Clinical Course and Factors Associated with Asthma Control in Children under Control-based Asthma Management: A Prospective Study
-
Qi Gao
,
Huijie Huang
,
Kang Zhu
,
Xiaoying Liu
,
Xiaoling Hou
,
Hui Guan
,
Yongge Liu
,
Deli Xin
,
Li Xiang
,
Kunling Shen
,
Xin Ni
Abstract
In the current study, we sought to track the clinical course of children under control-based asthma management and focused on respiratory pathogens monitoring. We prospectively explored influencing factors for asthma control. 121 children with uncontrolled asthma between 3-14 years of age were recruited. Common respiratory pathogens were detected with pharyngeal swabs and serum aeroallergen-specific IgE was measured. Numeric asthma control scores, airway resistance and fractional concentrations of exhaled nitric oxide (FENO) were evaluated. A proper control-based asthma management plan was established by the study physician. Regular reviews were performed, with the above measurements retested at set time intervals. The proportion of patients achieving asthma control at 1 month and 3 months were 59% and 76% ; respectively (p=0.013). These patients exhibited significant improvement in numeric scores and lung function parameters. The prevalence of common respiratory pathogens did not significantly differ between reviews. The number of sensitized aeroallergens significantly increased with age (r=0.235, p=0.010). Children with a high visual analogue scale (VAS) score for asthma at baseline were less likely to achieve asthma control after 1 month, while those sensitized to more aeroallergens were more likely to achieve asthma control after 1 month (p=0.016 and 0.012). In summary, children with asthma showed significant improvements in control rates and lung function during control-based asthma management, independent of respiratory pathogens testing reults. Patients with high VAS scores and fewer sensitizations to aeroallergens had difficulty achieving short-term asthma control.
1. Fergeson JE, Patel SS, Lockey RF. Acute asthma, prognosis and treatment. J Allergy Clin Immunol 2017; 193(2):438-447.
2. Helen K. Reddel, Eric D. Bateman, Allan Becker, Louis-Philippe Boulet, Alvaro A. Cruz, Jeffrey M. Drazen, et al. A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal 2015; 46(3):622-639.
3. Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, et al. Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study. J Asthma 2016; 53(7):699-706.
4. Cavkaytar O, Sekerel BE. Baseline management of asthma control. Allergol Immunopathol (Madr) 2014; 42(2):162-8.
5. Sandrock CE, Norris A. Infection in severe asthma exacerbations and critical asthma syndrome. Clin Rev Allergy Immunol 2015; 48(1):104-13.
6. Heymann PW, Carper HT, Murphy DD, Platts-Mills TA, Patrie J, McLaughlin AP, et al. Viral infections in relation to age, atopy, and season of admission among children hospitalized for wheezing. J Allergy Clin Immunol 2004; 114(2):239-47.
7. Soto-Quiros M, Avila L, Platts-Mills TA, Hunt JF, Erdman DD, Carper H, et al. High titers of IgE antibody to dust mite allergen and risk for wheezing among asthmatic children infected with rhinovirus. J Allergy Clin Immunol 2012; 129(6):1499-505 e5.
8. Hammond C, Kurten M, Kennedy JL. Rhinovirus and asthma: a storied history of incompatibility. Curr Allergy Asthma Rep 2015; 15(2):502.
9. Comberiati P, Di Cicco ME, D'Elios S, Peroni DG. How Much Asthma Is Atopic in Children? Front Pediatr 2017; 5:122.
10. Respiratory group of Pediatric Society, Chinese Medical Association, Editorial committee of Chinese Journal of Pediatrics. [Management and prevention guidelines of pediatric bronchial asthma]. Zhonghua Er Ke Za Zhi 2008; 46(10):745-753.
11. Respiratory group of Pediatric Society, Chinese Medical Association, Editorial committee of Chinese Journal of Pediatrics. [Management and prevention guidelines of pediatric bronchial asthma]. Zhonghua Er Ke Za Zhi 2016; 54(3):167-181.
12. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126(3):466-76.
13. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol 2007; 119(4):817-25.
14. Thomas M, Kay S, Pike J, Williams A, Rosenzweig JR, Hillyer EV, et al. The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Prim Care Respir J 2009; 18(1):41-9.
15. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113(1):59-65.
16. Halterman JS, Yoos HL, Kitzman H, Anson E, Sidora-Arcoleo K, McMullen A. Symptom reporting in childhood asthma: a comparison of assessment methods. Arch Dis Child 2006; 91(9):766-70.
17. Gupta D, Aggarwal AN, Subalaxmi MV, Jindal SK. Assessing severity of asthma: spirometric correlates with visual analogue scale (VAS). Indian J Chest Dis Allied Sci 2000; 42(2):95-100.
18. Miller A. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1992; 146(5 Pt 1):1368-9.
19. Komarow HD, Myles IA, Uzzaman A, Metcalfe DD. Impulse oscillometry in the evaluation of diseases of the airways in children. Ann Allergy Asthma Immunol 2011; 106(3):191-9.
20. Ewan PW, Coote D. Evaluation of a capsulated hydrophilic carrier polymer (the ImmunoCAP) for measurement of specific IgE antibodies. Allergy 1990; 45(1):22-9.
21. Ait-Khaled N, Enarson DA, Bencharif N, Boulahdib F, Camara LM, Dagli E, et al. Implementation of asthma guidelines in health centres of several developing countries. Int J Tuberc Lung Dis 2006; 10(1):104-9.
22. Haahtela T, Tuomisto LE, Pietinalho A, Klaukka T, Erhola M, Kaila M, et al. A 10 year asthma programme in Finland: major change for the better. Thorax 2006; 61(8):663-70.
