Asthma exacerbations can be life-threatening and patients might need Intermediate/Intensive Care Unit (ICU) admission.

Retrospective descriptive study of patients admitted with Asthma exacerbation in the Intermediate/Intensive Care Unit in the Vila Nova de Gaia/Espinho Hospital from January 2019 to December 2023, selected using the ICD-10 Codes for Asthma (J45; J452; J4520; J4521; J4522; J453; J4530; J4531; J4532; J454; J4540; J4541; J4542; J455; J4550; J4551; J4552; J459; J4590; J45901; J45902; J4599; J45991; J45998).

After evaluating the clinical records of the 44 patients selected, 16 patients with Primary or Secondary diagnosis of Asthma exacerbation in that admission episode were included, of which 56,25% (n= 9) were females, with a median age of 46,5 (22-75) years-old.

Of the 16, 43,75% (n=7) were overweight/obese, 43,75% (n=7) were current tobacco smokers, 37,5% (n=6) had Rhinitis/Rhinoconjutivitis and 37,5% (n=6) were atopic. Medication patterns varied, with 62,5% (n=10) under ICS-LABA daily, 18,75% (n=3) only taking LABA as-needed, and one patient did not have any asthma medication before admission in the ICU. From our selected patients, 12,5% (n=2) had underwent allergen immunotherapy. From the patients included, 68,75% (n=11) had Asthma exacerbation as the Primary Diagnosis that motivated admission in the ICU. At admission, 93,75% (n=15) presented with dyspnea, 93,75% (n=15) with hypoxia, 81,25% (n=13) with cough, 43,75% (n=7) with wheezing, 37,5% (n=6) with chest pain, and 6,25% (n=1) had cardiac arrest. Moreover, 87,5% (n=14) of patients had respiratory failure from which 50% (n=8) type 1 and 37,5% (n=6) type 2. Treatment in the ICU included inhaled bronchodilators (100% (n=16)), intravenous corticosteroids (93,75% (n=15), inhaled corticosteroids (87,5% (n=14)), and Magnesium Sulfate (68,75% (n=11)). In addition, 25% (n=4) of the patients required Invasive Mechanical Ventilation and 25% (n=4) needed High Flow Nasal Oxygen. Triggers for exacerbations included respiratory infections (68,75% (n=11)), 36,36% (n=4) of these attributed to SARS-Cov-2, and non-compliance to Asthma treatment 25% (n=4). Median ICU stay was 8 days, with no recorded deaths. Post-discharge, 81,25% (n=13) had Pneumology appointments scheduled and 1 patient loss follow-up due to missed appointments. Three patients (18,75%) had no follow-up appointment scheduled. Pulmonary function Tests were performed in 75% of patients (n=12).

Although respiratory infections were the most prevalent trigger for exacerbations in our cohort, non-compliance to the treatment also played a significant role. Despite the severity of the patients, no deaths occurred in the ICU. A quarter of the patients lost follow-up on their Asthma after being discharged, emphasizing the importance of future care strategies for this population.