Factors associated with poor asthma control in children: A prediction model

Wanaporn Anuntaseree, Kanokpan Ruangnapa, Araya Yuenyongviwat, Kantara Saelim, Pharsai Prasertsan

Affiliation:
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

Abstract

Background: Inhaled corticosteroids (ICS) are the first-line therapy for pediatric asthma. However, very few studies have developed simple tools for predicting treatment outcomes in pediatric asthma.
Objective: This study aimed to construct a predictive model for poor asthma control in children after 6 months of ICS therapy.
Methods: This retrospective study included children with asthma, aged 6-15 years, who received ICS with complete follow-up for 6 months. The potential factors associated with poor asthma control were assessed. Poor control was considered if the child had partial or uncontrolled symptoms according to the Global Initiative for Asthma guidelines.
Results: Among the 165 eligible children, 33 (20%) had poor symptom control. The factors associated with poor control were a history of more than four exacerbations in the 12 months before ICS treatment (odds ratio [OR], 3.39 [1.06, 10.83]), the presence of moderate to severe allergic rhinitis symptoms at the 6-month follow-up visit (OR, 21.93 [2.97, 162.05]), and poor adherence to asthma medications (OR, 4.16 [1.32, 13.12]). By incorporating these factors, a model for predicting poorly controlled asthma was constructed and converted into a nomogram with a total score of 200, with prediction risk ranging from 0 to 100%. The area under the receiver operating characteristic curve of the developed model was 0.737, indicating a moderate performance level.
Conclusions: We developed a predictive tool for poor asthma control. The model has a good discriminatory ability and is simple to use, which could facilitate the individualized management of children with asthma.
Key words: asthma, child, inhaled corticosteroids, prediction model, therapy