A systematic review of children with asthma aged 5-12 to identify and weight indicators of risk of asthma exacerbations
Asthma is the commonest long-term condition in children with exacerbations impacting on both school attendance and quality of life. Factors associated with an increased risk of future exacerbations have been identified, and could inform clinical assessment of risk and targeting of care. The aim of this research was to systematically review the literature to identify and weight factors associated with increased risk of exacerbations in children aged 5-12 years.
We systematically searched 6 databases and undertook forward citation searches, with no date/language restrictions. Two reviewers independently selected studies for inclusion, assessed methodological quality, and extracted data. Heterogeneity precluded a formal meta-analysis. An expert panel of four clinicians independently assessed each factor for both degree of risk and confidence in that assessment, based on study quality, effect sizes, biological plausibility, and consistency of results. Consensus was achieved by discussion and agreed at a multidisciplinary workshop.
We included 48 papers. The panel were very confident that previous exacerbations and African-American ethnicity (US studies) were associated with greatly increased risk of exacerbations. Persistent symptoms were associated with moderately/greatly increased risk. A moderately increased risk of exacerbation was associated with a sub-optimal drug regimen and high reliever use, co-morbid atopic diseases and allergic sensitisation, poverty, exposure to tobacco smoke and poor access to care. Younger age and obesity were associated with slightly increased risk. Gender and age of onset of asthma were not associated with risk.
Assessment of these clinical and demographic features will help clinicians to ‘spot the child’ at increased risk, and institute management to reduce risk. Population level factors (poverty, poor access to care) may be used by health service planners and policymakers to target healthcare initiatives.