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Published on: August 7, 2017
Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases
H M Kansen1,2, T M Le2, Cspm Uiterwaal3
1Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Uncontrolled asthma affects 39% of children in secondary care, including those with other atopic conditions. Family history and recurrent respiratory infections predict uncontrolled childhood asthma.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Epidemiology
Background:
- Childhood asthma remains a significant public health concern, with high rates of uncontrolled disease despite available treatments.
- Investigating uncontrolled asthma prevalence and predictors in children referred to secondary care is crucial for improving management.
Purpose of the Study:
- To determine the prevalence of uncontrolled asthma in children referred for asthma or other atopic diseases.
- To identify predictors associated with uncontrolled asthma in this pediatric population.
Main Methods:
- A cohort of 408 children (4-18 years) referred to 8 Dutch secondary care centers participated.
- An electronic portal (EP) with validated questionnaires, including the Asthma Control Test (ACT), was utilized.
- Univariable and multivariable logistic regression analyses identified predictors of uncontrolled asthma.
Main Results:
- 39% of all children had uncontrolled asthma; 47% of those referred for asthma and 26% for other atopic diseases.
- Key predictors of uncontrolled asthma included a family history of asthma (OR 2.08) and recurrent respiratory infections (OR 2.40 for upper, OR 2.00 for lower).
Conclusions:
- Uncontrolled asthma is highly prevalent in children seen in secondary care, even those referred for non-asthma atopic conditions.
- Routine assessment of asthma control is recommended for children with asthma or other atopic diseases in secondary care settings.
Background:
Uncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma.
Methods:
All children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses.
Results:
We included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively).
Conclusion:
Uncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.
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