Epidemiological characteristics and risk factors of severe asthma in children: a single-center prospective cohort study

doi:10.3969/j.issn.1674-8115.2023.06.002

Abstract

Abstract:

Objective ·To explore the epidemiological characteristics of severe asthma in children and analyze the risk factors. Methods ·A single-center prospective cohort study was conducted. Six hundred and seventy four children with difficult-to-treat asthma who visited the Children′s Hospital of Fudan University from January 1 to December 31, 2021 were included to establish a dynamic cohort. Basic information (including gender, age, gestational age at birth, birth weight, etc.) and comorbidity of the cohort members were collected. The asthma control status, drug inhalation technique level, medication compliance, pulmonary function parameters [forced expiratory volume in one second (FEV₁) as a percent-age of the predicted value (FEV₁%pred), FEV₁/ forced vital capacity (FVC), and the rate of estimated values of forced expiratory flow at 50% of FVC exhaled (FEF₅₀), FEF₇₅, and FEF_25-75 in percent-predicted value, respectively], airway inflammation index [fraction exhaled nitric oxide (FeNO)], and allergy status parameters [eosinophil (EOS) and immunoglobulin E (IgE)] of all cohort members were evaluated. All cohort members underwent re-evaluation respectively at the specialist asthma clinic of the hospital at 3, 6, 9, and 12 months. Results ·At the endpoint of the cohort, 52 children were diagnosed with severe asthma, accounting for 7.7%. A high proportion of severe asthma was found in children who were exposed to secondhand smoke, used air conditioning at home all year round, or had coexisting rhinitis/nasosinusitis, FEV₁%pred<80%, FEV₁/FVC<80%, small airway dysfunction, EOS>300/μL, IgE>200 IU/L, or FeNO>20/25 ppb [FeNO>20 ppb (≤12 years old) or >25 ppb (>12 years old), 1 ppb=1×10^-9 mol/L]. A high proportion of non-severe asthma was found in children who were breastfed for 6 months or longer, or had good medication compliance. The differences were statistically significant (all P<0.05). There were more males in children with severe asthma aged 6?11 years, and more females in children with severe asthma aged 12?17 years, with statistical significance (both P<0.05). Multiple-factor Logistic regression analysis showed that only small airway dysfunction was an independent risk factor for severe asthma [OR=5.158 (95%CI 2.516?10.572)]. Conclusion ·The proportion of children with severe asthma has a significantly decrease after one year of standardized management in children with difficult-to-treat asthma. Small airway dysfunction is an independent risk factor for the progression to severe asthma.

Key words: child, asthma, severe, diagnosis, treatment

CLC Number:

R725.6

WANG Yingwen, LI Xiaoling, DAI Jiajia, LIU Fang, HUANG Jianfeng, WANG Libo, ZHANG Xiaobo, FENG Rui. Epidemiological characteristics and risk factors of severe asthma in children: a single-center prospective cohort study[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(6): 665-672.

Figures/Tables 3

TrendMD

References 33

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Item	Non-severe asthma (n=622)	Severe asthma (n=52)	Z/χ² value	P value
Male/n(%)	419 (67.4)	37 (71.2)	0.166	0.684
Age/year	9.0 (6.0, 13.0)	9.0 (6.8, 12.2)	0.228	0.820
Age groups/n(%)			0.003	0.957
6‒11 years old	338 (54.3)	29 (55.8)
12‒17 years old	284 (45.7)	23 (44.2)
Gestational age<37 weeks/n(%)	33 (5.3)	5 (9.6)	0.963	0.326
Birth weight<2 500 g/n(%)	59 (9.5)	6 (11.5)	0.056	0.812
Taking vitamin D supplements regularly until 3-year-old/n(%)	277 (44.5)	27 (51.9)	0.781	0.377
Taking vitamin D supplements regularly during pregnancy/n(%)	298 (47.9)	31 (59.6)	2.184	0.139
Mother′s age at delivery/year	29.0 (26.0, 32.0)	29.0 (27.0, 31.2)	-0.242	0.809
Breastfeeding≥6 months/n(%)	333 (53.5)	10 (19.2)	21.247	0.000
Reside in city/n(%)	539 (86.7)	46 (88.5)	0.024	0.876
Expose to second-hand smoking at home/n(%)	95 (15.3)	15 (28.8)	5.518	0.019
Long-term use of air conditioning/n(%)	501 (80.5)	52 (100.0)	11.044	0.001
Annual household income/n(%)			0.349	0.840
<100 000 CNY	101 (16.2)	8 (15.4)
≥100 000 and <200 000 CNY	307 (49.4)	24 (46.2)
≥200 000 CNY	214 (34.4)	20 (38.5)
Educational level of the main household/n(%)			0.067	0.796
Senior high school or lower	116 (18.6)	11 (21.2)
College and above	506 (81.4)	41 (78.8)
Comorbidity/n(%)
Obesity	137 (22.0)	17 (32.7)	2.522	0.112
Obstructive sleep apnea	59 (9.5)	8 (15.4)	1.265	0.261
Rhinitis/sinusitis	317 (51.0)	38 (73.1)	8.546	0.003
MARS-A≥4.5/n(%)	301 (48.4)	17 (32.7)	4.137	0.042
Correct inhaler technique/n(%)	140 (22.5)	17 (32.7)	2.245	0.134
Pulmonary function/n(%)
FEV₁%pred<80%	2 (0.3)	17 (32.7)	171.928	0.000
FEV₁/FVC<80%	0 (0)	7 (13.5)	72.019	0.000
Small airway dysfunction^①	32 (5.1)	40 (76.9)	251.658	0.000
EOS>300 μL^-1/n(%)	329 (52.9)	46 (88.5)	23.176	0.000
IgE>200 (IU·L^-1)/n(%)	260 (41.8)	47 (90.4)	43.733	0.000
FeNO>20 or 25 ppb^②/n(%)	390 (62.7)	52 (100.0)	27.947	0.000
C-AST or ACT<20/n(%)	51 (8.2)	52 (100.0)	305.321	0.000

