Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study

Abstract

PurposeChildhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity.MethodsThis study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity.ResultsMild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma.ConclusionsModification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.

Characterization of severe asthma in the pediatric population

“…Regarding pulmonary function, our study showed that FEV1 <80% is a statistically significant risk factor for presenting more exacerbations that require emergency room visits, hospital admissions or PICU, similarly to several publications 11,13,14 . Besides, a non-adherence of 43.3% was observed showing statistically significant results of worse control of the symptoms of severe asthma and maybe that could explain a lower pulmonary function.…”

“…This can be related to impairs histone deacetylase-2 (HDAC2) function via phosphoinositide-3-kinase (PI3K) signaling activation, which could contribute to corticosteroid-insensitive inflammation in children with severe asthma, as recently suggested by Kobayashi 10 . Exposure to heavy traffic also is a significant severity criterion for emergency room visits/year and admissions, in keeping with Eun Lee 11 that shows that exposure to high levels of outdoor air pollution without air purifier was associated with moderate/severe asthma when mild intermittent asthma was considered as a reference.…”

“…Also, clinical biomarkers such as positive API, rhinitis, and atopic dermatitis proved to be statistically significant criteria for severe asthma. These results are comparable to Rosas-Salazar 8 in which asthmatic patients had a history of atopy, although it was not described in relation to severity, but opposite to Eun Lee 11 and the SARP III cohort 3 who did not observe a relationship between atopy and severe asthma. This disparity in results could be explained because asthma has a specific genetic component and its interaction with environmental factors seems to be the key in the development of the disease 12 .…”

A Suggested Approach for Management of Pediatric Asthma During the COVID-19 Pandemic

“…Extra body weight increases the risk of developing asthma, obesity is closely associated with asthma ( 42 – 44 ). A South Korean study on 667 children with asthma (mean age 9.47 ± 4.23 years, mean body mass index 18.6 ± 3.6 Kg/m 2 ) found that asthma severity increases from moderate to severe as the body mass index changes from 18.4 ± 3.6 to 19.1 ± 3.5 Kg/m 2 ( 44 ). When isolated at home, the activity levels are greatly reduced.…”

Heterogeneity of Childhood Asthma in Korea: Cluster Analysis of the Korean Childhood Asthma Study Cohort

“…These phenotypes differ in physiological and biochemical characteristics, and the various endotypes of asthma are characterized by distinct functional and/or pathophysiological mechanisms. 1 2 3 4 A clear differentiation of these clinical phenotypes and endotypes is necessary to improve asthma management, thereby improving and personalizing asthma treatment. 5 6 7 Unsupervised cluster analysis is a statistical method frequently utilized in clinical studies to group participants with similar characteristics.…”