23. Ozcan C, Toyran M, Civelek E, Erkocoglu M, Altas AB, Albayrak N, et al. Evaluation of respiratory viral pathogens in acute asthma exacerbations during childhood. J Asthma 2011; 48(9):888-93.
24. Leung TF, To MY, Yeung AC, Wong YS, Wong GW, Chan PK. Multiplex molecular detection of respiratory pathogens in children with asthma exacerbation. Chest 2010; 137(2):348-54.
25. Zhao M, Zhu WJ, Qian Y, Sun Y, Zhu RN, Deng J, et al. Association of Different Human Rhinovirus Species with Asthma in Children: A Preliminary Study. Chin Med J (Engl) 2016; 129(13):1513-8.
26. Chen DK, Wang DG, Liang YZ. Investigation of nasopharyngeal bacteria flora among preschool aged children in Bejing area. Zhonghua Er Ke Za Zhi 1999; 26(8):502.
27. Lin H, Sun Y, Lin RJ, Xv J, Li N. Influence of inhaled corticosteroids on distribution of throat flora in children with bronchial asthma. Chin J Otorhinolaryngol Head Neck Surg 2010;45(8):656-9.
28. De Schutter I, Dreesman A, Soetens O, De Waele M, Crokaert F, Verhaegen J, et al. In young children, persistent wheezing is associated with bronchial bacterial infection: a retrospective analysis. BMC Pediatr 2012; 12:83.
29. Tang LF, Shi YC, Xu YC, Wang CF, Yu ZS, Chen ZM. The change of asthma-associated immunological parameters in children with Mycoplasma pneumoniae infection. J Asthma 2009; 46(3):265-9.
30. Reddel HK, Jenkins CR, Marks GB, Ware SI, Xuan W, Salome CM, et al. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J 2000; 16(2):226-35.
31. Shuler MS, Yeatts KB, Russell DW, Trees AS, Sutherland SE. The Regional Asthma Disease Management Program (RADMP) for low income underserved children in rural western North Carolina: a National Asthma Control Initiative Demonstration Project. J Asthma 2015; 52(9):881-8.
32. Wu K, Gamazon ER, Im HK, Geeleher P, White SR, Solway J, et al. Genome-wide interrogation of longitudinal FEV1 in children with asthma. Am J Respir Crit Care Med 2014; 190(6):619-27.
33. Petsky HL, Cates CJ, Lasserson TJ, Li AM, Turner C, Kynaston JA, et al. A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils). Thorax 2012; 67(3):199-208.
34. Lu M, Wu B, Che D, Qiao R, Gu H. FeNO and asthma treatment in children: a systematic review and meta-analysis. Medicine (Baltimore) 2015; 94(4):e347.
35. Lee YK, Yang S, Park J, Kim H, Hahn YS. House dust mite-specific immunoglobulin E and longitudinal exhaled nitric oxide measurements in children with atopic asthma. Korean J Pediatr 2015; 58(3):89-95.
36. Kim HS, Kang SH, Won S, Lee EK, Chun YH, Yoon JS, et al. Immunoglobulin E to allergen components of house dust mite in Korean children with allergic disease. Asia Pac Allergy 2015; 5(3):156-62.
37. Tham R, Dharmage SC, Taylor PE, Katelaris CH, Vicendese D, Abramson MJ, et al. Outdoor fungi and child asthma health service attendances. Pediatr Allergy Immunol. 2014;25(5):439-49.
38. Arroyave WD, Rabito FA, Carlson JC. The relationship between a specific IgE level and asthma outcomes: results from the 2005-2006 National Health and Nutrition Examination Survey. J Allergy Clin Immunol Pract 2013; 1(5):501-8.
39. Fiocchi A, Pecora V, Petersson CJ, Dahdah L, Borres MP, Amengual MJ, et al. Sensitization pattern to inhalant and food allergens in symptomatic children at first evaluation. Ital J Pediatr 2015; 41:96.
40. Feliu A, Gonzalez-de-Olano D, Gonzalez E, Rodriguez B, Ruiz-Hornillos J, Jimeno L, et al. A multicenter study of sensitization profiles in an allergic pediatric population in an area with high allergen exposure. J Investig Allergol Clin Immunol 2013; 23(5):337-44.
41. Stanford RH, Gilsenan AW, Ziemiecki R, Zhou X, Lincourt WR, Ortega H. Predictors of uncontrolled asthma in adult and pediatric patients: analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS). J Asthma 2010; 47(3):257-62.
42. Papwijitsil R, Pacharn P, Areegarnlert N, Veskitkul J, Visitsunthorn N, Vichyanond P, et al. Risk factors associated with poor controlled pediatric asthma in a university hospital. Asian Pac J Allergy Immunol 2013; 31(3):253-7.
43. Soyer OU, Beyhun NE, Demir E, Yildirim S, Boz AB, Altinel N, et al. A multicenter survey of childhood asthma in Turkey. II: Utilization of asthma drugs, control levels and their determinants. Pediatr Allergy Immunol 2009; 20(2):172-9.
44. Morphew T, Kwong KY, Yang B, Galant SP. The relationship of aeroallergen sensitization phenotypes to asthma control in primarily Hispanic asthmatic children. J Asthma. 2014; 51(3):253-9.
45. Wisnivesky JP, Sampson H, Berns S, Kattan M, Halm EA. Lack of association between indoor allergen sensitization and asthma morbidity in inner-city adults. J Allergy Clin Immunol 2007; 120(1):113-20.
| Files | ||
| Issue | Vol 17, No 1 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Asthma Pediatrics respiratory function tests Respiratory pathogen Sensitization Visual analogue scale | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
