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Factors associated with poor asthma control in children: A prediction model
Wanaporn Anuntaseree1, Kanokpan Ruangnapa1, Araya Yuenyongviwat1
1Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Insights
A new tool predicts poor asthma control in children using inhaled corticosteroids (ICS). Factors like prior exacerbations, allergic rhinitis, and medication adherence help identify at-risk youth for better management.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Prediction Models
Background:
- Inhaled corticosteroids (ICS) are primary treatment for pediatric asthma.
- Predictive tools for treatment outcomes in pediatric asthma are scarce.
Purpose of the Study:
- To develop a predictive model for poor asthma control in children after 6 months of ICS therapy.
- To identify key factors associated with treatment outcomes in pediatric asthma.
Main Methods:
- Retrospective study of 165 children (aged 6-15) with asthma on ICS.
- Assessment of factors including prior exacerbations, allergic rhinitis, and medication adherence.
- Definition of poor control based on Global Initiative for Asthma guidelines.
Main Results:
- 20% of children experienced poor asthma control.
- Predictors of poor control included: >4 exacerbations (OR 3.39), allergic rhinitis (OR 21.93), and poor adherence (OR 4.16).
- A nomogram-based predictive model achieved an AUC of 0.737.
Conclusions:
- A simple, effective predictive tool for poor asthma control in children was developed.
- The model demonstrates good discriminatory ability for individualized asthma management.
- This tool can aid clinicians in tailoring treatment strategies for pediatric asthma patients.
Background:
Inhaled corticosteroids (ICS) are the first-line therapy for pediatric asthma. However, very few studies have developed simple tools for predicting treatment outcomes in pediatric asthma.
Objective:
This study aimed to construct a predictive model for poor asthma control in children after 6 months of ICS therapy.
Methods:
This retrospective study included children with asthma, aged 6-15 years, who received ICS with complete follow-up for 6 months. The potential factors associated with poor asthma control were also assessed. Poor control was considered if the child had partial or uncontrolled symptoms according to the Global Initiative for Asthma guidelines.
Results:
Among the 165 eligible children, 33 (20%) had poor symptom control. The factors associated with poor control were a history of more than four exacerbations in the 12 months before ICS treatment (odds ratio [OR], 3.39 [1.06, 10.83]), the presence of moderate to severe allergic rhinitis symptoms at the 6-month follow-up visit (OR, 21.93 [2.97, 162.05]), and poor adherence to asthma medications (OR, 4.16 [1.32, 13.12]). By incorporating these factors, a model for predicting poorly controlled asthma was constructed and converted into a nomogram with a total score of 200, with prediction risk ranging from 0 to 100%. The area under the receiver operating characteristic curve of the developed model was 0.737, indicating a moderate performance level.
Conclusions:
We developed a predictive tool for poor asthma control. The model has a good discriminatory ability and is simple to use, which could facilitate the individualized management of children with asthma.
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