More and more children end up in intensive care with an asthma attack

Asthma is the most common chronic disease in children in the Netherlands

More and more children in the Netherlands end up in intensive care with an asthma attack. Almost a quarter of them are exposed to cigarette smoke, according to research carried out by PhD candidate Shelley Boeschoten from Erasmus MC Sophia. “Parents are often not aware of it.”

Asthma is the most common chronic disease in children in the Netherlands. Each year, about 2,200 children end up in the hospital because of an asthma attack, 5 to 10 percent of whom are so short of breath that they have to go to the intensive care unit (IC).

Risk factor
“The biggest risk factor for an ICU admission is cigarette smoke,” explains Boeschoten. In her research, she found nicotine in the urine of 23 percent of the children who were in the intensive care unit because of asthma. It was 13 percent among children admitted to a general ward with asthma.

This concerns direct exposure, but also third-hand smoke. Then relatives who go outside to smoke a cigarette and then grab and hug the child. Boeschoten: ‘Parents are often not aware that they are consuming substances that are very harmful to their asthmatic child.’

‘It’s about direct exposure, but also about third-hand smoke’

The age of the child and the duration of asthma symptoms are also risk factors for intensive care unit admission. ‘The older the child is, the greater the chance,’ says Boeschoten. ‘And also the duration of complaints. If they continue for a long time, they can become so severe that an intensive care unit is necessary. If these ailments are not recognized at home, a child can become so short of breath that they go into cardiac arrest and need to be resuscitated. Then adequate action is of vital importance.’

There are also other factors that concern the PhD student. ‘We see a significant increase in the number of intensive care admissions of children with asthma. It has tripled in ten years. Factors that may have an impact include air pollution and climate change. We don’t know exactly what effect this will have yet, but it won’t be beneficial. We are still investigating that’, says Boeschoten.

Every year, 5 to 10 children in the Netherlands die from the consequences of an asthma attack. This usually happens outside the hospital and, according to Boeschoten, can be prevented. “I am in favor of the seriousness of the complaints being discovered more quickly and appropriate measures being taken. By the families themselves, but also by general practitioners and paediatricians. Intensify a treatment faster. It also goes without saying that smoking in the presence of children, even outside, is harmful. I hope parents will realize it better.’

Boeschoten examined 110 children over a period of two years in the seven pediatric intensive care units in the Netherlands. The control group consisted of 111 children who had been admitted for asthma to a children’s ward at Amphia Hospital, Maasstad Hospital, Rijnstate Hospital or Tergooi MC. On Wednesday 11 January, Boeschoten defended his thesis.

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A quarter of children with asthma in the intensive care unit have previously been exposed to tobacco
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