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Risk factors for exacerbations and hospital admissions in asthma of early childhood
J Wever-Hess1, J M Kouwenberg, E J Duiverman
1Department of Pediatric Respiratory Medicine, Juliana Children's Hospital, The Hague, The Netherlands.
Insights
Damp housing and colds are key risk factors for asthma exacerbations in children aged 0-1 year. For older children (2-4 years), hospital admissions are linked to damp housing, highlighting the need for preventive measures.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Respiratory Medicine
Background:
- Childhood asthma hospitalizations and readmissions present significant challenges.
- Identifying early risk factors for asthma exacerbations is crucial for intervention.
Purpose of the Study:
- To identify predisposing risk factors for asthma exacerbations and hospital admissions in children aged 0-4 years.
- To analyze risk factors separately for infants (0-1 year) and young children (2-4 years).
Main Methods:
- A 2-year follow-up study of children aged 0-4 years with doctor-diagnosed asthma.
- Evaluation of patient histories, atopic status (Phadiatop®), total IgE levels, and environmental factors like damp housing.
- Exacerbations defined by increased symptoms, beta(2)-agonist use, and oral corticosteroid need.
Main Results:
- In 0-1 year olds, damp housing (OR 7.6) and colds (OR 3.6) predicted exacerbations; damp housing (OR 3.8) and inhalant allergen sensitization (OR 8.1) predicted recurrent exacerbations.
- In 2-4 year olds, higher total IgE (OR 2.3) predicted exacerbations, and damp housing was associated with hospital admissions.
- Hospital admissions were significantly linked to the number of exacerbations in younger children and damp housing in older children.
Conclusions:
- Damp housing is a significant risk factor for asthma exacerbations and hospital admissions in young children.
- Sensitization to allergens and environmental factors like damp housing require attention for prevention.
- Early identification of at-risk children and preventive measures, including addressing damp housing, are essential.
Abstract:
Hospital admissions and readmissions for asthma in early childhood remain causes for concern. The purpose of this study was to identify predisposing risk factors related to asthma exacerbations and precursors of hospital admissions in young children. Subjects were patients with doctor-diagnosed asthma from a clinical registration study, aged 0-4 years, and followed up for 2 years. Data from histories and laboratory tests for atopic status at initial presentation, and the patient's condition at visits over the 2-year follow-up period were evaluated. Exacerbation was defined as increases in cough and/or wheeze and/or breathlessness, increase in beta(2)-agonist use, and a clinical need for a short course of oral corticosteroids. Age groups 0-1 year and 2-4 years, based on age at initial presentation, were analyzed separately. In the age group 0-1 year, 71/113 (63%) patients had at least one exacerbation, and 20 experienced recurrent exacerbations (>/=3). Predisposing risk factors for exacerbation were damp housing (odds ratio (OR) 7.6 (2. 0-28.6)) and colds (OR 3.6 (1.4-9.6)), and for recurrent exacerbations sensitization to inhalant allergens (Phadiatop(R)) (OR 8.1 (1.6-40.5)) and damp housing (OR 3.8 (1.1-12.8)). Hospital admissions were significantly associated with number of exacerbations. In the age group 2-4 years, 58/144 (40%) patients had at least one exacerbation, and 21 experienced recurrent exacerbations (>/=2). Predisposing risk factors for exacerbation were mean age at initial presentation (OR 0.92 (0.88-0.97)) and level of total IgE (OR 2.3 (1.4-3.9)), whereas for recurrent exacerbations no predictor variables were found. Hospital admissions were significantly associated with damp housing. Results from this study may facilitate recognition of young asthmatic patients at risk of (recurrent) exacerbations, and help to identify those in whom early intervention with anti-inflammatory therapy may be necessary. We also emphasize the importance of preventive measures in decreasing damp housing.