Real life data on incidence and risk factors of severe asthma exacerbations in children in primary care

Abstract

Real-life data on the incidence rates (IR) and risk factors of severe asthma exacerbations in children are sparse. We aimed to assess IR and risk factors of severe asthma exacerbations in children in real life. We conducted a population-based cohort study using a Dutch GP database containing complete medical records of >1 million patients. All records of children with physician-diagnosed asthma aged 5-18 years between 2000 and 2012 were examined for exacerbations, defined as either hospitalization, emergency department visit or need of systemic steroids for asthma. IR was expressed as number of exacerbations per person year (PY). We identified 14,303 asthmatic children with 35,118 PY of follow-up and 732 exacerbations. The overall IR was 2.1/100PY (95% CI 1.9-2.2), 4.1/100PY (3.8-4.4) for children on asthma treatment. Re-exacerbation occurred in 2% (1.3-4.3) of patients within 1 month, in 25% (20.6-28.8) within 1 year. Predictors for (frequent) exacerbations were age, medication use and prior exacerbations (all p < 0.001). The overall IR of severe asthma exacerbations was 4/100PY in children on asthma treatment, highest in spring and fall. 25% of the patients with an exacerbation will experience a next exacerbation within 1 year. More severe asthma is a predictor of subsequent and future exacerbations.

Profile of Patients Presenting with Asthma in Pediatric OPD of Kathmandu Medical College

“…In this study, most of the pa ents were found to have taken asthma medica ons in the past year which was consistent 13 with findings of other studies as well. Most of the pa ents were found to have been given salbutamol and/ or oral steroids by their parent for cough.…”

Longitudinal trajectories of severe wheeze exacerbations from infancy to school age and their association with early‐life risk factors and late asthma outcomes

“…Children who exacerbated made up 32% of our wheezing population, which is similar to other UK cohorts. Non‐UK cohorts showed either lower or higher exacerbation rates, although some of the studies reporting higher exacerbation rates were carried out in high‐risk populations with preponderance of severe asthmatics …”

“…One limitation of our study is that we do not have a replication popu- population, which is similar to other UK cohorts. Non-UK cohorts showed either lower 3,30 or higher 31 exacerbation rates, although some of the studies reporting higher exacerbation rates were carried out in high-risk populations with preponderance of severe asthmatics. 31 We acknowledge that there may be an underestimation of severe exacerbations among pre-school children as a consequence of a relatively stringent definition we used, and we cannot exclude the possibility that the underestimation of severity may be more likely requiring the use of oral and/or injectable corticosteroids-that is the phenotype which we focussed on relates to genuinely severe exacerbations.…”

Addressing the risk domain in the long‐term management of pediatric asthma

“…The strongest clinical predictor of a general risk for future asthma attacks remains a previous asthma attack: 25% of children with a previous asthma attack had at least one subsequent asthma attack in the following 12 months. 73 In an attempt to summarize this clinical risk, the Asthma Exacerbation Clinical Score (ECS)-ascertained from 17 questions in the four domains of symptoms, medication, healthcare utilization, and medical history-was validated in a cross-sectional study and evaluated using data from the Childhood Asthma Management Program (CAMP). ECS was able to predict asthma attacks up to 1 year later with a sensitivity of 0.69; therefore, it may be a helpful tool in patients with increased risk.…”