Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.
School of Social Work, The University of Maryland, Baltimore, Md.
J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):844-852. doi: 10.1016/j.jaip.2017.08.007. Epub 2017 Sep 22.
Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied.
To examine the risk factors associated with VPC asthma in urban minority children.
This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months.
At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14).
Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.
儿童重度未控制（VPC）哮喘与持续的急性加重有关，但与 VPC 相关的因素研究较少。
研究城市少数族裔儿童 VPC 哮喘的相关危险因素。
本描述性研究检查了参加正在进行的急诊部门/家庭环境控制干预随机对照试验的儿童在基线和 6 个月时的哮喘控制水平（控制良好[WC]、控制不佳[NWC]和 VPC）。数据收集在急诊就诊时进行，包括过敏原特异性 IgE 和唾液可替宁检测以及对社会人口统计学和儿童健康特征的照顾者访谈。在 6 个月时收集随访数据。未调整分析检查了哮喘控制水平的社会人口统计学和健康特征的关联。多变量分析测试了与 6 个月时 VPC 哮喘相关的显著因素。
在基线时，大多数儿童被归类为 VPC 哮喘（WC，0%；NWC，47%；VPC，53%），并且在 6 个月时 VPC 哮喘的发生率略有改善（WC，13%；NWC，41%；VPC，46%）。过敏性鼻炎患儿发生 VPC 哮喘的风险是两倍（优势比[OR]，2.42），过去 3 个月内有 2 次或更多次初级保健提供者哮喘就诊（OR，2.77）或照顾者担心药物副作用（OR，2.13），当哮喘控制在秋季或春季评估时，发生 VPC 哮喘的风险增加 3 至 4 倍（OR：秋季，3.32；春季，4.14）。
改善 VPC 哮喘的低收入、高风险儿童的哮喘控制需要治疗合并症、关注照顾者的药物信念，并熟练使用逐步治疗。
