Characteristics of Allergic, Eosinophilic, and Overlapping Asthma Phenotypes Among Pediatric Patients with Current Asthma: A Cross-Sectional Study from Saudi Arabia

Abstract

Purpose

Asthma is one of the most common chronic diseases affecting 10%–30% of children in Saudi Arabia. Although data exist on adult asthma phenotyping and endotyping in Saudi Arabia, little is known about asthma phenotypes in Saudi children.

Patients and Methods

This cross-sectional study enrolled pediatric patients diagnosed with bronchial asthma and followed in the pediatric pulmonology clinic of the Abha Maternity and Children Hospital between August 2021 and May 2023.

Results

A total of 321 children (aged 5–14 years) were analyzed. The population was classified into allergic [169 (52.6%)], eosinophilic [144 (44.9%)], and overlapping allergic and eosinophilic asthma [97 (30.2%)] phenotypes. Regarding asthma severity, 35.5%, 50.2%, and 14.3% were classified as mild, moderate, and severe, respectively. Of the 321 patients in the study, 124 (38.6%) had at least one asthma exacerbation that required hospitalization. The number of reported missed school days in the previous year was 1571 days [190 (59.2%) patients reported at least one missed school day]. The factors associated with the likelihood of uncontrolled asthma for all study participants included: emergency room (ER) visit last year (OR = 3.7, 95% CI:0.6–15.9]), overlapping eosinophilic and allergic (OR = 3.2, 95% CI = 1.8–5.9), and allergic phenotype (OR = 2.7, 95% CI = 1.3–5.4). The level of asthma control differed significantly among the three asthma phenotypes (p = 0.037).

Conclusion

Allergic asthma is the most prevalent asthma phenotype in this study, followed by the eosinophilic phenotype. The research has also shown that several factors predict uncontrolled asthma, including a family history of asthma, previous admission to the PICU, and previous hospitalization ever. There is, therefore, a definite need for multicenter cohort studies to better understand the phenotypes and endotypes of childhood asthma, as it could offer therapeutic and prognostic relevance.

Keywords:

• children
• asthma
• childhood asthma phenotypes
• uncontrolled asthma
• allergic asthma

Ethics Approval and Informed Consent

The study was approved by the Research Ethical Committee (REC), General Directorate of Health Affairs-Aseer, Abha, Saudi Arabia (approval number REC#5-10-2019). The study was conducted according to the Declaration of Helsinki. Informed consent was obtained from all parent or legal guardian of the patients involved in the study.

Acknowledgments

The authors extend their appreciation to the Ministry of Education in KSA for funding this research work through the project number (KKU-IFP2-H-13). In addition, the author is thankful for the study participants for their time and effort in participating in this research.

Disclosure

The author declares no competing interests in this work.