Uncontrolled asthma in school-aged children—a nationwide specialist care study

Abstract

BackgroundUncontrolled asthma is different from severe asthma and can be identified in children across all ranges of prescribed treatment. ObjectiveTo characterize uncontrolled childhood asthma in pediatric specialist care. MethodsWe performed a nationwide cross-sectional study of 5497 children (6-17 years) with asthma, treated by pediatricians at out-patient clinics during 2019 and registered in the Swedish National Airway Register. Uncontrolled asthma was defined as Asthma Control Test (ACT) ≤19 and/or ≥2 exacerbations last year and/or FEV1<80% predicted. Treatment was categorized from step 1 to 5 according to the Global Initiative for Asthma (GINA). ResultsUncontrolled asthma (UCA) was identified in 1690 children (31%), of whom 64% had ACT≤19, 20% had recurrent exacerbations and 31% had FEV1<80%. UCA was associated with female sex (OR 1.29, (CI 1.15-1.45)), older age (OR 1.02, (CI 1.00-1.04)), obesity (OR 1.43, (CI 1.12-1.83)) and more treatment using step 1-2 as reference (step 3: OR 1.28 (1.12-1.46), step 4-5 OR 1.32 (1.10-1.57)). UCA in children prescribed step 1-2 treatment (UCA1-2) occurred in 28% (n=887) of all children in this treatment step. Children with UCA1-2 had more often exacerbations compared to children with UCA in children prescribed step 4-5 treatment (24% vs. 15%, p=0.001). ConclusionUncontrolled asthma was common and associated with female sex, increasing age, obesity and higher GINA treatment step. Surprisingly, uncontrolled asthma was also common in children prescribed less than maximum treatment and these children could be considered as under-treated patients.