Asthma Severity Does Not Affect Overall Asthma Control in Children

Pediatric asthma
Pediatric asthma
Regardless of severity, when children's asthma was appropriately managed according to guidelines, they experienced significant improvements.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Regardless of baseline severity, children with persistent asthma experienced significant improvement when their condition was managed using appropriate asthma guidelines, according to research presented at the CHEST Annual Meeting, held October 6-10, 2018, in San Antonio, Texas.

Researchers of this 3-year prospective cohort study sought to examine whether asthma severity had an impact on asthma management and improvement in children whose condition was controlled per National Asthma Education and Prevention Program, Expert Panel Report 3 guidelines.

The study sample included 395 children, aged 2 to 17 years, who had received a diagnosis of uncontrolled asthma; all patients had been enrolled in the study’s pediatric center since 2011 and received asthma care per National Asthma Education and Prevention Program guidelines. Participants and their families completed asthma questionnaires, including data on acute care need and symptom control, and took the Asthma Control Test during each center visit (every 3 to 6 months).

The researchers compared results between patients with a severe persistent asthma diagnosis and patients with mild to moderate persistent asthma, measuring their scores by mean, standard deviation, median, and interquartile range, depending on the data. The Poisson Mixed Effects Model was used to estimate change in asthma indicators over 6-month increments.

Of the 395 children, 101 had a diagnosis of mild persistent asthma (26%), 265 had moderate persistent asthma (67%), and 28 had severe persistent asthma (7%). Although African Americans made up 42% of the patients diagnosed with severe asthma, the difference in demographic characteristics in children with or without severe persistent asthma was not significant. Comparing data from baseline through follow-up, significant improvement in asthma care was reported across the total study cohort.

Specifically, participants reported improvement in areas of acute care need (hospital admissions, emergency department visits, urgent care visits, school days missed, and number of days per month requiring albuterol), mean Asthma Control Test scores, mean percentage of predicted forced expiratory volume in 1 second, and days per month with wheezing (P <.0001 for all). The initial severity of asthma reported at baseline served as a covariate in study analysis.

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Children with severe asthma had higher acute care need, more days per month with wheezing, higher incidence of nighttime cough, elevated exercise intolerance, and lower scores in the Asthma Control Test compared with children with nonsevere asthma, but both groups improved significantly from baseline, and improvement persisted throughout the follow-up period. The researchers suggested that asthma severity was not a significant factor in overall asthma control as long as guidelines were followed.

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Sheikh S, Pitts J, Salvator A, Nemastil C, Sabrina S, Thompson R. Impact of severity of asthma on long-term asthma control in children. Presented at: CHEST Annual Meeting 2018; October 9, 2018; San Antonio, TX.