Risk Factors Associated With Health Care Utilization in Preschool Recurrent Wheezers in a Tropical Environment.

César Muñoz,María-Isabel Escamilla,Jose Miguel Escamilla-Arrieta,Lissette Guevara,Ronald Regino,Nathalie Acevedo

doi:10.3389/falgy.2021.761492

Abstract

Introduction: The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear.Objective: To evaluate the factors associated with health care utilization in preschool recurrent wheezers in Cartagena, Colombia.Methods: One hundred twenty-seven recurrent wheezers (age 2–6 years old) who were admitted to the emergency room (ER) due to wheezing in a Pediatric reference hospital in Cartagena were included. Children were evaluated by means of questionnaires and classified according to the number of ER visits, need for hospitalization and history of intensive care unit (ICU) admission due to wheezing within the last year. Total serum IgE and specific IgE to house dust mite allergens (HDM) were measured by ImmunoCAP® and allergen sensitization was evaluated by skin prick tests (SPT).Results: The maternal report of nocturnal cough without fever in their children increased the risk to have ≥5 ER visits in the last year due to wheezing. The use of montelukast was negatively associated with hospitalization, while a history of pneumonia and lack of tap water, increased the risk of hospitalization due to wheezing. A history of bronchiolitis, family history of asthma, cohabiting with two or more siblings, passive exposure to smoke and lack of sewage facilities increased the risk of ICU admission due to wheezing. The presence of atopy evaluated by SPT reactivity, total IgE levels or specific IgE to HDM were not associated with health care utilization. We also found that seroprevalence of positive IgE (≥0.35 kU/L) was 27% to B. tropicalis and 20.3% to D. pteronyssinus but the prevalence of positive IgE sensitization to these allergens was below 2% and 8% when evaluated by SPT, respectively.Conclusions: Poverty indicators are associated with ICU admission in a group of preschool recurrent wheezers and should be considered as aggravating factors for wheezing. These factors must be systematically assessed in the medical approach in underdeveloped regions in the tropics. Nocturnal cough without fever is a symptom associated with frequent ER visits while atopy was not associated with health care utilization in preschool recurrent wheezers.

Highlights

The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear
As an attempt to define severity in this age group, the Spanish Guideline for Asthma Management (GEMA, for its Spanish initials) makes an important statement about the nature of asthma in infants, suggesting that it is an episodic disease with asymptomatic periods between crises, and for that reason, other classifications based on adult asthma cannot be applied in children [11]
We aim to identify factors associated with health care utilization in preschool children with recurrent wheezing in Cartagena, Colombia

Summary

Introduction

The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear. Several studies conducted in temperate/industrialized regions classify wheezing into several phenotypes, but few patients can be assigned to one of them [5,6,7,8,9] These classifications are not useful for identifying the severity or for guiding management [6, 10]. In accordance with GEMA, the Japanese guideline of childhood asthma uses the frequency of symptoms to classify asthma severity in preschool children (and the need of controller medication) compared to adults [12]. Other guidelines, such as the Expert Panel Report 3 (EPR3) from the National Heart, Lung, and Blood Institute, have used the need for hospitalization, ICU admission [13], and use of oral/parenteral corticosteroids over the previous year [14] as proxies for the risk aspect of severity

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