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Published on: November 4, 2010
Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study
Cristina Ardura-Garcia1,2, Erick Arias3, Paola Hurtado3
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland crisardura@gmail.com.
Insights
In Ecuador, nearly half of children treated for asthma attacks experienced recurrence within six months. Younger age, prior diagnosis, and corticosteroid use predicted repeat emergency visits, highlighting a need for risk assessment tools in low-resource settings.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Health in Low- and Middle-Income Countries (LMICs)
- Epidemiology of Asthma Exacerbations
Background:
- Asthma exacerbations are a significant cause of emergency care utilization globally, particularly in LMICs.
- Limited prospective research exists on predictors of recurrent severe asthma attacks in LMIC emergency departments.
- Understanding risk factors is crucial for developing targeted interventions in resource-limited settings.
Purpose of the Study:
- To identify predictors of recurrent severe asthma attacks requiring emergency care in children in Ecuador (LMIC).
- To explore the utility of clinical data, laboratory samples, and lung function tests in predicting asthma attack recurrence.
- To inform the development of risk-assessment tools for high-risk pediatric asthma patients in similar settings.
Main Methods:
- Prospective cohort study of 283 children (5-15 years) treated for asthma attacks in public emergency facilities.
- Data collection included clinical history, blood and nasal wash samples, spirometry, and exhaled nitric oxide measurements.
- Follow-up for 6 months or until the next severe asthma attack to identify recurrence predictors using Cox regression.
Main Results:
- 46% of children experienced a subsequent severe asthma attack requiring emergency care within 6 months.
- Independent predictors of recurrence included younger age, prior asthma diagnosis, and previous parenteral corticosteroid use.
- Food triggers and eczema diagnosis were also associated with recurrence; urban residence showed a protective effect. Laboratory and lung function tests did not predict recurrence.
Conclusions:
- Key clinical factors independently predict recurrent emergency care attendance for asthma attacks in a LMIC.
- A simple risk-assessment tool using readily available information could be developed for emergency rooms in resource-limited settings.
- Identifying high-risk children allows for focused resource allocation and potentially improved asthma management outcomes.
Abstract:
Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.
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