EIMD), the investigators were able to identify the socio-economic status of those admitted to PICU because of their asthma, or who had died.
The researchers found that the number of PICU admissions, the use of any form of ventilation and deaths were all higher in the most deprived areas compared to the least deprived.
38% of PICU admissions for asthma came from most deprived neighbourhoods, and 11% from least deprived neighbourhoods.
Most admissions and mechanical ventilation occurred in preschool children, and deaths were more common in 10-14-year-olds.
This study highlights the need to identify how to improve asthma outcomes for children, particularly those in poorer areas. Reductions in PICU admissions could be achieved by addressing the cause of acute asthma attacks through education and appropriate treatment.
Asthma education for children, parents and caregivers could help them act early in preventing acute asthma attacks from progressing. Delivered through social and healthcare settings, this could lead to reduced hospital and PICU admissions.
Reducing severe asthma attacks will require a coherent, consistent and cross-disciplinary approach (healthcare professionals, schools, third sector) to raise awareness of severe asthma and how children and parents/caregivers can reduce its impact.
This study is the first in England to identify an association between deprivation and asthma PICU admissions, ventilation and deaths. To reduce both hospital and PICU admissions, a focus on asthma education of children, parents/caregivers is urgently needed to act early in preventing acute asthma attacks from progressing which should be delivered in partnership between primary care and local schools.
Mome Mukherjee, Lead author on the study
Read the paper
The publication is available from Scientific Reports