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Emergency management and asthma risk in young Medicaid-enrolled children with recurrent wheeze
Isabel J Hardee1, Isabella Zaniletti2, Melisa S Tanverdi3
1Department of Pediatrics, University of CO School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
Insights
Young children with recurrent wheeze who develop persistent wheeze are at risk for childhood asthma. Identifying risk factors like male sex and Black race can aid early asthma detection and prevention.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Epidemiology
Background:
- Recurrent wheeze in young children is a common reason for emergency department (ED) visits.
- Identifying children at risk for persistent wheeze and subsequent childhood asthma is crucial for timely intervention.
Purpose of the Study:
- To describe the clinical characteristics of young children presenting to the ED for early recurrent wheeze.
- To determine factors associated with subsequent persistent wheeze and the risk for early childhood asthma.
Main Methods:
- A retrospective cohort study analyzed Medicaid-enrolled children aged 0-3 years with a history of recurrent wheeze.
- Data from index ED visits and subsequent outcomes up to ages 4-6 years were collected.
- Logistic regression identified risk factors for persistent wheeze.
Main Results:
- Over 41,000 children were included; 28% experienced persistent wheeze between ages 4-6.
- Factors associated with persistent wheeze included male sex, Black race, atopy, and prior use of bronchodilators or corticosteroids.
- A higher number of wheezing episodes correlated with increased odds of ED asthma medication treatment.
Conclusions:
- Young children with persistent wheeze face an elevated risk of developing childhood asthma.
- Early identification of risk factors for persistent wheeze in this population can facilitate earlier asthma diagnosis and preventative strategies.
Objectives:
To describe clinical characteristics of young children presenting to the emergency department (ED) for early recurrent wheeze, and determine factors associated with subsequent persistent wheeze and risk for early childhood asthma.
Methods:
Retrospective cohort study of Medicaid-enrolled children 0-3 years old with an index ED visit for wheeze (e.g. bronchiolitis, reactive airway disease) from 2009 to 2013, and at least one prior documented episode of wheeze at an ED or primary care visit. The primary outcome was persistent wheeze between 4 and 6 years of age. Demographics and clinical characteristics were collected from the index ED visit. Logistic regression was used to estimate the association between potential risk factors and subsequent persistent wheeze.
Results:
During the study period, 41,710 children presented to the ED for recurrent wheeze. Mean age was 1.3 years; 59% were male, 42% Black, and 6% Hispanic. At index ED visits, the most common diagnosis was acute bronchiolitis (40%); 77% of children received an oral corticosteroid prescription. Between 4 and 6 years of age, 11,708 (28%) children had persistent wheeze. A greater number of wheezing episodes was associated with an increased odds of ED treatment with asthma medications. Subsequent persistent wheeze was associated with male sex, Black race, atopy, prescription for bronchodilators or corticosteroids, and greater number of visits for wheeze.
Conclusions:
Young children with persistent wheeze are at risk for childhood asthma. Thus, identification of risk factors associated with persistent wheeze in young children with recurrent wheeze might aid in early detection of asthma and initiation of preventative therapies.
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