Risk factors for emergency re-attendance for acute childhood asthma in the city of Esmeraldas, Ecuador

Abstract

Introduction: Asthma exacerbations are common and are associated with substantial morbidity and a risk of death. A tool to assess a child9s risk of recurrent acute exacerbations could help optimise their treatment and address modifiable risk factors. Targeting resources toward those at highest risk is a particular need in lower-income settings. Aim: To identify predictors of future asthma attacks in children requiring emergency re-attendance in a low resource setting. Methods Design: prospective cohort study. Setting: Public hospital and health centres in Esmeraldas City, Ecuador. Population: Children aged 5-15 years presenting to the ER with acute asthma. Measures: questionnaires; blood, stool, and nasal wash samples; spirometry; Fraction of Exhaled Nitric Oxide (FeNO). Outcomes: Number and severity of asthma attacks over subsequent 6 months. Results: 119 of 241 children completing 6-month follow-up had a subsequent asthma attack requiring emergency care. In univariate analysis, risk factors for recurrence were: younger age, early life severe respiratory illness, food triggers, number and severity of previous attendances for asthma, serum eosinophils and post-bronchodilator FEV1. In a multivariate logistic regression model, prior asthma diagnosis (OR: 2.11, 95% CI: 1.02-4.36), food trigger (OR: 2.04, 95% CI: 1.04-3.98), and post-bronchodilator FEV1 (% of predicted) (OR: 1.01, 95% CI: 1.01-1.03), remained statistically significant. Conclusions: Independent risk factors for recurrent emergency attendance with asthma can be identified. These factors differ in some respects from those previously identified in higher-income countries, and were largely not modifiable.