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Risk Factors for Moderate-Severe Asthma in Children Ages 5-11 Years With Early-Onset Atopic Dermatitis
Robert S Zeiger1, Michael Schatz2, Botao Zhou3
1Department of Allergy, Kaiser Permanente Southern California (KPSC), San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif; Department of Research and Evaluation, KPSC, Pasadena, Calif.
Insights
Early childhood atopic dermatitis (AD) can predict moderate-severe persistent asthma (MS-Asthma). Factors like male sex, non-Hispanic Black ethnicity, and infections increase risk, while exclusive breastfeeding and maternal diabetes are protective.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Epidemiology
Background:
- Identifying early childhood risk factors for persistent asthma is crucial for timely intervention.
- Early-onset atopic dermatitis (AD) is a known precursor to other atopic diseases, including asthma.
Purpose of the Study:
- To identify risk factors for developing moderate-severe persistent asthma (MS-Asthma) between ages 5-11 in children with early-onset AD.
- To develop predictive risk models for MS-Asthma using early childhood and maternal data.
Main Methods:
- A birth cohort of 10,688 children with AD onset before 36 months was analyzed using electronic health records up to age 11.
- MS-Asthma was defined as GINA step care level ≥3 for ≥4 years between ages 5-11.
- Robust Poisson regression was used to determine risk ratios for MS-Asthma.
Main Results:
- Children who developed MS-Asthma were more likely to be male, non-Hispanic Black, preterm, and not exclusively breastfed for one month.
- Significant risk factors included perinatal respiratory disorders, infections, food allergy, allergic rhinitis, asthma, sensitization, and elevated eosinophils.
- Maternal comorbidities, antibiotic use, and fewer pre-existing diabetes cases were associated with increased MS-Asthma risk. Protective factors included exclusive breastfeeding and maternal diabetes.
Conclusions:
- Risk models for later childhood MS-Asthma can be developed using early childhood and maternal factors from administrative data.
- Early identification of at-risk children with AD can facilitate targeted prevention and management strategies.
Background:
Knowledge of risk factors in early childhood predisposing to moderate-severe persistent asthma (MS-Asthma) in later childhood is needed.
Objective:
To identify the risk factors for MS-Asthma at age 5 to 11 years in children with early-onset atopic dermatitis.
Methods:
Electronic health records identified a birth cohort to 11 years of 10,688 children with AD onset between birth and age 36 months. International Classification of Diseases, Ninth Revision/Tenth Revision-coded visits and laboratory data to 36 months were used to detect potential child and maternal risk factors for MS-Asthma. MS-Asthma was defined as Global Initiative for Asthma-step-care level of 3 or higher for a minimum of 4 years from ages 5 to 11 years. Robust Poisson regression determined risk ratios for MS-Asthma.
Results:
Compared with children who did not develop MS-Asthma (N = 10,168), those developing MS-Asthma (N = 520 [4.9%]) from age 5 to 11 years were significantly (P ≤.01) more likely to be male, of non-Hispanic Black ethnicity, preterm, not-exclusively breast-fed for 1 month, and up to age 3 years have more perinatal respiratory disorders and respiratory infections, food allergy, allergic rhinitis, asthma, allergic sensitizations, and elevated blood eosinophil levels. Mothers of children with MS-Asthma had significantly more comorbidities and antibiotics dispensed, and less preexisting diabetes (P < .001). Significant adjusted risk factors observed before 36 months associated with increased MS-Asthma at age 5 to 11 years included food allergy; 6 or more atopic dermatitis medication dispensings; nasal corticosteroid dispensing; and number of dispensings of inhaled short-acting beta-agonists, montelukast, and inhaled corticosteroids. Significant protective risk factors were 1-month exclusive breast-feeding and preexisting maternal diabetes.
Conclusions:
Risk models for MS-Asthma in later childhood were developed on the basis of early childhood and maternal factors using administrative data.
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