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Uncontrolled asthma in school-aged children-a nationwide specialist care study
Caroline Stridsman1, Øyvind Martinsen2,3, Stina Selberg1
1Department of Public Health and Clinical Medicine, Division of Medicine/OLIN Unit, Umeå University, Umeå, Sweden.
Insights
Uncontrolled childhood asthma (UCA) affects 31% of pediatric patients and is linked to female sex, older age, and obesity. Many children with UCA are undertreated, indicating a need for better asthma management strategies.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Public Health
Background:
- Uncontrolled asthma (UCA) is a distinct condition from severe asthma, observable in children regardless of prescribed treatment intensity.
- Identifying UCA in pediatric populations is crucial for effective asthma care and management strategies.
Purpose of the Study:
- To characterize the prevalence and associated factors of uncontrolled childhood asthma (UCA) within pediatric specialist care settings.
- To investigate the relationship between UCA and various demographic, clinical, and treatment parameters in children.
Main Methods:
- A nationwide cross-sectional study involving 5497 children (aged 6-17 years) with asthma treated in Swedish outpatient clinics in 2019.
- UCA was defined using criteria including Asthma Control Test score ≤19, ≥2 exacerbations annually, or FEV1 <80% predicted.
- Treatment steps were categorized according to the Global Initiative for Asthma (GINA) guidelines (steps 1-5).
Main Results:
- Uncontrolled asthma (UCA) was identified in 31% of the study cohort (n=1690).
- Factors associated with UCA included female sex (OR=1.29), older age (OR=1.02), and obesity (OR=1.43).
- UCA prevalence increased with higher GINA treatment steps (step 3: OR=1.28; steps 4-5: OR=1.32). Notably, 28% of children on lower treatment steps (1-2) had UCA, with higher exacerbation rates (24%) compared to UCA patients on higher steps (15%).
Conclusions:
- Uncontrolled childhood asthma is common and associated with specific demographic factors and higher treatment steps.
- A significant proportion of children with UCA are on lower treatment steps, suggesting potential undertreatment.
- These findings highlight the need to reassess and optimize asthma management strategies in pediatric care to address UCA effectively, particularly in potentially undertreated populations.
Background:
Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment.
Objective:
Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care.
Methods:
We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma.
Results:
UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P = .001]).
Conclusion:
UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.
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