Risk Factors for Life‐Threatening Asthma Attacks and Asthma‐Related Mortality in Children—A Systematic Review

Awareness of factors associated with life-threatening asthma attacks and asthma mortality is essential for risk prediction in asthma care. There is limited evidence to inform risk factors in children and young people (CYP). The aim of this systematic review is to synthesize existing data to report risk factors for life-threatening asthma attacks and asthma deaths in CYP. This review followed PRISMA-reporting-guidelines and was registered on PROSPERO (CRD42023494203). We included observational studies of CYP aged 0-18 years with asthma, published in English, from 2000 to the present, exploring variables influencing asthma mortality and life-threatening attacks (defined as intensive care [ICU] admissions). CINAHL, MEDLINE, Central Cochrane Library, and Scopus databases were searched. Reference lists of eligible studies were screened. The MEDLINE search strategy was adapted across the databases. Results were synthesized narratively. Six studies met our inclusion criteria (five retrospective cohort, one case-control study). All were conducted in high-income countries. In descending order of strength of association, factors found to be associated with ICU admissions were: high salbutamol use, previous hospitalization, low socioeconomic status, allergies, Black ethnicity, prescription of asthma medications, history of pneumonia, rural location, adolescence, paternal asthma, and co-existing comorbidity. For the outcome of mortality, one study reported a sevenfold risk of asthma death in children of Black ethnicity compared with White. The included studies had low quality of evidence by the GRADE assessment. The small number and high heterogeneity between available studies, identifies a need for robust epidemiological studies and better risk prediction for near-fatal and fatal attacks in CYP-asthma.