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Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care
  1. David Lo1,2,
  2. Caroline Beardsmore1,
  3. Damian Roland3,4,
  4. Matthew Richardson1,
  5. Yaling Yang5,
  6. Lesley Danvers2,
  7. Andrew Wilson6,
  8. Erol A Gaillard1,2
  1. 1Department of Respiratory Sciences, University of Leicester, Leicester, UK
  2. 2Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  4. 4SAPPHIRE Group, University of Leicester, Leicester, UK
  5. 5Nuffield Department of Primary Care Health Science, Oxford University, Oxford, UK
  6. 6Department of Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Erol A Gaillard, Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; eag15{at}leicester.ac.uk

Abstract

Objective To identify risk factors for asthma attacks and poor asthma control in children aged 5–16 years.

Methods Prospective observational cohort study of 460 children with asthma or suspected asthma from 10 UK general practices.

Gender, age, ethnicity, body mass index, practice deprivation decile, spirometry and fraction of exhaled nitric oxide (FeNO) were recorded at baseline. Asthma control scores, asthma medication ratio (AMR) and the number of asthma attacks were recorded at baseline and at 6 months.

The above independent variables were included in binary multiple logistic regression analyses for the dependent variables of: (1) poor symptom control and (2) asthma attacks during follow-up.

Results Poor symptom control at baseline predicted poor symptom control at 6 months (OR 4.4, p=0.001), while an increase in deprivation decile (less deprived) was negatively associated with poor symptom control at 6 months (OR 0.79, p=0.003). Higher FeNO levels (OR 1.02, p<0.001) and a recent history of asthma attacks (OR 2.03, p=0.02) predicted asthma attacks during follow-up. Asian ethnicity was associated with a lower OR for a future attack (OR 0.32, p=0.02).

A decrease in AMR was also associated with an increased OR for future asthma attacks (OR 2.99, p=0.003) when included as an independent variable.

Conclusions We identified risk factors for poor symptom control and asthma attacks in children. Routine assessment of these factors should form part of the asthma review to identify children at an increased risk of adverse asthma-related events.

  • physiology
  • data collection

Data availability statement

Data are available on reasonable request. The datasets used and analysed for this study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The datasets used and analysed for this study are available from the corresponding author on reasonable request.

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Footnotes

  • Twitter @david__lo, @damian_roland

  • Contributors EAG, DL, CB, DR, MR, YY and AW participated in the initial design of the study. DL and LD were responsible for data collection and providing training to the general practices. DL was responsible for data analyses and initial manuscript preparation with input from EAG and CB. Statistical input was provided by MR. All coauthors contributed to the interpretation of results and provided revisions and approval of the final manuscript.

  • Funding This study was funded from grants provided by the Midlands Asthma and Allergy Research Association and Circassia Pharmaceuticals to EAG. The project fellow (DL) was funded by Health Education East Midlands.

  • Competing interests EAG: consultancy work for Boehringer Ingelheim in November 2016 and Anaxsys in July 2018 with money paid to the institution (University of Leicester), investigator led research grant from Circassia and Gilead. Research collaboration with Medimmune. Travel grants from Vertex.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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