Asthma and Risk of Appendicitis in Children: A Population-Based Case-Control Study

Abstract

Objective To assess whether asthma is associated with risk of appendicitis in children. Methods We used a population-based case-control study design utilizing a comprehensive medical record review and predetermined criteria for appendicitis and asthma. All children (age<18 years) who resided in Olmsted County, Minnesota, and developed appendicitis between 2006 and 2012 were matched to controls (1:1) with regard to birthday, gender, registration date, and index date. Asthma status was ascertained using predetermined criteria. Active (current) asthma was defined as the presence of asthma symptoms or asthma-related events (eg, medication use, clinic visits, emergency department, or hospitalization) within one year prior to the index date. Inactive asthma was defined as subjects without these events. A conditional logistic regression model was used. Results Among the 309 appendicitis cases identified, when stratified by asthma status, active asthma was associated with significantly increased risk of appendicitis when compared to inactive asthma (OR=2.48; 95% CI, 1.22–5.03) and to no asthma (OR=1.88; 95% CI, 1.07–3.27) (overall p-value=0.035). When controlling for potential confounders such as gender, age, and smoking status, active asthma was associated with a higher odds of developing appendicitis compared to non-asthmatics (adjusted OR=1.75, 95% CI 0.99–3.11) whereas inactive asthma was not (overall p-value=0.049). Tobacco smoke exposure within three months was associated with an increased risk of appendicitis (adjusted OR=1.66; 95% CI, 1.02, 2.69). Among asthma medications, leukotriene receptor antagonists reduced the risk of appendicitis (OR=0.18; 95% CI, 0.04–0.74). Conclusions Active asthma may be an unrecognized risk factor for appendicitis in children while a history of inactive asthma does not pose such risk. Further investigation exploring the underlying mechanisms is warranted.

Increased risk of appendectomy in patients with asthma

“…Similar to the present results, a case-control study reported a 1.88-times higher risk of appendicitis in asthma patients than in a control group composed of individuals younger than 18 years old (95% CI 1.07–3.27, P = .035). [13] The higher odds of appendectomy for asthma patients were consistent according to the number of clinic visits of asthma.…”

“…On the contrary, a previous study did not match for the socioeconomic status between the study and control groups. [13] Because medical accessibility is a crucial factor for detecting appendicitis and recommending appendectomy, socioeconomic status should be considered to prevent selection bias. Moreover, this study used a control group that was matched for past medical history of hypertension, diabetes, and dyslipidemia and demographic factors, such as age, sex, income, and region of residence.…”

“…When the PubMed and Embase databases were searched for studies using the keywords “(asthma) AND ([appendicitis] OR [appendectomy] OR [appendix]),” only 1 study reported an association between asthma and appendicitis through June, 2018. [13] A population case-control study described an increased risk of appendicitis in asthma patients compared with children in a control group. [13] However, few previous studies have investigated the risk of appendicitis in asthma patients in adult populations.…”

“…[13] A population case-control study described an increased risk of appendicitis in asthma patients compared with children in a control group. [13] However, few previous studies have investigated the risk of appendicitis in asthma patients in adult populations.…”

Early Identification of Childhood Asthma: The Role of Informatics in an Era of Electronic Health Records

“…Both children and adults with asthma are at an increased risk of serious respiratory infections [e.g., pneumococcal pneumonia or invasive pneumococcal diseases (20–22), pertussis (23), and common upper respiratory infections (e.g., otitis media and strep infection) (24–26). Furthermore, AIICs are not limited to respiratory infections but also non-respiratory infections such as blood stream infection, appendicitis, herpes zoster (27–30) as well as inflammatory condition including Celiac disease (32). While these AIICs can cause a significant morbidity, the impact of AIICs in children with asthma is currently overlooked.…”