Predicting Future Asthma Morbidity in Preschool Inner-City Children

Abstract

To determine which clinical and environmental factors are predictive of poor long-term asthma control in preschool inner-city children.Preschool inner-city children with a history of persistent asthma.Baseline characteristics determined to be potential predictors of asthma severity were examined: demographics, asthma symptoms, medication use, healthcare utilization, early life medical history, family history, allergen exposure and allergic disease, and pollutant exposure. Bivariate and multivariate analyses were performed by using logistic regression to examine the association of predictosrs of asthma severity with healthcare utilization at 2 years.Of the 150 children at baseline, the follow-up rate was 83% at 2 years; therefore, 124 children were included in final analyses. At baseline, the mean age was 4.4 years, and participants were predominantly African-American (90%). Most of the children were atopic, and 32.5% reported using inhaled corticosteroids. Nighttime awakening from asthma and a history of pneumonia were predictive of future poor control.Preschool children with nighttime awakening from asthma and a history of pneumonia may deserve closer monitoring to prevent future asthma morbidity.The authors offer very important insights into the clinical presentation of asthma for young preschoolers and longitudinal outcomes. By identifying simple clinical clues, including nocturnal waking and a history of recurrent pneumonia, this study allows the clinician to triage high-risk asthmatic children within the context of an examination or clinic visit. These tools allow for further coordination of both asthma education and more aggressive medical intervention to reduce the morbidity and burden these children face due to their asthma.