Current Treatments for Pediatric Critical Asthma: An Interim Analysis From the CATCHUP Study

Introduction: Critical asthma is a common reason for admission to North American pediatric intensive care units (PICU). Lack of evidence regarding optimal treatment approaches has led to wide variability between institutions. We aimed to obtain a point prevalence estimate of current treatments being used for critical asthma in North American PICUs.


Methods: This was an interim analysis of a 12-month point prevalence study of pediatric critical asthma from November 2024 to May 2025. Sites were recruited through the Pediatric Acute Lung Injury and Sepsis Investigators research network. Critical asthma was defined as patients aged 2-18 years who received continuous albuterol or every 2-hour albuterol plus adjunctive asthma therapies regardless of floor or PICU location. Screening is conducted monthly on rotating days. Data collected included respiratory support and pharmacologic treatments both pre-hospital and during admission.


Results: We included a total of 398 patients from 36 centers. Prior to hospital admission, 265 (66.6%) of patients received continuous albuterol, 262 (65.8%) received ipratropium, 283 (71.1%) received intravenous (IV) magnesium, 152 (38.2%) received heated high flow nasal cannula (HFNC), and 162 (40.7%) received non-invasive positive pressure ventilation (NIV). During hospital admission, 134 (33.7%) received ipratropium, 136 (34.2%) received intermittent IV magnesium, 52 (13.1%) received continuous IV magnesium, 45 (11.3%) received IV terbutaline, and 28 (7.0%) received IV aminophylline. The highest respiratory support received was HFNC for 152 (38.2%) patients, NIV for 162 (40.7%) patients, and invasive mechanical ventilation for 23 (5.8%) of patients. Patients given HFNC received 20 (15-25) (Median (IQR)) L/min for a total of 30.4 (14.3-49.1) hours, while those who received NIV were given a starting inspiratory pressure of 12.5 (12-16) and expiratory pressure of 6.0 (6.0-8.0) for 26.1 (11.9-43.4) total hours.


Conclusions: Pharmacologic treatments and respiratory support management varies between patients, with ipratropium and magnesium being the most common adjunctive medications and HFNC and NIV both being common support devices used.