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Characterization of severe asthma in the pediatric population
Amalui Vasquez Perez1,2, Anna Bobé Pol1, Elizabeth Rua Hernandez3
1Hospital Universitari Joan XXIII, Calle Mallafre Guasch 4, Tarragona, Cataluña, España, CP 43005.
Insights
Pediatric severe asthma is linked to factors like prematurity, allergies, environmental exposures, and poor adherence. Identifying these risk factors can guide personalized treatment strategies for better symptom control and prevention.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Environmental Health
Background:
- Understanding the multifactorial nature of pediatric severe asthma is crucial for effective management.
- Personalized treatment and prevention strategies require detailed knowledge of causal mechanisms and symptom severity.
- Identifying specific risk factors in children with severe asthma can improve clinical outcomes.
Purpose of the Study:
- To investigate the relationship between causal mechanisms and symptom severity in pediatric severe asthma.
- To identify key characteristics and risk factors associated with severe asthma in children.
- To inform the development of tailored treatment and prevention approaches.
Main Methods:
- Retrospective review of 698 medical histories of asthmatic children aged 6-18 years over two years.
- Analysis of variables including demographics, perinatal and allergy history, asthma predictive index (API), environmental exposures (tobacco, traffic), lung function, symptom onset, healthcare utilization, medication use, and adherence.
- Focus on a subgroup of 86 children diagnosed with severe asthma.
Main Results:
- Severe asthma in children was associated with prematurity, positive API, rhinitis, atopic dermatitis, elevated IgE, eosinophilia, and exposure to passive smoking and heavy traffic.
- Reduced lung function (FEV1) and significant healthcare utilization (hospital admissions, emergency visits) were noted.
- Adherence to controller medication was suboptimal in a considerable proportion of patients.
Conclusions:
- Children with severe asthma often present with a combination of atopic conditions, specific environmental exposures, and indicators of inflammation.
- Factors such as prematurity, positive API, rhinitis, atopic dermatitis, high IgE, eosinophilia, passive smoking, traffic exposure, reduced lung function, and low adherence characterize this patient group.
- These findings underscore the need for comprehensive assessment and personalized interventions for pediatric severe asthma management.
Introduction And Objectives:
Relationship between the causal mechanisms of pediatric severe asthma and severity of symptoms would be helpful for developing personalized strategies for treatment and prevention.
Materials And Methods:
For this study, 698 medical histories of asthmatics between 6 and 18 years of age were reviewed in a period of 2 years. Variables analyzed were: age, sex, ethnicity, perinatological history, allergy history, asthma predictive index (API), exposure to tobacco, heavy traffic or epithelium, lung function, age of onset of symptoms, hospitalization admissions/PICU, systemic corticosteroids, daily symptoms control, device prescribe for daily control, and adherence.
Results:
A total of 86 children with severe asthma were included (12.3%). Mean age 13.3 +/- 1.86 years, sex ratio1:1, mean age of symptom onset 2.765 +/- 3.06 years, mean IgE 1076.18KU / L +/- 1136, mean eosinophils 604c / mcl +/- 511.9, mean of FEV1 93.15% +/- 16.3. Evidently, 70 children (81.4%) had positive API, 68 (79.1%) rhinitis, 34 (39.5%) atopic dermatitis. 73 (83.9%) sensitized to inhalants and 56 (65.1%) to dermatophagoides, 39 (45.3%) passive smokers, 19 (22.1%) exposure to heavy traffic; 55 (64%) showed symptoms with exercise, 35 (40.7%) had audible wheezing. The mean systemic corticosteroid cycles/year was 3.63 +/- 3.23, mean PICU admissions 0.36 +/- 0.83, mean hospital admissions 4.31 +/- 5.3, average emergency room visits/year 19.44 +/- 16.28. 38 (56.7%) had good adherence, 44 (51%) used an MDI device and 39 (45.3%) used dry powder.
Conclusions:
Children with severe asthma meet the following criteria: premature, positive API, rhinitis, atopic dermatitis, high IgE, eosinophilia, passive smokers, exposure to heavy traffic, decreased lung function, and low adherence to controller medication.
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