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Published on: August 7, 2017
Association between asthma control trajectories in preschoolers and disease remission
Cristina Longo1,2,3,4, Lucie Blais2,3, Marni Brownell5,6
1Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.
Insights
Asthma control trajectories in preschoolers diagnosed with asthma significantly impact disease remission. Poorly controlled asthma early on is linked to lower remission rates, emphasizing the need for monitoring early asthma control.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Epidemiology
Background:
- Early childhood asthma morbidity is linked to persistent disease.
- The influence of asthma control trajectories on remission in preschoolers is not well understood.
Purpose of the Study:
- To investigate the association between asthma control trajectories within two years post-diagnosis in preschoolers and subsequent disease remission.
- To determine if early asthma control patterns predict long-term asthma outcomes.
Main Methods:
- A retrospective cohort study of 48,687 children diagnosed with asthma before age five in four Canadian provinces.
- Asthma control trajectories were classified over four 6-month periods post-diagnosis.
- Remission was defined as two consecutive years without asthma-related medical visits or medication claims.
Main Results:
- The pooled remission rate was 8.91 per 100 person-years.
- Compared to children with consistently controlled asthma, those with improving, fluctuating, worsening, or consistently uncontrolled asthma showed incrementally lower remission rates.
- Specifically, 'out of control throughout' had the lowest remission hazard ratio (HR 0.52).
Conclusions:
- Asthma control trajectories in the initial two years post-diagnosis in preschoolers are significantly associated with disease remission.
- These findings underscore the clinical importance of tracking asthma control patterns in early childhood for predicting long-term outcomes.
Introduction:
Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission.
Methods:
We conducted a multicentre population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as one or more medical visits or medications for asthma every 6-month period for at least four of the six periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as 2 consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: "controlled throughout", "improving control", "worsening control", "out of control throughout" and "fluctuating control". Adjusted Cox models estimated associations between asthma control trajectories and time to remission. A random effects meta-analysis summarised province-specific hazard ratios (HRs).
Results:
The pooled remission rate was 8.91 (95% CI 8.80-9.02) per 100 person-years. Compared with children controlled throughout, poorer asthma control was associated with incrementally lower hazard ratios of remission in four other trajectories: improving control (HR 0.89, 95% CI 0.82-0.96), fluctuating control (HR 0.78, 95% CI 0.71-0.85), worsening control (HR 0.68, 95% CI 0.62-0.75) and out of control throughout (HR 0.52, 95% CI 0.45-0.59).
Conclusions:
Asthma control trajectories 2 years following a diagnosis in preschoolers were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life.
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