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Hospitalization for asthma: atopic, pulmonary function, and psychological correlates among participants in the
Leonard B Bacharier1, Christopher Dawson, Gordon R Bloomberg
1Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri 63110, USA. bacharier_l@kids.wustl.edu
Insights
Children with asthma hospitalized previously had earlier onset, longer duration, and more severe asthma. Lower IQ and increased airflow obstruction were key risk factors for childhood asthma hospitalizations.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Childhood asthma significantly impacts families, often requiring hospital care for exacerbations.
- Allergen sensitization and exposure are linked to asthma hospitalizations in children.
Purpose of the Study:
- Identify specific risk factors for prior asthma hospitalization in children aged 5-12.
- Analyze data from the Childhood Asthma Management Program (CAMP) to differentiate hospitalized from non-hospitalized children.
Main Methods:
- Retrospective analysis of screening data from 1041 children in the CAMP study.
- Comparison of demographic, clinical, and immunological factors between children with and without prior asthma hospitalization.
Main Results:
- Prior hospitalization was associated with younger age of asthma onset, longer asthma duration, increased atopy markers, higher immunoglobulin E, eosinophilia, inhaled corticosteroid use, airflow obstruction, airway hyperresponsiveness, and lower IQ.
- Multivariate analysis identified younger age of onset, longer duration, recent controller therapy, airflow obstruction, and lower IQ as significant predictors of prior hospitalization.
- Sensitization and high dog allergen exposure increased hospitalization likelihood.
Conclusions:
- Children with prior asthma hospitalization exhibit greater asthma severity, earlier onset, and lower IQ.
- While atopy markers were more prevalent, they were not independent predictors of hospitalization in multivariate analysis.
- Clinicians should monitor pulmonary function and atopy markers to identify children at risk for future hospitalizations.
Background:
Asthma in childhood has a significant impact on children and families, in part because of the frequent need for hospital-based care for acute exacerbations. Sensitization and exposure to inhalant allergens have been identified as risk factors for asthma hospitalization.
Objective:
The Childhood Asthma Management Program (CAMP), comprised of 1041 children aged 5 to 12 with mild-to-moderate asthma, provides the opportunity to identify specific risk factors for prior hospitalization for asthma.
Methods:
Data gathered during the screening period from CAMP were evaluated to elucidate differences between patients who had ever been hospitalized for asthma before enrollment in CAMP and those who had never been hospitalized.
Results:
Univariate analyses indicated that prior hospitalization for asthma was associated with a younger age of asthma onset, longer duration of asthma, greater number of positive allergy skin tests, higher serum immunoglobulin E level, greater peripheral blood eosinophilia, greater recent inhaled corticosteroid use, greater airflow obstruction, greater airway hyperresponsiveness, and lower patient intelligence quotient (IQ). Gender, race, and family income did not differ between hospitalized and never-hospitalized patients. The combination of both sensitization and exposure to high levels of dog allergen (Can f1) was associated with greater likelihood of prior hospitalization. Forward multivariate logistic regression analysis identified younger age of asthma onset, longer duration of asthma, recent use of asthma controller therapy, greater airflow obstruction, and lower patient IQ as significant risk factors for prior hospitalization when all risk factors identified by univariate analysis were included in the model.
Conclusions:
Children with mild-to-moderate asthma who had a past hospitalization for acute asthma had greater asthma severity, younger age of onset, and lower patient IQ at the time of entry into CAMP. They also had more markers of atopy than children without prior hospitalization, although atopy was not associated with prior hospitalization on multivariate analysis. Although we have identified these risk factors in a retrospective manner, one can speculate that the persistence of these features should alert the clinician to closely follow abnormalities on pulmonary function tests and general features of atopy to potentially identify patients at risk for future hospitalization.
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