Predictor of recurrent exacerbations in pediatric asthma

  • Ly Cong Tran Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Hung Viet Phan Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Thu Vo-Pham-Minh Department of Internal Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Nghia Quang Bui Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Chuong Nguyen-Dinh-Nguyen Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Nguyen Thi Nguyen Thao Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Ai Uyen Nguyen Huynh Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Nhu Thi Huynh Tran Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
  • Phuong Minh Nguyen Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
Keywords: asthma, children, exacerbation, prognosis, spirometry
Abstract viewed: 2 times
PDF downloaded: 0 times
HTML downloaded: 0 times
EPUB downloaded: 0 times

Abstract

BACKGROUND Asthma imposes a heavy morbidity burden during childhood. Severe persistent asthma significantly increases patients’ risk of exacerbations, hospital admissions, and mortality and often substantially impairs their quality of life. This study aimed to identify high-risk patients for exacerbation recurrence using spirometric parameters.

METHODS A prospective cohort study involving patients with asthma aged 6–15 years was conducted at the principal children’s hospital in Mekong Delta, Vietnam, from June 2020 to June 2022. Demographic, clinical, and lung function characteristics of the patients were collected. Spirometry measurement parameters were utilized as predictive factors for the short-term asthma exacerbation recurrence.

RESULTS Among all patients (mean age of 9.5 years old), 10.4% experienced recurrent exacerbations. FEV1, FVC, FEV1/FVC, FEF25–75, FEF25–75/FVC, and PEF, gradually decreased with increasing exacerbation severity (p<0.01). All patients showed a positive bronchodilator responsiveness (BDR), with a mean value of 16.85 (3.00)%, which was significantly different between the severe and non-severe asthma groups (20.53 [2.83] versus 16.00 [2.35], p<0.001). After adjusting in multivariable logistic regression, a BDR ≥20% was identified as the sole independent factor associated with an increased risk of asthma exacerbation recurrence (aOR 6.95, 95% CI 1.08–44.75, p = 0.041).

CONCLUSIONS A high BDR can serve as a predictor of acute asthma exacerbation recurrence.

References

  1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204−22. Erratum in: Lancet. 2020;396(10262):1562.

  2. The Global Asthma Report 2022. Int J Tuberc Lung Dis. 2022;26(Supp 1):1−104. https://doi.org/10.5588/ijtld.22.1010

  3. Ministry of Health. Guidelines for diagnosis and treatment of asthma in children under 5 years old. Decision No. 4888/QĐ-BYT. Hanoi; 2016.

  4. Do TH. Asthma phenotypes in children over 5 years old at Vietnam National Children's Hospital. J Pediatr Res Pract. 2019;1(2009):41-8.

  5. Global Asthma Network. The global asthma report 2018. Auckland: Global Asthma Network; 2018.

  6. Global Initiative for Asthma. Global strategy for asthma management and prevention. Global Initiative for Asthma; 2019.

  7. Bui NQ, Mai CT, Nguyen NK, Nguyen T, Duong LM. Characteristics of asthmatic children with Mycoplasma pneumoniae infection in Vietnam. Sri Lanka J Child Health. 2024;53(1):15-9. https://doi.org/10.4038/sljch.v53i1.10672

  8. Engelkes M, Baan EJ, de Ridder MAJ, Svensson E, Prieto-Alhambra D, Lapi F, et al. Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase pediatric cohort study. Pediatr Allergy Immunol. 2020;31(5):496−505. https://doi.org/10.1111/pai.13237

  9. Settipane RA, Kreindler JL, Chung Y, Tkacz J. Evaluating direct costs and productivity losses of patients with asthma receiving GINA 4/5 therapy in the United States. Ann Allergy Asthma Immunol. 2019;123(6):564−72.e3. https://doi.org/10.1016/j.anai.2019.08.462

  10. Engelkes M, de Ridder MA, Svensson E, Berencsi K, Prieto-Alhambra D, Lapi F, et al. Multinational cohort study of mortality in patients with asthma and severe asthma. Respir Med. 2020;165:105919. https://doi.org/10.1016/j.rmed.2020.105919

  11. Gallucci M, Carbonara P, Pacilli AMG, di Palmo E, Ricci G, Nava S. Use of symptoms scores, spirometry, and other pulmonary function testing for asthma monitoring. Front Pediatr. 2019;7:54. https://doi.org/10.3389/fped.2019.00054

  12. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. an official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70−88. https://doi.org/10.1164/rccm.201908-1590ST

  13. Jat KR. Spirometry in children. Prim Care Respir J. 2013;22(2):221−9. https://doi.org/10.4104/pcrj.2013.00042

  14. Daniel WW, Cross CL. Biostatistics: a foundation for analysis in the health sciences. 11th Ed. Hoboken: Wiley; 2019. 720 p.

  15. Ho TH. Treatment outcomes of asthma exacerbation using pediatric asthma score in categorizing severity at children's hospital No. 1 from October 2014 to April 2015 [Thesis of Residency Program]. [Ho Chi Minh City]: Can Tho University of Medicine and Pharmacy; 2015.

