1 - Allergy and Clinical Immunology Department, São José Local Health Unit, Lisbon, Portugal
2 - Lisbon Academic Clinical Center, Lisbon, Portugal
3 - Comprehensive Health Research Center (CHRC), NOVA Medical School, Nova University Lisbon, Lisbon, Portugal
- Póster no World Allergy Congress 2024, setembro 2024, Lisboa
Resumo:
Introduction and objective: Asthma is one of the most common chronic diseases in childhood. Poorly controlled asthma frequently results in exacerbations and increased absenteeism from school among children. The substantial societal burden, encompassing increased morbidity and rising healthcare costs, has prompted efforts to understand the conditions influencing disease control. With the increasing prevalence of asthma in pediatric populations and emerging evidence linking disease control to quality of life and the development of comorbidities, this study aims to explore the impact of diverse factors on asthma control in children.
Material and methods: Observational, cross-sectional study including children aged 6-12 years with a clinical diagnosis of asthma, followed up at the Allergy and Clinical Immunology department of a tertiary hospital. Data were collected using a standardized questionnaire and complemented by reviewing clinical records. Sociodemographic characteristics of the participants, body mass index (BMI), preterm delivery (defined as occurring before 37 weeks of gestation), sensitization to aeroallergens, exposure to tobacco smoke, Childhood Asthma-Control Test (c-ACT), Pediatric Sleep Questionnaire (PSQ), GINA treatment step, spirometry, and fractional nitric oxide concentration in exhaled breath (FeNO) were considered. PSQ scores were used to identify children at high risk for developing Sleep-related Breathing Disorders (SRBD), with a score greater than 0.33 indicating high risk. Univariate and multivariate binary logistic regression analyses were conducted to identify associations between the listed variables and uncontrolled asthma based on the c-ACT. A c-ACT score below 20 indicated uncontrolled asthma. Variables with a p-value less than 0.25 were included in the multivariate analysis. A p-value less than 0.05 was considered statistically significant.
Results: Out of the 104 included children, 63 (60.60%) were male. The median age of participants was 9.96 years (IQR 3.25), with a median BMI of 17.59 (IQR 5.18). Preterm delivery occurred in 12 cases (12%), 40 children (39.2%) demonstrated sensitization to aeroallergens, and 38 (36.9%) reported exposure to tobacco smoke. Median FEV1(%pred) was 104 (IQR 17.75), and median FeNO was 17 (IQR 33). According to PSQ scores, 43 children (41.30%) were classified as high-risk of SRBD. Based on c-ACT questionnaire, asthma was poorly controlled in 36 participants (34.60%). In the univariate analysis, only BMI (OR 1.10; 95% CI, 1.00–1.21; p=0.05) and SRBD risk (OR 3.52; 95% CI, 1.51–8.19; p<0.01) showed statistically significant associations with poor asthma control among all analyzed variables. However, in the multivariate logistic regression SRBD risk remained statistically significant (OR 3.27; 95% CI 1.39–7.72; p=0.01), whereas BMI did not (OR 1.09; 95% CI, 0.98–1.20; p=0.09).
Conclusion: Notably, SRBD risk emerged as the sole variable associated with uncontrolled asthma, despite not typically being included in the follow-up of these patients. Additionally, despite the lack of statistical significance between overweight and poorer asthma control in multivariate logistic regression, our findings remain noteworthy given the common occurrence of obesity as a comorbidity in childhood asthma, potentially influencing its control. These findings underscore the importance of adopting a holistic approach to manage pediatric asthma. Effective asthma control in children requires addressing SRBD alongside conventional treatments. Early intervention and comprehensive management strategies can mitigate the health burden associated with poor disease control, thereby enhancing health outcomes and improving quality of life.
Palavras Chave: asma, imunoalergologia pediátrica, distúrbios do sono