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

Figures & data

Figure 1 Study population flowchart.

Abbreviations: (C-) ACT, (Child) Asthma Control Test; EP, electronic portal; n, number.

Figure 2 Venn diagrams displaying the proportion of atopic comorbidities among children with asthma stratified by referral reason (A and B). Data are n (%).

Table 1 Clinical Characteristics of Children with Asthma

	All Children	Referral Reason		p-value^a
		Asthma	Atopic Disease Other Than Asthma
	408 (100)	259 (63)	149 (37)
Demographic Characteristics
Age in years, mean (SD)	10.6 (3.5)	10.3 (3.4)	11.2 (3.6)	0.021
Male gender	238 (58)	160 (62)	78 (52)	0.076
Both parents Dutch	340 (83)	210 (81)	130 (87)	0.129
Maternal education level				0.459
Low	55 (14)	33 (13)	22 (15)
Middle	164 (40)	100 (39)	64 (43)
High	189 (46)	126 (49)	63 (42)
Family history of asthma	198 (49)	124 (48)	74 (50)	0.758
Family history of other atopic disease	331 (81)	205 (79)	126 (85)	0.191
Current smoke exposure	31 (8)	17 (7)	14 (9)	0.334
Current pet ownership	165 (40)	105 (41)	60 (40)	1.000
Asthma Characteristics
Wheezing at night (past year)	173 (42)	124 (48)	49 (33)	0.004
Coughing at night (past year)	196 (48)	132 (51)	64 (43)	0.124
Inhaled short-acting β2-agonists (past week)	228 (56)	158 (61)	70 (47)	0.007
Inhaled corticosteroids (daily) ^b				<0.001
No	118 (29)	53 (21)	65 (44)
Yes, adherent	213 (52)	154 (60)	59 (40)
Yes, non-adherent	77 (19)	52 (20)	25 (16)
(Atopic) Comorbidities
Any atopic comorbidity	291 (71)	159 (61)	132 (89)	<0.001
Food allergy	87 (21)	30 (12)	57 (38)	<0.001
Allergic rhinitis	200 (49)	100 (39)	100 (67)	<0.001
Atopic dermatitis	173 (42)	91 (35)	82 (55)	<0.001
Recurrent upper RTIs (yes)	146 (36)	89 (34)	57 (38)	0.454
Recurrent lower RTIs (yes)	116 (28)	82 (32)	34 (23)	0.068
Quality of Life
PAQLQ, median (IQR)	6.1 (5.4–6.7)	5.9 (5.0–6.6)	6.2 (5.6–6.8)	0.003
RAND, mean (SD)	21 (4.6)	21 (4.5)	21 (4.7)	0.991
Referral Reason
Asthma	259 (64)	259 (100)	0
Food allergy	73 (18)	0	73 (49)
Allergic rhinitis	38 (9)	0	38 (26)
Atopic dermatitis	27 (7)	0	27 (18)
Other, none of the above	11 (3)	0	11 (7)

Notes: Data are n (%) unless otherwise stated. ^aStatistical comparisons between referral groups with p values of less than 0.003 taken to be significant according to Bonferroni correction for multiple testing. ^bMedication adherence was assessed by the Medication Adherence Rating Scale (MARS).²³ Children with a total MARS score ≥21 were considered adherent and a score <21 were considered non-adherent.²⁴

Abbreviations: IQR, interquartile range; RTIs, respiratory tract infections; n, number; NA, not applicable; SD, standard deviation.

Table 2 Univariable and Fitted Multivariable Logistic Regression Analysis with Uncontrolled Asthma (ACT Score <20) as the Outcome

Predictor	Children with Asthma n=408
	Univariable Analysis		Fitted Multivariable Analysis^a
	OR (95% CI)	p-value	OR (95% CI)	p-value
Age category		0.616
4–12 years	Ref
12–18 years	0.90 (0.60 to 1.36)
Male gender	1.45 (0.97 to 2.18)	0.074	1.50 (0.96 to 2.37)	0.073
Maternal education level		0.196		0.099
Low	Ref		Ref
Middle	1.52 (0.81 to 2.91)		1.60 (0.81 to 3.23)
High	1.06 (0.57 to 2.03)		0.98 (0.50 to 1.98)
Family history of asthma	1.81 (1.21 to 2.72)	0.004	2.08 (1.34 to 3.24)	0.001
Current smoke exposure	1.73 (0.82 to 3.63)	0.146
Current pet ownership	1.42 (0.95 to 2.13)	0.087	1.51 (0.97 to 2.36)	0.066
Inhaled corticosteroids (daily)^b		0.027		0.147
No	Ref		Ref
Yes, adherent	1.54 (0.96 to 2.50)		1.05 (0.62 to 1.79)
Yes, non-adherent	2.22 (1.23 to 4.04)		1.78 (0.93 to 3.44)
Food allergy	0.52 (0.30 to 0.86)	0.011
Allergic rhinitis	0.87 (0.58 to 1.29)	0.486
Atopic dermatitis	0.85 (0.57 to 1.27)	0.430
Recurrent upper RTIs (yes)	2.20 (1.45 to 3.34)	<0.001	2.40 (1.52 to 3.81)	<0.001
Recurrent lower RTIs (yes)	2.27 (1.47 to 3.53)	<0.001	2.00 (1.25 to 3.23)	0.004
Referral reason		<0.001		<0.001
Referral for atopic diseases other than asthma	Ref		Ref
Referral for asthma	2.47 (1.60 to 3.87)		2.60 (1.61 to 4.26)

Notes: ^aFitted multivariable logistic regression model after backward selection. ^bMedication adherence was assessed by the Medication Adherence Rating Scale (MARS).²³ Children with a total MARS score ≥21 were considered adherent and a score <21 were considered non-adherent.²⁴

Abbreviations: ACT, Asthma Control Test; CI, confidence interval; RTIs, respiratory tract infections; n, number; OR, odds ratio; Ref, Reference category.

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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.