Item	Non-severe asthma (n=622)	Severe asthma (n=52)	Z/χ² value	P value
Male/n(%)	419 (67.4)	37 (71.2)	0.166	0.684
Age/year	9.0 (6.0, 13.0)	9.0 (6.8, 12.2)	0.228	0.820
Age groups/n(%)			0.003	0.957
6‒11 years old	338 (54.3)	29 (55.8)
12‒17 years old	284 (45.7)	23 (44.2)
Gestational age<37 weeks/n(%)	33 (5.3)	5 (9.6)	0.963	0.326
Birth weight<2 500 g/n(%)	59 (9.5)	6 (11.5)	0.056	0.812
Taking vitamin D supplements regularly until 3-year-old/n(%)	277 (44.5)	27 (51.9)	0.781	0.377
Taking vitamin D supplements regularly during pregnancy/n(%)	298 (47.9)	31 (59.6)	2.184	0.139
Mother′s age at delivery/year	29.0 (26.0, 32.0)	29.0 (27.0, 31.2)	-0.242	0.809
Breastfeeding≥6 months/n(%)	333 (53.5)	10 (19.2)	21.247	0.000
Reside in city/n(%)	539 (86.7)	46 (88.5)	0.024	0.876
Expose to second-hand smoking at home/n(%)	95 (15.3)	15 (28.8)	5.518	0.019
Long-term use of air conditioning/n(%)	501 (80.5)	52 (100.0)	11.044	0.001
Annual household income/n(%)			0.349	0.840
<100 000 CNY	101 (16.2)	8 (15.4)
≥100 000 and <200 000 CNY	307 (49.4)	24 (46.2)
≥200 000 CNY	214 (34.4)	20 (38.5)
Educational level of the main household/n(%)			0.067	0.796
Senior high school or lower	116 (18.6)	11 (21.2)
College and above	506 (81.4)	41 (78.8)
Comorbidity/n(%)
Obesity	137 (22.0)	17 (32.7)	2.522	0.112
Obstructive sleep apnea	59 (9.5)	8 (15.4)	1.265	0.261
Rhinitis/sinusitis	317 (51.0)	38 (73.1)	8.546	0.003
MARS-A≥4.5/n(%)	301 (48.4)	17 (32.7)	4.137	0.042
Correct inhaler technique/n(%)	140 (22.5)	17 (32.7)	2.245	0.134
Pulmonary function/n(%)
FEV₁%pred<80%	2 (0.3)	17 (32.7)	171.928	0.000
FEV₁/FVC<80%	0 (0)	7 (13.5)	72.019	0.000
Small airway dysfunction^①	32 (5.1)	40 (76.9)	251.658	0.000
EOS>300 μL^-1/n(%)	329 (52.9)	46 (88.5)	23.176	0.000
IgE>200 (IU·L^-1)/n(%)	260 (41.8)	47 (90.4)	43.733	0.000
FeNO>20 or 25 ppb^②/n(%)	390 (62.7)	52 (100.0)	27.947	0.000
C-AST or ACT<20/n(%)	51 (8.2)	52 (100.0)	305.321	0.000

Category	Severe asthma	Non-severe asthma	χ² value	P value
6‒11 years old/n(%)			4.634	0.031
Male (n=256)	27 (10.5)	229 (89.5)
Female (n=111)	2 (1.8)	109 (98.2)
12‒17 years old/n(%)			9.105	0.003
Male (n=200)	10 (5.0)	190 (95.0)
Female (n=107)	13 (12.1)	94 (87.9)

Category	Severe asthma	Non-severe asthma	χ² value	P value
6‒11 years old/n(%)			4.634	0.031
Male (n=256)	27 (10.5)	229 (89.5)
Female (n=111)	2 (1.8)	109 (98.2)
12‒17 years old/n(%)			9.105	0.003
Male (n=200)	10 (5.0)	190 (95.0)
Female (n=107)	13 (12.1)	94 (87.9)

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