Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark.
Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
Respir Res. 2023 Jun 27;24(1):173. doi: 10.1186/s12931-023-02482-7.
Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood.
A Danish nationwide cohort of children and adolescents aged 2-17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2-11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care. The population is chosen due to detailed medical records in the setting of universal health care.
The cohort comprised of 29,851 children and adolescents (59% boys), with a median age of 9 years. While 17% of children were on high dose ICS, 22% were on daily ICS below GINA low dose cut-off. Prevalence of severe asthma (3.0-6.5%) was lower than poor asthma control (6.4-25%); both declined from childhood to adolescence. Exacerbations occurred in 7.1-9.0% of children, with median number of exacerbations being 1 (IQR 1-1). Despite being classified as having mild-to-moderate asthma, 15% had poor asthma control and 3.8% experienced exacerbation(s), respectively. While 61% of children with severe asthma and 58% with exacerbation-prone disease were in specialist care, only 24% with uncontrolled disease were receiving specialist care. Of children and adolescents using high-dose ICS, 71% were managed in primary care, while the use of additional controllers was more common in specialist care.
Throughout childhood and adolescence, there was a high prevalence of severe asthma and poor control, although their prevalence declined with age. We demonstrate a large unmet need for specialist care among children with at-risk asthma, particularly among those with poorly controlled asthma, even in a system with free-to-access, tax-funded healthcare.
哮喘是儿童和青少年中的常见疾病，具有终身影响，尤其是在那些有患严重疾病、控制不佳和/或频繁恶化风险的人群中。建议为高危儿童和青少年提供专科护理，但在免费医疗保健环境中，获得专科管理的情况仍了解甚少。
丹麦一项针对 2-17 岁持续性哮喘儿童和青少年的全国性队列研究，其定义为在 2015 年期间反复使用吸入性皮质类固醇（ICS），这些儿童和青少年在两年内被确定为高危儿童和青少年，包括患有严重哮喘（根据 GINA 2020 指南分类）、控制不佳（定义为使用 400/600（2-11/12 岁+）年速效支气管扩张剂剂量）或频繁恶化（定义为使用口服类固醇或住院）的儿童和青少年，并接受专科护理。由于在全民医疗保健环境中存在详细的医疗记录，因此选择了该人群。
该队列包括 29851 名儿童和青少年（59%为男孩），中位年龄为 9 岁。虽然 17%的儿童使用高剂量 ICS，但 22%的儿童使用低于 GINA 低剂量截断值的每日 ICS。严重哮喘的患病率（3.0-6.5%）低于哮喘控制不佳（6.4-25%）；两者均从儿童期下降到青春期。7.1-9.0%的儿童发生恶化，中位数恶化次数为 1 次（IQR 1-1）。尽管被归类为轻度至中度哮喘，但分别有 15%的儿童控制不佳，3.8%的儿童发生恶化。虽然 61%的严重哮喘儿童和 58%的易恶化疾病儿童在专科护理中，但只有 24%的未控制疾病儿童在接受专科护理。在使用高剂量 ICS 的儿童和青少年中，71%在初级保健中得到管理，而在专科护理中更常见使用额外的控制器。
在整个儿童期和青春期，严重哮喘和控制不佳的患病率都很高，尽管随着年龄的增长，其患病率有所下降。我们发现，高危哮喘儿童，尤其是控制不佳的哮喘儿童，对专科护理的需求很大，但在免费、税收资助的医疗体系中，这一需求仍未得到满足。
