Poor mental, social health associated with worse asthma outcomes in children

Key takeaways:

• Children with poorer mental and social health measures experienced more ED use and hospitalizations for asthma.
• These measures include general life satisfaction, meaning and purpose, stress and relationships.

Children with poor measures of mental and social health also experienced poor respiratory outcomes following intensive care use for asthma, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Routine assessment may identify these children so they can receive targeted intervention, Jocelyn R. Grunwell, MD, PhD, assistant professor, department of pediatrics, Emory University School of Medicine, and colleagues wrote.

The study involved 83 children aged 6 to 17 years (median age, 10 years; 62% boys; 84% Black; 71% using public insurance) admitted to the Children’s Healthcare of Atlanta pediatric ICU for a life-threatening asthma exacerbation between July 2019 and February 2023.

Children and caregivers completed patient-reported and proxy-reported outcome measures of asthma and mental and social health using the Patient-Reported Outcomes Measurement Information System (PROMIS).

These tools assessed asthma impact, general life satisfaction, meaning and purpose, positive affect, psychological stress, and family and peer relationships during the previous 7 days.

Cluster analysis of the number of medical visits and hospitalizations for asthma attacks in the year following discharge from the hospital produced two clusters of 57 (90%) and 26 (84%) children each.

The children in the second cluster were more likely to have visited the ED and urgent care for asthma symptoms as well as report more daily use of albuterol in the year following admission than those in the first cluster.

Also, the children in the second cluster had median T-scores for most PROMIS measures that were more than 10 points different from the children in the first cluster, indicating significantly poorer PROMIS mental and social health measures, the researchers said.

Median PROMIS asthma impact T-scores included 61 (interquartile range [IQR], 55-66) for the second cluster and 56 (IQR, 51-63) for the first cluster (P = .034). Other specific median T-scores included:

• life satisfaction: 59 for the first cluster and 43 for the second cluster (P < .001);
• meaning and purpose: 58 for the first cluster and 46 for the second cluster (P < .001);
• positive affect: 63 for the first cluster and 42 for the second cluster (P < .001);
• psychological stress: 49 for the first cluster and 58 for the second cluster (P < .001);
• family relationships: 60 for the first cluster and 49 for the second cluster (P < .001); and
• peer relationships: 56 for the first cluster and 44 for the second cluster (P < .001).

Median times to next asthma exacerbation within a year of discharge included 287 days (IQR, 84-365 days) for cluster 2 and 365 days (IQR, 231-365) for cluster 1 (P = .02).

The second cluster also had a hazard ratio of 2 (95% CI, 0.96-4.16) for experiencing an asthma exacerbation within a year of hospital discharge compared with the first cluster as well, although the researchers said this was not statistically significant.

Proportions of children who sought medical care in an ED or urgent care included 42% of those in the second cluster and 25% of those in the first cluster. Additionally, 55% of the second cluster and 40% of the first cluster sought care in an allergy or pulmonary clinic.

Hospitalization rates during the follow-up year included 38% in the second cluster and 18% in the first cluster (P = .04), with 35% of the second cluster and 14% of the first cluster admitted multiple times (P = .03).

Based on these findings, the researchers concluded that there is a subgroup of children who have life-threatening asthma as well as overall poorer measures of mental and social health, more ED utilization and hospitalization, and shorter time to exacerbation than other children with life-threatening asthma.

Increased awareness of the impact that asthma has on the mental and social health of children with life-threatening asthma, the researchers continued, may help providers identify those children at high risk for exacerbations that may lead to ER utilization and hospitalization.

The use of standardized screening via patient-reported outcome measures, the researchers said, may help improve respiratory-related outcomes among children who have life-threatening asthma.