Risk factors associated with uncontrolled asthma in children - a systematic review and meta-analysis

We aim to assess the risk factors of uncontrolled asthma in children and adolescents.

A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to July 17, 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effects model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio and the corresponding 95% confidence interval. We also used a narrative approach where it was not feasible to quantitatively assess the outcome.

Ten observational studies were used to conduct this systematic review and meta-analysis. A quantitative analysis of five factors was done. Pooled analysis showed a statistically significant risk of uncontrolled asthma in association with past hypersensitivity reactions (standardized mean difference [SMD] = 1.51 (1.16, 1.98); p = .002; I² = 84%) and incomplete controller adherence (SMD = 3.15 (1.83, 5.41); p < .0001; I² = 94%). While non-significant relation was seen in parental asthma (SMD = 1.23 (0.98, 1.55); p = .07; I² = 15%), oral corticosteroid use (SMD = 0.99 (0.72, 1.36); p = .96; I² = 81%) and education of caregivers (SMD = 0.99 (0.72, 1.36); p = .96; I² = 81%). Some other factors were also discussed qualitatively.

Our study shows that some significant risk factors might cause uncontrolled asthma in children and adolescents like past hypersensitivity reactions and incomplete controller adherence.