Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol

Abstract

IntroductionAsthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.Methods and analysisProspective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5–17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.Ethics and disseminationEthical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

Integrated health care systems for asthma: A qualitative narrative study from the perspective of Ecuadorian health professionals

“…The present study forms part of the Asthma Attacks study [11][12]. It aimed to understand better the causes of recurrence of asthma attacks and optimize strategies to improve asthma control and prevent asthma attacks [11].…”

“…The qualitative component of the " Asthma Attacks Causes and Prevention Study in Latin America (Asthma Attack)" [11,12] was developed in 2019 in collaboration with partners from the United Kingdom (UK), Brazil and Ecuador, and focused on understanding perspectives of health workers on the coordination of asthma care between the primary and specialized levels in Ecuador. Asthma is a chronic condition affecting more than 300 million people worldwide, especially in low and middle-income countries, is a major drain on health resources, requires long-term medications, and is a major cause of hospital admissions due to asthma attacks [13].…”

“…Based on the characteristics of the qualitative research [12], we aimed to explore health workers' perspective in asthma care coordination and to describe and compare healthcare levels in Ecuador.…”