  16. Kelly CS, Andersen CL, Pestian JP, Wenger AD, Finch AB, Strope GL, et al. Improved outcomes for hospitalized asthmatic children using a clinical pathway. Ann Allergy Asthma Immunol. 2000;84(5):509−16. https://doi.org/10.1016/S1081-1206(10)62514-8

  17. Williams AM, Abramo TJ, Shah MV, Miller RA, Burney-Jones C, Rooks S, et al. Safety and clinical findings of BiPAP utilization in children 20 kg or less for asthma exacerbations. Intensive Care Med. 2011;37(8):1338−43. https://doi.org/10.1007/s00134-011-2238-9

  18. Sherenian MG, Wang Y, Fulkerson PC. Hospital admission associates with higher total IgE level in pediatric patients with asthma. J Allergy Clin Immunol Pract. 2015;3(4):602−3.e1. https://doi.org/10.1016/j.jaip.2015.01.014

  19. Stevens MW, Gorelick MH. Short-term outcomes after acute treatment of pediatric asthma. Pediatrics. 2001;107(6):1357−62. https://doi.org/10.1542/peds.107.6.1357

  20. Chang LS, Li JH, Wang PM, Huang CF, Kuo HC. Association between serum total and specific immunoglobulin E levels and body height: a cross-sectional study of children and adolescents. Children (Basel). 2022;9(5):661. https://doi.org/10.3390/children9050661

  21. Trivedi M, Denton E. Asthma in children and adults-what are the differences and what can they tell us about asthma? Front Pediatr. 2019;7:256. https://doi.org/10.3389/fped.2019.00256

  22. Coverstone AM, Bacharier LB, Wilson BS, Fitzpatrick AM, Teague WG, Phipatanakul W, et al. Clinical significance of the bronchodilator response in children with severe asthma. Pediatr Pulmonol. 2019;54(11):1694−703. https://doi.org/10.1002/ppul.24473

  23. Sorkness RL, Teague WG, Penugonda M, Fitzpatrick AM; National Institutes of Health, National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Sex dependence of airflow limitation and air trapping in children with severe asthma. J Allergy Clin Immunol. 2011;127(4):1073−4. https://doi.org/10.1016/j.jaci.2010.12.1079

  24. Tan CC, McDowell KM, Fenchel M, Szczesniak R, Kercsmar CM. Spirometry use in children hospitalized with asthma. Pediatr Pulmonol. 2014;49(5):451−7. https://doi.org/10.1002/ppul.22854

  25. van Dalen C, Harding E, Parkin J, Cheng S, Pearce N, Douwes J. Suitability of forced expiratory volume in 1 second/forced vital capacity vs percentage of predicted forced expiratory volume in 1 second for the classification of asthma severity in adolescents. Arch Pediatr Adolesc Med. 2008;162(12):1169−74. https://doi.org/10.1001/archpedi.162.12.1169

  26. Schifano ED, Hollenbach JP, Cloutier MM. Mismatch between asthma symptoms and spirometry: implications for managing asthma in children. J Pediatr. 2014;165(5):997−1002. https://doi.org/10.1016/j.jpeds.2014.07.026

  27. Fitzpatrick AM, Teague WG; National Institutes of Health/National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Progressive airflow limitation is a feature of children with severe asthma. J Allergy Clin Immunol. 2011;127(1):282−4. https://doi.org/10.1016/j.jaci.2010.10.036

  28. Soremekun S, Heaney LG, Skinner D, Bulathsinhala L, Carter V, Chaudhry I, et al. Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study. Thorax. 2023;78(7):643−52. https://doi.org/10.1136/thorax-2021-217032

  29. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19−24. https://doi.org/10.1164/rccm.200807-1126OC

  30. Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J. 2007;30(3):452−6. https://doi.org/10.1183/09031936.00165106

  31. Busse WW. Consequences of severe asthma exacerbations. Curr Opin Allergy Clin Immunol. 2023;23(1):44−50. https://doi.org/10.1097/ACI.0000000000000870

  32. Matsunaga K, Hirano T, Oka A, Tanaka A, Kanai K, Kikuchi T, et al. Progression of irreversible airflow limitation in asthma: correlation with severe exacerbations. J Allergy Clin Immunol Pract. 2015;3(5):759−64.e1. https://doi.org/10.1016/j.jaip.2015.05.005

  33. Busse WW, Panettieri RA Jr, Corren J. Bronchodilator responsiveness: an underappreciated biomarker for asthma exacerbations. J Allergy Clin Immunol Pract. 2022;10(1):229−30. https://doi.org/10.1016/j.jaip.2021.10.055

  34. Sharma S, Litonjua AA, Tantisira KG, Fuhlbrigge AL, Szefler SJ, Strunk RC, et al. Clinical predictors and outcomes of consistent bronchodilator response in the childhood asthma management program. J Allergy Clin Immunol. 2008;122(5):921−8.e4. https://doi.org/10.1016/j.jaci.2008.09.004

Published
2024-04-05
How to Cite
1.
Tran LC, Phan HV, Vo-Pham-Minh T, Bui NQ, Nguyen-Dinh-Nguyen C, Nguyen Thao NT, Nguyen Huynh AU, Tran NTH, Nguyen PM. Predictor of recurrent exacerbations in pediatric asthma. Med J Indones [Internet]. 2024Apr.5 [cited 2024May22];33(1):42-8. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/7309
Section
Clinical Research

Most read articles by the same author(s)