RT Journal Article
SR Electronic
T1 Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1802419
DO 10.1183/13993003.02419-2018
A1 Cristina Ardura-Garcia
A1 Erick Arias
A1 Paola Hurtado
A1 Laura J. Bonnett
A1 Carlos Sandoval
A1 Augusto Maldonado
A1 Lisa J. Workman
A1 Thomas A.E. Platts-Mills
A1 Philip J. Cooper
A1 John D. Blakey
YR 2019
UL http://erj.ersjournals.com/content/early/2019/08/14/13993003.02419-2018.abstract
AB Asthma is a common cause of emergency care attendance in low and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been done in a LMIC.We followed a cohort of 5–15 year olds treated for asthma attacks in Emergency Rooms (ERs) of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and did spirometry and Fractional exhaled Nitric Oxide measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months follow-up.We recruited 283 children of whom 264 (93%) were followed up for at least 6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adj. OR; 95% CI) younger age (0.87 per year; 0.79–0.96), previous asthma diagnosis (2.2; 1.2–3.9), number of parenteral corticosteroid courses in previous year (1.3; 1.1–1.5), food triggers (2.0; 1.1–3.6), and eczema diagnosis (4.2; 1.02–17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adj. HR: 0.69; 0.50–0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests a simple risk-assessment tool could potentialy be created for ERs in similar settings to identify higher risk children on whom limited resources might be better focussed.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Ardura-Garcia has nothing to disclose.Conflict of interest: Dr. Arias has nothing to disclose.Conflict of interest: Dr. Hurtado has nothing to disclose.Conflict of interest: Dr. Bonnett has nothing to disclose.Conflict of interest: Dr. Sandoval has nothing to disclose.Conflict of interest: Dr. Maldonado has nothing to disclose.Conflict of interest: Dr. Workman has nothing to disclose.Conflict of interest: Dr. Platts-Mills has nothing to disclose.Conflict of interest: Dr. Cooper reports grants from PATH Vaccines, grants from National Institutes of Health Research, outside the submitted work.Conflict of interest: Dr. Blakey reports personal fees and non-financial support from Astra Zeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Teva, personal fees and non-financial support from Napp, non-financial support from Novartis, outside the submitted work.