Asthma exacerbation trajectories and their predictors in children with incident asthma

Abstract

Background: Asthma exacerbation trajectories in children after incident asthma diagnosis are understudied. Objective: To identify trajectories of asthma exacerbation and predictors of these trajectories in children with incident asthma. Methods: Children from the National Longitudinal Survey of Children and Youth, Canada, with incident asthma were followed-up for up to 12 years during childhood. Latent class growth modeling was used to identify distinct asthma exacerbation trajectory groups. Multinomial logistic regression was performed to identify predictors of trajectory group membership. Results: The mean age at asthma diagnosis among 403 children was 5.9 years. Three distinct trajectories were identified: low increasing (21.3% of children), medium decreasing (45.8% of children), and high decreasing (32.8% of children). Asthma attack probability increased gradually after diagnosis in low increasing group, decreased from moderate level after diagnosis to almost zero probability at the end of follow-up in the medium decreasing group, and decreased after diagnosis but remained higher in the high decreasing group than the other 2 groups at 12 years after diagnosis. Children having more siblings at home were more likely to belong to the medium decreasing and high decreasing trajectory groups, whereas children older at asthma diagnosis were less likely to belong to the medium decreasing and high decreasing trajectory groups than the low increasing trajectory group. Conclusion: Our results suggest that children with incident asthma follow 3 distinct trajectories of asthma exacerbations after asthma diagnosis. The trajectory group with initial moderate exacerbation probability has better long-term prognosis.

Trajectories of asthma symptom presenting as wheezing and their associations with family environmental factors among children in Australia: evidence from a national birth cohort study

“…1 It is one of the most common chronic illnesses in children, 2 3 presents with periodic exacerbations and remissions, and accounts for substantial medical and economic burden. 4 Global studies of asthma in children have reported that the prevalence of asthma symptoms has increased in the last few decades, which is concerning. 5 Australia is one of the developed countries where asthma continues to be a significant public health concern.…”

“…These include transient asthma, early-onset chronic asthma, late-onset chronic asthma and no asthma from early childhood to adolescence. 4 24 25 28 One study described the trajectories as low progressive, early transient and early persistent asthma symptoms. 24 All studies showed that the prevalence was high at 2–5 years of age for all unfavourable types of asthma symptoms trajectories.…”

Long‐term predictors of loss of asthma control in school‐aged well‐controlled children with mild to moderate asthma: A 5‐year follow‐up

“…The quality of the data in our study was high as it was based on objective measures of, for example, height, weight, lung function, FeNO, atopic comorbidity and registrations in the patient's medical and pharmacy files of prescription of asthma controllers, OCS, treatment adherence as well as outpatient contacts, ED and hospital admissions. This is an advantage compared with studies using similar exposures and outcomes based on surveys or information by parents, which is more prone to recall bias 2,19,20 . However, it is a limitation that some previously identified risk factors in larger studies could not be included in this retrospective study, for example, previous exacerbations, environmental triggers such as allergens and tobacco exposure, 5,12,21 and socioeconomic status 4,22 …”

“…This is an advantage compared with studies using similar exposures and outcomes based on surveys or information by parents, which is more prone to recall bias. 2,19,20 However, it is a limitation that some previously identified risk factors in larger studies could not be included in this retrospective study, for example, previous exacerbations, environmental triggers such as allergens and tobacco exposure, 5,12,21 and socioeconomic status. 4,22 A significant strength of our study is the long-term design with 5 years of follow-up.…”

Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort

“…Exacerbation cohorts may provide useful information on pathomolecular interactions, which can be used for the definition of biomarkers [ 52 , 53 , 54 ]. However, data from exacerbation cohorts of children with asthma are still scarce [ 52 , 53 , 54 ].…”