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Longitudinal asthma exacerbation phenotypes in the Korean childhood asthma study cohort
Ji Soo Park1, Dong In Suh1, Dae Jin Song2
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
Insights
Predicting exacerbation-prone asthma (EPA) in children is crucial. Baseline lung function and white blood cell count, alongside asthma control, can predict persistent asthma exacerbations in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Clinical Prediction Modeling
Background:
- Asthma exacerbations (AE) impose significant social and economic burdens.
- Identifying children with exacerbation-prone asthma (EPA) is essential for proactive management.
- Long-term adverse outcomes are associated with recurrent asthma exacerbations in children.
Purpose of the Study:
- To predict exacerbation-prone asthma (EPA) in a pediatric cohort.
- To identify key risk factors associated with frequent asthma exacerbations in children.
- To develop and validate a predictive model for EPA.
Main Methods:
- Utilized the Korean Childhood Asthma Study (KAS), a prospective nationwide pediatric cohort.
- Defined EPA based on the frequency of asthma exacerbations over three 6-month visits.
- Employed logistic regression to identify risk factors and build a prediction model for EPA.
Main Results:
- Established prevalence rates for EPA (5%), exacerbation-intermittent asthma (EIA) (47%), and exacerbation-resistant asthma (ERA) (48%) among 497 children.
- Identified key predictors of EPA: forced expiratory volume in 1 second (FEV1) z-score, forced vital capacity (FVC) z-score, white blood cell (WBC) count, and asthma control test (ACT) score.
- Developed an EPA prediction model with an area under the receiver operating characteristic curve (AUROC) of 0.841, incorporating FVC z-score, WBC count, ACT score, sex, and parental education.
Conclusions:
- Asthma exacerbations can decrease with appropriate management, but persistent EPA may occur.
- Baseline lung function (FVC z-score) and white blood cell (WBC) count are significant predictors of EPA.
- Asthma control level, in addition to lung function and WBC count, aids in predicting EPA in children.
Background:
Asthma exacerbation (AE) leads to social and economic costs and long-term adverse outcomes. We aimed to predict exacerbation-prone asthma (EPA) in children.
Methods:
The Korean childhood Asthma Study (KAS) is a prospective nationwide pediatric asthma cohort of children aged 5-15 years followed every 6 months. Patients with AE during the 6 months prior to all three visits, with AE prior to one or two visits, and without AE prior to any visit were defined as having EPA, exacerbation-intermittent asthma (EIA), and exacerbation-resistant asthma (ERA), respectively. Risk factors and prediction models of EPA were explored.
Results:
Of the 497 patients who completed three visits, 42%, 18%, and 15% had exacerbations prior to visits 1, 2, and 3 and 5%, 47%, and 48% had EPA, EIA, and ERA, respectively. Univariate and multivariable logistic regression revealed forced expiratory volume in 1 s (FEV1) z-score, forced vital capacity (FVC) z-score, white blood cell (WBC) count, and asthma control test (ACT) score as relevant EPA risk factors. The EPA prediction model comprised FVC z-score, WBC count, ACT score, sex, and parental education level (area under the receiver operating characteristic curve [AUROC] 0.841 [95% confidence interval (CI): 0.728-0.954]).
Conclusion:
With appropriate management, AE decreases over time, but persistent AEs may occur. Apart from asthma control level, baseline lung function and WBC count predicted EPA.
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