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Association Between Asthma Control Trajectories in Preschoolers and Long-Term Asthma Control
Cristina Longo1, Lucie Blais2, Marni Brownell3
1Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada; Research Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Early asthma control in preschoolers significantly impacts long-term outcomes. Suboptimal control trajectories shortly after diagnosis are linked to persistent, unsatisfactory asthma control throughout childhood.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Health Outcomes Research
Background:
- The long-term effects of early-life asthma control are not well understood.
- Investigating early asthma control is crucial for predicting childhood outcomes.
Purpose of the Study:
- To determine if asthma control patterns in the first two years after diagnosis in preschoolers predict long-term unsatisfactory asthma control.
- To identify early indicators of persistent asthma issues.
Main Methods:
- A multicenter, population-based retrospective cohort study using Canadian administrative data.
- Included preschoolers (<5 years) diagnosed with asthma.
- Analyzed asthma control trajectories over four 6-month periods post-diagnosis using a validated index.
- Defined long-term unsatisfactory control based on medication use or exacerbations up to age 16.
Main Results:
- In 50,188 preschoolers, 42% experienced unsatisfactory asthma control at some point.
- Compared to consistently controlled asthma, risk ratios for long-term unsatisfactory control increased with poorer early control: improving (1.38), fluctuating (1.54), worsening (1.70), and out of control (2.00).
Conclusions:
- Suboptimal asthma control trajectories in early childhood are associated with long-term unsatisfactory asthma control.
- Early asthma control patterns can effectively predict the risk of adverse long-term outcomes.
Background:
The potential influence of asthma control in early life on long-term outcomes in childhood remains largely unknown.
Objective:
To examine whether asthma control trajectories in the 2 years after diagnosis in preschoolers are associated with long-term unsatisfactory asthma control.
Methods:
We conducted a multicenter population-based retrospective cohort study, including four Canadian provincial birth cohorts derived from administrative databases. We included preschoolers (aged <5 years) with a diagnosis of asthma, defined as having one hospitalization or two physician visits for asthma within 2 years. Asthma control trajectories, ascertained over four 6-month periods after diagnosis using a validated index, were classified as controlled throughout, improving control, fluctuating control, worsening control, and out of control throughout. Long-term unsatisfactory control was defined as four or more short-acting β2-agonist average doses per week or an exacerbation, measured within 6 months before index ages 6, 8, 10, 12, 14, and 16 years. Average risk ratios for long-term unsatisfactory control across all index ages were estimated using a robust Poisson model by province and meta-analyzed with a random effects model.
Results:
In 50,188 preschoolers with asthma, the pooled average risk of having unsatisfactory control at any index age was 42% (95% confidence interval, 34.6-49.4). Compared with children who were controlled throughout, incrementally higher average risk ratios (95% confidence interval) of long-term unsatisfactory control were observed in each trajectory: improving control, 1.38 (1.28-1.49); fluctuating control, 1.54 (1.40-1.68); worsening control, 1.70 (1.55-1.86) and out of control throughout, 2.00 (1.80-2.21).
Conclusions:
Suboptimal asthma control trajectories shortly after a preschool diagnosis were associated with long-term unsatisfactory asthma control. Early control trajectories appear to be promising for predicting the risk for long-term adverse outcomes.
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