Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study

Ardura‐Garcia, Cristina; Arias, Erick; Hurtado, Paola; Bonnett, Laura; Sandoval, Carlos; Maldonado, Augusto; Workman, Lisa J.; Platts-Mills, Thomas A.E.; Cooper, Philip J.; Blakey, John

doi:10.1183/13993003.02419-2018

Cited by 17 publications

(27 citation statements)

References 39 publications

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“…Given the major and increasing pressure on healthcare systems [43] further development of clinical prediction models for asthma appears to be a potentially valuable investment. This may be especially true in lower income countries where asthma is an increasing burden [44] and where risk factors may differ from those identified in North America and Europe [45].…”

Section: Discussionmentioning

confidence: 96%

A systematic review of methodology used in the development of prediction models for future asthma exacerbation

Bridge

Blakey

Bonnett

2020

BMC Med Res Methodol

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Background: Clinical prediction models are widely used to guide medical advice and therapeutic interventions. Asthma is one of the most common chronic diseases globally and is characterised by acute deteriorations. These exacerbations are largely preventable, so there is interest in using clinical prediction models in this area. The objective of this review was to identify studies which have developed such models, determine whether consistent and appropriate methodology was used and whether statistically reliable prognostic models exist. Methods: We searched online databases MEDLINE (1948 onwards), CINAHL Plus (1937 onwards), The Cochrane Library, Web of Science (1898 onwards) and ClinicalTrials.gov, using index terms relating to asthma and prognosis. Data was extracted and assessment of quality was based on GRADE and an early version of PROBAST (Prediction study Risk of Bias Assessment Tool). A meta-analysis of the discrimination and calibration measures was carried out to determine overall performance across models. Results: Ten unique prognostic models were identified. GRADE identified moderate risk of bias in two of the studies, but more detailed quality assessment via PROBAST highlighted that most models were developed using highly selected and small datasets, incompletely recorded predictors and outcomes, and incomplete methodology. None of the identified models modelled recurrent exacerbations, instead favouring either presence/absence of an event, or time to first or specified event. Preferred methodologies were logistic regression and Cox proportional hazards regression. The overall pooled c-statistic was 0.77 (95% confidence interval 0.73 to 0.80), though individually some models performed no better than chance. The meta-analysis had an I 2 value of 99.75% indicating a high amount of heterogeneity between studies. The majority of studies were small and did not include internal or external validation, therefore the individual performance measures are likely to be optimistic. Conclusions: Current prognostic models for asthma exacerbations are heterogeneous in methodology, but reported c-statistics suggest a clinically useful model could be created. Studies were consistent in lacking robust validation and in not modelling serial events. Further research is required with respect to incorporating recurrent events, and to externally validate tools in large representative populations to demonstrate the generalizability of published results.

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Section: Discussionmentioning

confidence: 96%

A systematic review of methodology used in the development of prediction models for future asthma exacerbation

Bridge

Blakey

Bonnett

2020

BMC Med Res Methodol

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“…Fractional exhaled nitric oxide was measured in parts per billion using NObreath (Bedfont Scientific, UK). Nasal wash samples were collected at 8 years as described 20 …”

Section: Methodsmentioning

confidence: 99%

Impact of early life geohelminths on wheeze, asthma and atopy in Ecuadorian children at 8 years

Cooper

Ster

Chico

et al. 2021

Allergy

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Background Early‐life exposures to geohelminths may protect against development of wheeze/asthma and atopy. Objective To study the effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma and airways reactivity/inflammation at 8 years. Methods Birth cohort of 2404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO) and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy. Results 1933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were as follows: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%) and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72). Childhood Trichuris trichiura infections during the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoides at 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite‐specific effects on wheeze/asthma and airways reactivity and inflammation were observed in non‐atopic children. Conclusions Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086).

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“…This may explain the non-significant findings for e.g., age and BMI, and the lack of association between non-attendance, adherence to asthma maintenance therapy and risk of exacerbations. A contributing factor to this may be that the children in our study merely have mild to moderate asthma, are generally well-controlled and have fewer exacerbations compared to other studies [ 19 , 20 , 21 ]. ACQ and/or ACT would also have been helpful for assessment of asthma control, but such data was not collected.…”

Section: Discussionmentioning

confidence: 86%

Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma

et al. 2021

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Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments.

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Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study

Cited by 17 publications

References 39 publications

A systematic review of methodology used in the development of prediction models for future asthma exacerbation

A systematic review of methodology used in the development of prediction models for future asthma exacerbation

Impact of early life geohelminths on wheeze, asthma and atopy in Ecuadorian children at 8 years

Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma

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