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Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian
Diana Morillo1, Santiago Mena-Bucheli1, Angélica Ochoa2
1Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador.
Insights
This study investigated factors contributing to recurrent asthma attacks in children in Ecuador. Identifying these risk factors can help reduce emergency care visits and improve long-term health outcomes for pediatric asthma patients.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology
- Public Health in Low- and Middle-Income Countries
Background:
- Childhood asthma is a significant and growing public health concern in urban areas of low- and middle-income countries.
- Asthma exacerbations are a leading cause of emergency department visits and contribute to long-term illness in children.
- Identifying factors associated with recurrent asthma attacks is crucial for effective management and prevention strategies.
Purpose of the Study:
- To prospectively identify risk factors for recurrent asthma attacks in children and adolescents.
- To analyze the association between various clinical, sociodemographic, and biological factors and asthma exacerbation recurrence.
- To inform targeted interventions for reducing asthma attack frequency in vulnerable pediatric populations.
Main Methods:
- Prospective cohort study involving 450 children and adolescents (aged 5-17) in three Ecuadorian cities.
- Data collection included questionnaires on asthma history, management, quality of life, and costs, alongside monthly symptom tracking.
- Biomarkers such as spirometry, fractional exhaled nitric oxide (FeNO), and SARS-CoV-2 antibodies were measured.
Main Results:
- Recruitment initiated in 2019, with modified criteria due to the COVID-19 pandemic to include children with uncontrolled asthma.
- Analysis will utilize logistic regression and survival analyses to determine factors associated with asthma attack recurrence.
- Detailed findings on specific risk factors and their impact are pending full data analysis.
Conclusions:
- The study aims to provide critical insights into the drivers of recurrent asthma attacks in a vulnerable pediatric population.
- Findings are expected to guide the development of targeted public health interventions and clinical management strategies.
- Dissemination of results will occur through publications, conferences, and stakeholder engagement to inform policy and practice.
Introduction:
Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.
Methods And Analysis:
Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.
Ethics And Dissemination:
Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.
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