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Original article
Presence of atopy increases the risk of asthma relapse
  1. Laurel Teoh1,2,
  2. Ian M Mackay3,4,
  3. Peter P Van Asperen5,6,
  4. Jason P Acworth7,
  5. Mark Hurwitz8,
  6. John W Upham9,
  7. Weng Hou Siew3,
  8. Claire Y T Wang3,4,
  9. Theo P Sloots3,4,
  10. Teresa Neeman10,
  11. Anne B Chang2,4,11
  1. 1 Department of Paediatrics and Child Health, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
  2. 2 Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  3. 3 Queensland Paediatric Infectious Diseases Laboratory, The University of Queensland, Brisbane, Queensland, Australia
  4. 4 Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
  5. 5 Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, New South Wales, Australia
  6. 6 Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  7. 7 Emergency Medicine Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia
  8. 8 Department of Respiratory and Sleep Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
  9. 9 School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  10. 10 Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia
  11. 11 Respiratory and Sleep Medicine Department, Lady Cilento Children’s Hospital, Brisbane, Queensland, Australia
  1. Correspondence to Dr Laurel Teoh, Department of Paediatrics and Child Health, Centenary Hospital for Women and Children, Canberra, ACT 2606, Australia; laurelteoh{at}yahoo.com.au

Abstract

Objectives To describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations.

Design This was a prospective study performed during 2009–2011.

Setting The study was performed in the emergency departments of two hospitals.

Patients 244 children aged 2–16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed.

Main outcome measures The outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days).

Results PCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23).

Conclusions The presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.

  • asthma
  • acute exacerbation
  • respiratory viruses
  • atopy

https://doi.org/10.1136/archdischild-2017-312982

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    Footnotes

    • Contributors LT contributed to the conception and design, acquisition of data, analysis and interpretation of data, and writing of the manuscript. PPVA, JPA and MH contributed to the conception and design, supervision and revision of the manuscript. WHS and CYTW contributed to the acquisition of data. IMM and TPS contributed to the acquisition of data and revision of the manuscript. JWU contributed to the interpretation of data and revision of the manuscript. TN contributed to the analysis and interpretation of data and revision of the manuscript. ABC contributed to the conception and design, supervision, interpretation of data and revision of the manuscript. All authors approved the final manuscript.

    • Funding Asthma Foundation of Queensland (LT, ABC).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval ACT Health Human Research Ethics Committee and the Royal Children’s Hospital Human Research Ethics Committee, Brisbane.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at A component of this manuscript has been presented at the Thoracic Society of Australia and New Zealand Annual Scientific Meeting in 2014.