Epidemiology of Pediatric Critical Asthma

Introduction: Critical asthma is a leading cause of pediatric respiratory failure but has been poorly characterized in the contemporary era. The recently published clinical practice guidelines for pediatric critical asthma (PCA) introduced a new standard definition for use in studying this population. Our study seeks to provide the first epidemiologic description of PCA using this new definition.


Methods: We conducted a 6-month interim analysis of the PALISI research network’s CATCHUP study, a one-year multi-center point prevalence study of PCA in North American children’s hospitals including data from November 2024 to May 2025. Inclusion criteria consisted of meeting the definition of PCA while admitted to the pediatric wards or PICU: age ≥2 years and < 18 and either receipt of continuous albuterol or PCA adjunctive therapies. Study screening was performed monthly, alternating between Monday through Thursday and Friday through Saturday collection periods. Data are shown as n (%) and median (IQR). Chi-square and Kruskal-Wallis testing was used for comparisons.


Results: Complete data were available from 30 sites. During the study period, 345 children met critical asthma criteria, 287 received care in an ICU, and 58 were cared for on the wards only. These subjects represented 540 inpatient days out of 10,596 total PICU inpatient days for the 21 calendar days during the screening period, resulting in a daily PCA prevalence of 5.1%. Center level prevalence varied from 1.1% to 18.3% with a median of 4.6% (3.0%-7.2%). Urban sites represented 80% of centers, 13% were suburban, and 7% were rural. There was no difference in prevalence between center size category (p = 0.66) or day of the week (p=0.71). Fourteen (47%) of the sites allowed continuous albuterol use on the wards. The median subject age was 6.0 (4, 10) years, hospital LOS was 3.1 days (2.07, 4.94), and PICU LOS was 2.21 days (1.4, 3.44). There were 3 deaths for a mortality rate of 0.9%.


Conclusions: Pediatric critical asthma is a common cause of respiratory failure that has a wide variation in prevalence between centers. Mortality is rare, but these data show the persistent burden PCA places on children, family, and hospitals.