ASTHMA intensive care unit (ICU) admissions remained stable in adults but rose significantly among children, Ontario’s decade-long population study found.
The retrospective study analyzed health administrative data for Ontario residents aged 0–59 years with prevalent asthma from 2013–2022. After excluding people aged 60 or older and those with chronic obstructive pulmonary disease, the cohort included 1.96 million people. Among 52,919 patients hospitalized for asthma or an asthma-related condition, 71,258 admissions occurred and 7,870, or 11%, required ICU care. Despite advances in asthma treatment, the overall burden of ICU care did not decline.
Among children aged 0–18 years, the asthma ICU admission rate rose from 0.64 per 1,000 prevalent asthma cases in 2013 to 1.67 in 2022, a nearly threefold increase. The rise was greatest among children aged 0–5 years, particularly in 2021 and 2022. Even after the pandemic years were excluded, pediatric ICU admission rates increased significantly from 2013–2019. More than 30% of ICU admissions involved children younger than 6 years.
The adult pattern was different. Among those aged 19–59 years, asthma ICU admissions remained relatively stable, at 0.33 per 1,000 in 2013 and 0.28 in 2022. There was no significant prepandemic change in adult ICU admission or invasive ventilation rates. However, adult ICU stays longer than 10 days increased from 2013–2019, and one-third of adult ICU admissions in 2022 exceeded 10 days.
Across all ICU admissions, 27% required invasive ventilation. In children, investigators found a nonsignificant trend toward lower invasive ventilation rates, alongside fewer ICU stays longer than 10 days and more stays lasting 1–5 days. In-hospital mortality did not change significantly over time. Rising pediatric asthma ICU admissions therefore should not automatically be interpreted as worsening physiologic severity. Greater noninvasive ventilation use or changing admission practices may have contributed, but the data could not establish either explanation.
Patients receiving ICU care also had more obesity, anxiety or depression, rural residence, and prior asthma-related emergency department visits or hospitalizations than those not requiring ICU care. These associations warrant further investigation.
Administrative data could not identify specific reasons for ICU admission or reliably measure noninvasive ventilation. Asthma-related diagnoses may also have captured other respiratory illnesses, particularly in children younger than 6 years. Although the Canadian setting limits direct extrapolation to U.S. practice, persistent severe adult admissions and rising ICU use among young children support age-specific surveillance and healthcare planning.
Reference
McCoy J et al. Trends in intensive care unit admissions in patients with asthma: A 10-year population-based study. Ann Am Thorac Soc. 2026. doi:10.1093/annalsats/aaoag247.
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