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Asthma attacks more frequent in younger children during spring, fall

Children aged 0 to 4 years are at an increased risk of asthma exacerbations than other children, with an additional increased risk for exacerbations in the spring and fall seasons,  according to research presented at the Pediatric Academic Societies 2018 Meeting.

“Childhood asthma exacerbations cause substantial child and parent distress, morbidity and health care-related expenses,” Heather Hoch, MD, from Children's Hospital Colorado, and colleagues wrote. “Finding effective ways to identify and preemptively intervene for those at risk for an exacerbation is important to reduce asthma morbidity.”

To successfully recognize those who are more prone to asthma exacerbations and provide early intervention, the researchers assessed data from electronic health records for patients between 0 and 20 years of age who were diagnosed with asthma in Denver, Colorado. All data were placed into the electronic health records between Jan. 1, 2011, and March 30, 2016, and included information on patient demographics, as well as clinical and laboratory records.

Once patients with asthma who were at-risk of further exacerbations were identified, Hoch and colleagues examined eosinophil levels and categorized into high levels (greater than 0.30 x 10³/µL) and low levels (less than 0.30 x 10³/µL), and the socioeconomic factors linked to census tract for these patients were identified using data collected from the American Community Survey.

Furthermore, the researchers examined data collected on which seasons asthma exacerbations were most likely to be experienced in by using logistic regression models that included generalized estimating equations, odds ratio tests for gender, age, eosinophil level and season. Hoch and colleagues also considered time and repeated measures within the data. Once data were collected, each season was compared with the average of the other seasons.

Of the 14,547 children with an asthma diagnosis, more than half were male (55%), with the most prevalent races and ethnicities being white (55%), black (22%), Hispanic (51%) and unknown or other (23%). Most patients were labeled in the census as low income (61%), and most children were followed for 30 months on average.

Exacerbations were observed in 41% of all children during the study period, and those who were male were more likely to experience an exacerbation than females (OR = 1.10; 95% CI, 1.03-1.18). Age provided a significant risk of exacerbation, with children between the ages of 0 and 4 years more likely to have an exacerbation than those between 5 and 11 years (OR = 1.89; 95% CI, 1.77-2.02) or 12 to 21 years (OR = 3.15; 95% CI, 2.93-3.39).  Additionally, children who had high eosinophilic levels were more likely to have an exacerbation than those with low levels (OR = 1.89; 95% CI, 1.56-2.26).

When seasons were considered, children were least likely to have an asthma exacerbation in the summer (OR = 0.6; 95% CI, 0.57-0.63). Children were at an increased risk of exacerbation during the spring (OR = 1.25; 95% CI, 1.20-1.30) and fall (OR = 1.31; 95% CI, 1.26-1.36).

“Identifying children at risk for an asthma exacerbation to support anticipatory interventions by pediatricians is feasible,” Hoch and colleagues wrote. “Attention should be paid to younger children with asthma during the fall and spring time frames, especially males with higher recent eosinophil counts.”–by Katherine Bortz

References:

Hoch H, et al. Assessing risk for asthma exacerbations in the real world: What markers should pediatricians use? Board 96. Presented at: The Pediatric Academic Societies 2018 Meeting; May 5-8, 208; Toronto.