At-risk children with asthma (ARC): a systematic review

Area of Science:

• Pediatric Pulmonology
• Epidemiology
• Public Health

Background:

• Asthma attacks cause significant morbidity and mortality in children.
• Identifying and weighting risk factors is crucial for effective asthma management and care prioritization.

Purpose of the Study:

• To identify and weight risk factors for asthma attacks in children aged 5-12 years.
• To inform and prioritize clinical care and public health initiatives for pediatric asthma.

Main Methods:

• Systematic literature search across six databases with no language or date restrictions.
• Independent study selection, quality assessment, and data extraction by two reviewers.
• Expert Panel assessment and consensus for weighting risk factors due to heterogeneity precluding meta-analysis.

Main Results:

• Previous asthma attacks strongly predicted future attacks (ORs 2.0-4.1).
• Persistent symptoms (ORs 1.4-7.8) and poor access to care (ORs 1.2-2.3) moderately/greatly increased risk.
• Other moderately increased risks included suboptimal drug regimen, allergic comorbidities, African-American ethnicity, poverty, and vitamin D deficiency. Slightly increased risks were associated with environmental tobacco smoke, younger age, obesity, and low parental education.

Conclusions:

• Clinical and demographic features can help clinicians identify high-risk children for targeted risk reduction.
• Population-level factors can guide health service planners and policymakers in targeting healthcare initiatives for pediatric asthma.