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Applying UK real-world primary care data to predict asthma attacks in 3776 well-characterised children: a
Steve W Turner1, Clare Murray2,3, Mike Thomas4,5
1Child Health, University of Aberdeen, Aberdeen, UK.
Insights
A history of previous asthma attacks is the strongest predictor of future attacks in children. Identifying at-risk children using primary care records can help target interventions for asthma attack prevention.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Primary Care Research
Background:
- Current asthma attack risk factor research in children relies on small, well-characterized groups or large, poorly defined populations.
- A need exists for studies combining large sample sizes with detailed characterization of pediatric asthma patients.
Purpose of the Study:
- To identify predictors of future asthma attacks in a large, well-characterized cohort of children with asthma.
- To inform primary care interventions by identifying key risk factors for asthma exacerbations.
Main Methods:
- An observational study utilized data from two UK primary care databases (Clinical Practice Research Datalink and Optimum Patient Care research Database).
- A cohort of 3776 children aged 5-12 years with asthma was analyzed over two consecutive years.
- Predictors including treatment step, prior asthma attacks, blood eosinophil count, peak flow, and obesity were assessed against asthma attacks in the outcome year.
Main Results:
- Of 3776 children, 525 (14%) experienced at least one asthma attack in the outcome year.
- A history of one prior attack increased the odds ratio (OR) for a future attack to 3.7 (95% CI 2.9, 4.8); two or more prior attacks increased the OR to 7.7 (95% CI 5.6, 10.7).
- Higher treatment step, younger age, lower respiratory tract infections, reduced peak flow, and eosinophil counts >400/μL were also associated with increased odds of asthma attacks.
Conclusions:
- Past asthma attacks are the most significant predictor of future asthma attacks in children.
- Primary care data can effectively identify children at high risk for asthma attacks, enabling targeted preventative strategies.
Abstract:
Current understanding of risk factors for asthma attacks in children is based on studies of small but well-characterised populations or pharmaco-epidemiology studies of large but poorly characterised populations. We describe an observational study of factors linked to future asthma attacks in large number of well-characterised children. From two UK primary care databases (Clinical Practice Research Datalink and Optimum Patient Care research Database), a cohort of children was identified with asthma aged 5-12 years and where data were available for ≥2 consecutive years. In the "baseline" year, predictors included treatment step, number of attacks, blood eosinophil count, peak flow and obesity. In the "outcome" year the number of attacks was determined and related to predictors. There were 3776 children, of whom 525 (14%) had ≥1 attack in the outcome year. The odds ratio (OR) for one attack was 3.7 (95% Confidence Interval (CI) 2.9, 4.8) for children with 1 attack in the baseline year and increased to 7.7 (95% CI 5.6, 10.7) for those with ≥2 attacks, relative to no attacks. Higher treatment step, younger age, lower respiratory tract infections, reduced peak flow and eosinophil count >400/μL were also associated with small increases in OR for an asthma attack during the outcome year. In this large population, several factors were associated with a future asthma attack, but a past history of attacks was most strongly associated with future attacks. Interventions aimed at reducing the risk for asthma attacks could use primary care records to identify children at risk for asthma attacks.
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