Predictors of asthma control differ from predictors of asthma attacks in children: The Swiss Paediatric Airway Cohort.

Autor: Ardura-Garcia C; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Mallet MC; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland., Berger DO; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland., Hoyler K; Kinderpneumologie Horgen, Private Practice for Pediatric Pneumology, Horgen, Switzerland., Jochmann A; Department of Paediatric Pulmonology, University Children's Hospital Basel, Basel, Switzerland., Kuhn A; Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland., Moeller A; Department of Respiratory Medicine, University Children's Hospital Zurich and Children's Research Centre, University of Zurich, Zurich, Switzerland., Regamey N; Division of Paediatric Pulmonology, Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland., Singer F; Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria., Pedersen ESL; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Kuehni CE; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Jazyk: angličtina
Zdroj: Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology [Clin Exp Allergy] 2023 Nov; Vol. 53 (11), pp. 1177-1186. Date of Electronic Publication: 2023 Sep 02.
DOI: 10.1111/cea.14390
Abstrakt: Background: It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children.
Objective: We evaluated predictors for these two outcomes in a clinical cohort study.
Methods: The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children (5-16 years old) diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks.
Results: At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline (e.g. ≥1 night wheeze/week OR: 3.2; 95% CI: 1.7-6), wheeze triggered by allergens (2.2; 1.4-3.3), colds (2.3; 1.4-3.6) and exercise (3.2; 2-5), a more intense treatment at baseline (2.4; 1.3-4.4 for Step 3 vs. 1), history of preschool (2.6; 1.5-4.4) and persistent wheeze (2; 1.4-3.2), and exposure to tobacco smoke (1.7; 1-2.6). Incident asthma attacks were associated with previous episodes of severe wheeze (2; 1.2-3.3) and asthma attacks (2.8; 1.6-5 for emergency care visits), younger age (0.8; 0.8-0.9 per 1 year) and non-Swiss origin (0.3; 0.2-0.5 for Swiss origin). Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks.
Conclusion: Children at risk of long-term suboptimal asthma control differ from those at risk of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.
(© 2023 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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