Use of lung function tests in asthmatic children is associated with lower risk of hospitalization. A Danish population-based follow-up study

Abstract

Background. Asthma is the most common chronic disease in childhood. Large variations in hospitalization rates are observed and adherence to and appropriateness of guidelines are often subject of discussion. The aim was to examine if adherence to guidelines concerning use of lung function tests at time of diagnosis and during the first year after the start of medical treatment was associated with risk of hospitalization. Research Design. A Danish nationwide population-based cohort study was performed for the study period 1999–2004 using data from five nationwide registries linked by a unique personal registration number. Methods. Risk of hospitalization was examined in relation to whether asthmatic children aged 6–14 had a lung function test at the start of treatment and during the first year of follow-up and a medication ratio of controller-to-total medication of at least 0.5. Cox regression analysis was used to calculate hazard ratios (HRs) adjusted for sex, age, socioeconomic factors, care provider, and severity of disease. Results. A total of 27,193 asthmatic children were followed for at least 1 year after the start of medication. The adjusted HR for hospitalization was 0.64 (95% confidence interval: 0.55–0.74) for having had a lung function test at the start of treatment; 0.82 (0.68–1.00) for having had a lung function test during the first 6 months of follow-up; 0.67 (0.55–0.81) for having a medication ratio of at least 0.5. Children from low-income families and children aged 6–8 had an increased risk of hospitalization. Conclusion. Adherence to the guidelines concerning use of lung function test for asthmatic children was associated with a reduced risk of hospitalization. Likewise, a medication ratio of controller-to-total medication of at least 0.5 was associated with a lower risk of hospitalization.

• pediatric asthma
• guidelines
• hospitalization
• registry data
• care pathway

Acknowledgments

We thank Statistics Denmark for their cooperation in providing the registry data for the study, Ineta Sokolowski for statistical advice, and Eva Højmark and Morten Pilegaard for improving the English version of this manuscript. Finally, we thank the Health Research Fund of Central Denmark Region for financial support. This funding source had no involvement in the study.

Declaration of Interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.