Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases

Abstract

Background

Uncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma.

Methods

All children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses.

Results

We included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively).

Conclusion

Uncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.

Keywords:

• asthma
• asthma control
• atopic diseases
• respiratory tract infections
• prognosis

Acknowledgments

The authors would like to thank the members of the Expert Network P.F. Eskes (Department of Pediatrics, Meander Medical Center, Amersfoort, the Netherlands), R. van Gent (Department of Pediatrics, Máxima Medical Center, Veldhoven, the Netherlands; R. van Gent passed away on May 28, 2014) and A.G. Ketel (Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands). Furthermore, the authors would like to thank P.M.J. Welsing (Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands) for his statistical advice and L.M. Verhagen (Department of Pediatrics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands) for her help to define recurrent respiratory tract infections in children. An abstract of this paper was presented at the European Academy of Allergy and Clinical Immunology Congress, 2019, as a poster presentation with interim findings. The poster’s abstract was published in “Abstracts LB PDS” in Allergy (https://onlinelibrary.wiley.com/toc/13989995/2019/74/S106).

Abbreviations

ACT, Asthma Control Test; C-ACT, Child Asthma Control Test; CI, Confidence interval; EP, electronic portal; ISAAC, International Study of Asthma and Allergies in Childhood; IQR, Interquartile range; MARS, Medication Adherence Rating Scale; OR, Odds ratio; PAQLQ, Pediatric Asthma Quality of Life Questionnaire; RAND, RAND (no abbreviation) general health-rating index; SD, Standard deviation.

Ethics Approval and Consent to Participate

The study has been approved by the Medical Ethics Committee of the University Medical Center Utrecht (No. 10/348). All parents and/or children gave informed consent.

Availability of Data and Material

The datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request.

Author Contributions

HK substantially contributed to design, concept, acquisition of data, analysis and interpretation of data, and drafting the article. TL, FE and CE substantially contributed to design, interpretation of data, and drafting the article. BE, WB, DG, EV, MV and GS substantially contributed to acquisition of data and revising the article critically for important intellectual content. CU, YM and AK substantially contributed to interpretation of data and revising the article critically for important intellectual content. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Funding

This study was supported by the Stichting Astma Bestrijding Nederland. The electronic portal was supported by an unrestricted grant of GlaxoSmithKline and ALK-Abelló.

Disclosure

Esther de Vries reports grants from Takeda, outside the submitted work. HM Kansen reports grants from Stichting Astma Bestrijding Nederland, GlaxoSmithKline, and ALK-Abéllo, during the conduct of the study. Cornelis van der Ent reports grants from GlaxoSmithKline during the conduct of the study. The authors have declared that they have no competing interests in relation to this study.