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Prevalence and Predictors of Uncontrolled Asthma in Children Referred for Asthma and Other Atopic Diseases

Authors Kansen HM, Le TM, Uiterwaal CSPM, van Ewijk BE, Balemans WAF, Gorissen DMW, de Vries E, van Velzen MF, Slabbers GHPR, Meijer Y, Knulst AC, van der Ent CK, van Erp FC

Received 20 September 2019

Accepted for publication 13 December 2019

Published 30 January 2020 Volume 2020:13 Pages 67—75


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Amrita Dosanjh

HM Kansen,1,2 TM Le,2 CSPM Uiterwaal,3 BE van Ewijk,4 WAF Balemans,5 DMW Gorissen,6 E de Vries,7 MF van Velzen,8 GHPR Slabbers,9 Y Meijer,1 AC Knulst,2 CK van der Ent,1 FC van Erp2

1Department of Pediatric Pulmonology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; 2Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; 3Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; 4Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands; 5Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands; 6Department of Pediatrics, Deventer Hospital, Deventer, The Netherlands; 7Department of Pediatrics, Jeroen Bosch Academie (Research), Jeroen Bosch Hospital, ‘S Hertogenbosch, The Netherlands; 8Department of Pediatrics, Meander Medical Center, Amersfoort, The Netherlands; 9Department of Pediatrics, Bernhoven Hospital, Uden, The Netherlands

Correspondence: HM Kansen
Department of Pediatric Pulmonology and Allergology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, Utrecht 3508 AB, The Netherlands
Tel +31 30 88 75 75 2 84

Background: Uncontrolled asthma in children is still highly prevalent despite the availability of effective asthma treatment. We investigated 1) the prevalence of uncontrolled asthma among children referred for asthma and referred for atopic diseases other than asthma (ie food allergy, allergic rhinitis or atopic dermatitis) to secondary care; and 2) the predictors associated with uncontrolled asthma.
Methods: All children (4 to 18 years) referred for asthma or atopic diseases other than asthma to 8 secondary care centers in The Netherlands were invited to an electronic portal (EP). The EP is a web-based application with several validated questionnaires including the ISAAC questionnaires and the Asthma Control Test (ACT). Children were eligible for inclusion in this study when their parents reported in the EP that their child had asthma diagnosed by a physician. The ACT was used to assess asthma control. Multiple predictors of asthma control (patient, asthma and atopic characteristics) were evaluated by univariable and multivariable logistic regression analyses.
Results: We included 408 children: 259 children (63%) with asthma referred for asthma and 149 children (37%) with asthma referred for atopic diseases other than asthma. Thirty-nine percent of all children had uncontrolled asthma: 47% of the children referred for asthma and 26% of the children referred for atopic diseases other than asthma. Predictors associated with uncontrolled asthma were a family history of asthma (odds ratio [OR] 2.08; 95% confidence interval [95% CI] 1.34 to 3.24), and recurrent upper and lower respiratory tract infections in the past year (OR 2.40; 95% CI 1.52 to 3.81 and OR 2.00; 95% CI 1.25 to 3.23, respectively).
Conclusion: Uncontrolled asthma is highly prevalent in children with asthma referred to secondary care, even if children are primarily referred for atopic diseases other than asthma. Thus, attention should be paid to asthma control in this population.

Keywords: asthma, asthma control, atopic diseases, respiratory tract infections, prognosis

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