Severe asthma features in children: a case–control online survey

Abstract

BackgroundVery few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy.MethodsWe conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6–17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients’ characteristics and severe asthma or non-severe persistent asthma.ResultsFeatures independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95 % Confidence Interval (CI), 1.21–18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95 % CI, 1.11–12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95 % CI, 2.70–53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95 % CI, 2.66–61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients’ comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE .ConclusionsAs expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13052-016-0217-z) contains supplementary material, which is available to authorized users.

Relationship between quality of life and behavioural disorders in children with persistent asthma: a Multiple Indicators Multiple Causes (MIMIC) model

“…persistent asthma are at higher risk than healthy children of worse QoL and behavioural problems, which are both related to asthma severity and symptom control [1][2][3] . In a previous study, we showed worse QoL in children and adolescents with severe asthma (SA) than in those with non-severe persistent asthma 4 . A reduced QoL has also been found in children with non-controlled asthma (NC) compared to children with well-controlled (WC) asthma 5,6 .…”

“…Sample size calculation and statistical analysis. The sample size for the two groups was determined on the basis of a previous study on asthmatic children 4 , where the PAQLQ score in SA was 5.9 (2.3-7.0) and 6.6 (3.7-7.0) in children with non-severe persistent asthma. Detecting the same difference with a 90% statistical power and a 5% significance level would have required a minimum sample size of 34 children for SA and 68 for MA.…”

What are the effects of rhinitis on patients with asthma?

“…Moreover, AR appears to be a negative earlylife predictive factor for an accelerated decline in lung function. Interestingly, a persistent, severe, and protracted history of AR is associated both with a major airway dysfunction and with a severe asthma phenotype [4,6].…”

Severe Asthma in adolescents and adults: a National, multicenter registry in real life

“…These treatments offer an improvement in the management of the disease, but the heterogeneity of clinical outcomes and phenotypes suggests that many subjects could be difficult to treat and drugs could be not efficacious, especially in children (12-14). To face up this problem, the Society of Pediatric Respiratory Diseases (SIMRI) developed, for the first time in Italy, a registry for the collection of pediatric cases of SA with the aim to identify risks factors, clinical phenotypes and develop a customized therapy (15). Nevertheless, the SIMRI-registry results have two limitations: i) adolescents are not admitted to pediatric medical units and for this reason they are not recorded in the registry; ii) it is impossible to evaluate how the disease progresses and evolves from adolescence to adulthood.…”