A review of 68 worldwide studies has identified the factors which put children at risk of a severe asthma attack.
Clinicians will be able to use this information to focus risk reduction management strategies on the high risk child.
The Asthma-UK funded review, led by Professor Hilary Pinnock from the Asthma UK Centre for Applied Research, found that children aged 5–12 years who had a history of previous attacks and persistent asthma symptoms were at greatly increased risk of a future attack, especially if they had poor access to care.
Other key markers of moderately increased risk were a suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity, poverty and vitamin D deficiency.
Younger age, exposure to environmental tobacco smoke, being overweight and low parental education were associated with a slightly increased risk, but gender, urban residence and Hispanic ethnicity were not associated with increased risk.
The review, published in Thorax, concludes that many of the risk factors identified are potentially modifiable.
The authors suggest that to reduce the risk of an asthma attack:
Clinicians should ensure they are delivering evidence-based treatment and self-management support to high risk children.
Parents should focus on eliminating tobacco smoke from their child’s environment and make sure the child adheres to regular controller medication.
Commissioners should ensure their population has equitable access to care and that their policy initiatives address social deprivation and the public health challenges of smoking and obesity.
Hilary says: “Our findings will help clinicians to spot the child with asthma who is at risk of an acute attack. Clinicians should look out for the child with persistent symptoms who has had previous attacks and is on a suboptimal treatment regimen, especially if they have poor access to healthcare services. These children are at increased risk of attacks, so consider targeting additional care: offer regular follow-up appointments, reinforce the importance of preventer medication and ensure that they understand their action plan.”