Predictor of recurrent exacerbations in pediatric asthma

Abstract

BACKGROUND Asthma imposes a heavy morbidity burden during childhood. Severe persistent asthma significantly increases patients’ risk of exacerbations, hospital admissions, and mortality and often substantially impairs their quality of life. This study aimed to identify high-risk patients for exacerbation recurrence using spirometric parameters. METHODS A prospective cohort study involving patients with asthma aged 6–15 years was conducted at the principal children’s hospital in Mekong Delta, Vietnam, from June 2020 to June 2022. Demographic, clinical, and lung function characteristics of the patients were collected. Spirometry measurement parameters were utilized as predictive factors for the short-term asthma exacerbation recurrence. RESULTS Among all patients (mean age of 9.5 years old), 10.4% experienced recurrent exacerbations. FEV1, FVC, FEV1/FVC, FEF25–75, FEF25–75/FVC, and PEF, gradually decreased with increasing exacerbation severity (p<0.01). All patients showed a positive bronchodilator responsiveness (BDR), with a mean value of 16.85 (3.00)%, which was significantly different between the severe and non-severe asthma groups (20.53 [2.83] versus 16.00 [2.35], p<0.001). After adjusting in multivariable logistic regression, a BDR ≥20% was identified as the sole independent factor associated with an increased risk of asthma exacerbation recurrence (aOR 6.95, 95% CI 1.08–44.75, p = 0.041). CONCLUSIONS A high BDR can serve as a predictor of acute asthma exacerbation recurrence.