Predicting the Requiring Intubation and Invasive Mechanical Ventilation among Asthmatic Exacerbation-related Hospitalizations.

Objective: To identify the predictors of requiring intubation and invasive mechanical ventilation (IMV) in asthmatic exacerbation (AE)-related hospitalizations. Methods: This study was conducted in southern Thailand between October 2016 and September 2018. The characteristics and clinical findings of patients admitted for AE requiring intubation and IMV were analyzed. The variables were evaluated by univariate and multivariate analysis to identify the independent predictors. Results: A total of 509 patients with a median age of 53 years were included in the study. Being female (60.2%), having no previous use of a controller (64.5%), having a history of smoking, and having a high level of white blood cell count (14,820 cells/mm3) were the significantly more common characteristics of the patients requiring mechanical ventilation. Univariate analysis showed that being male (OR =1.96 95%CI, 1.22-3.13), having a history of 1-2 AEs in the past 12 months (OR =3.27 95%CI, 1.75-6.12), and having an absolute eosinophil count ≥300 cells/mm3 (OR =1.68 95%CI, 1.05-2.69) were associated with patients requiring IMV, whereas the patients who were taking a reliever (OR =0.36 95%CI, 0.23-0.57) and controller (OR =0.42 95%CI, 0.27-0.68) were associated with a decreased risk of requiring intubation and IMV. In multivariate analysis, only 1-2 AEs within the past 12 months (OR =3.12, 95%CI:1.19-8.21) was an independent predictor of requiring intubation and IMV in patients with AE-related hospitalization (p = 0.021). Conclusions: This study found that a history of 1-2 asthmatic exacerbations in the past 12 months was a strong independent predictor for the requirement of intubation and IMV in patients hospitalized for AE-related conditions.