Characteristics of Allergic, Eosinophilic, and Overlapping Asthma Phenotypes Among Pediatric Patients with Current Asthma: A Cross-Sectional Study from Saudi Arabia.

Abstract

Asthma is one of the most common chronic diseases affecting 10%-30% of children in Saudi Arabia. Although data exist on adult asthma phenotyping and endotyping in Saudi Arabia, little is known about asthma phenotypes in Saudi children. This cross-sectional study enrolled pediatric patients diagnosed with bronchial asthma and followed in the pediatric pulmonology clinic of the Abha Maternity and Children Hospital between August 2021 and May 2023. A total of 321 children (aged 5-14 years) were analyzed. The population was classified into allergic [169 (52.6%)], eosinophilic [144 (44.9%)], and overlapping allergic and eosinophilic asthma [97 (30.2%)] phenotypes. Regarding asthma severity, 35.5%, 50.2%, and 14.3% were classified as mild, moderate, and severe, respectively. Of the 321 patients in the study, 124 (38.6%) had at least one asthma exacerbation that required hospitalization. The number of reported missed school days in the previous year was 1571 days [190 (59.2%) patients reported at least one missed school day]. The factors associated with the likelihood of uncontrolled asthma for all study participants included: emergency room (ER) visit last year (OR = 3.7, 95% CI:0.6-15.9]), overlapping eosinophilic and allergic (OR = 3.2, 95% CI = 1.8-5.9), and allergic phenotype (OR = 2.7, 95% CI = 1.3-5.4). The level of asthma control differed significantly among the three asthma phenotypes (p = 0.037). Allergic asthma is the most prevalent asthma phenotype in this study, followed by the eosinophilic phenotype. The research has also shown that several factors predict uncontrolled asthma, including a family history of asthma, previous admission to the PICU, and previous hospitalization ever. There is, therefore, a definite need for multicenter cohort studies to better understand the phenotypes and endotypes of childhood asthma, as it could offer therapeutic and prognostic relevance.