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Published on: November 4, 2010

Timing of High-Risk Asthma Specialist Enrollment and Severe Asthma Exacerbations in Children

Arthur H Owora1, Samuel Strunk2, Bowen Jiang2

  • 1Translational Informatics, Biostatistics and Epidemiology Lab, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Ind.

The Journal of Allergy and Clinical Immunology. in Practice
|June 19, 2026
PubMed

Insights

Children with high asthma risk face delays in specialty care, leading to worsening symptoms. Early identification and enrollment in high-risk asthma clinics significantly reduce severe asthma exacerbations.

Area of Science:

  • Pediatric Pulmonology
  • Asthma Management
  • Healthcare Disparities

Background:

  • Specialty care improves asthma outcomes in children.
  • Timeliness of enrollment and impact of delays in pediatric asthma specialty care are not well understood.

Purpose of the Study:

  • To identify factors associated with delayed enrollment in pediatric specialty asthma care.
  • To assess the impact of specialty care on severe asthma exacerbations (SAE) before and after enrollment, considering patient characteristics.

Main Methods:

  • A quasi-experimental longitudinal cohort study of 229 children (<11 years) with moderate-to-severe asthma.
  • Quantified early childhood asthma risk factors and used Cox models for enrollment correlates.
  • Applied piecewise generalized linear mixed-effects models to estimate changes in SAE odds pre- and post-enrollment.

Main Results:

  • Children with higher early asthma risk burdens experienced delayed enrollment and increased SAE odds for 2-3 years prior.
  • Enrollment in high-risk asthma (HRA) care reduced SAE odds by 36%.
  • Greater SAE reductions were observed in children who initiated inhaled corticosteroids within 12 months of diagnosis.

Conclusions:

  • Specialty asthma care reduces severe exacerbation risk, but high-risk children face significant enrollment delays.
  • Early risk stratification is crucial for timely specialty care access and improved pediatric asthma outcomes.
Abstract

Keywords:
Difficult-to-treat asthmaEarly detectionPassive digital markerPediatric asthmaSevere asthma exacerbationsSpecialist care

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