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

Abstract

Background: Long-term follow-up studies establishing risk factors for loss of asthma control in well-controlled children with mild to moderate disease are lacking and are of importance for improving patient quality of life and utilization of health-care resources.Methods: Loss of asthma control was assessed in 146 school-aged children with well-controlled mild to moderate asthma from a Danish pediatric asthma outpatient clinic based on hospital admissions, emergency department (ED), or outpatient management of exacerbations, oral corticosteroid (OCS) use, or step-up of regular asthma treatment according to Global Initiative for Asthma (GINA) guidelines through a 5-year follow-up period. Risk factors included sex, ethnicity, age, body mass index (BMI), atopic comorbidity and predisposition, lung function, fractional exhaled nitric oxide (FeNO) level, exercise challenge test results, regular physical activity, GINA treatment step at baseline, and adherence to controller therapy.Results: A total of 27 (18%) children experienced 56 acute events defined by hospital admission, ED, or outpatient management. Risk of experiencing any acute event was increased with female sex (adjusted odds ratio, aOR = 2.4 (1.0-5.9), p = 0.047) and higher baseline GINA treatment step (aOR = 1.6 (1.1-2.5), p = 0.03). Furthermore, female sex (aOR = 6.1 (1.4-42.2), p = 0.01) and higher FeNO (aOR = 1.8(1.0-3.2), p = 0.04) were associated with OCS prescriptions, whereas no risk factors were identified for GINA treatment step-up during the 5-year follow-up.Conclusions: Female sex, higher FeNO, and higher baseline GINA treatment step increase the risk of long-term loss of control including acute events and OCS use in well-controlled children with mild to moderate asthma. These findings are important for primary physicians and clinicians in asthma outpatient clinics to identify seemingly well-controlled children at risk to plan more frequent follow-ups.

Analysis of the Consumption of Drugs Prescribed for the Treatment of Asthma in Belgian Children

“…It would be interesting to analyze the consumption of asthma medications according to other factors. For example, the body mass index, ethnic origin, or medication adherence could be linked with the consumption of asthma medications [ 27 , 28 ]. Unfortunately, we do not have access to this information in our database.…”

Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma

“…This is a retrospective investigation of a cohort of children with asthma who were recruited and followed since 2015 in our asthma outpatient clinic as previously detailed [ 7 , 8 ]. The inclusion criteria for the study were: (1) an asthma diagnosis established by a pediatrician in the clinic, and (2) one or more scheduled outpatient visits during 5-year of follow-up.…”

Pediatric pulmonology 2021 year in review: Asthma

“…Currently, there are no guidelines for interpretation or categorization of higher FeNO levels. 21 conducted a retrospective cohort study to assess risk factors for asthma control over a 5-year period. The study found that female gender, elevated FeNO, and higher GINA treatment level were associated with loss of asthma control and increased oral corticosteroids prescriptions.…”

“…Based on these findings, FeNO levels should be considered when assessing patients with asthma, especially when PFT findings are inconclusive. Additional study by Hauersley et al 21 conducted a retrospective cohort study to assess risk factors for asthma control over a 5‐year period. The study found that female gender, elevated FeNO, and higher GINA treatment level were associated with loss of asthma control and increased oral corticosteroids prescriptions.…”