Background
Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support ...front‐line clinicians’ decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature.
Methods
We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re‐attendance or hospital readmission for acute childhood asthma.
Results
Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African‐American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission.
Conclusion
Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re‐attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children.
We evaluated predictors for these two outcomes in a clinical cohort study.
The Swiss ...Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children (5-16 years old) diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks.
At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline (e.g. ≥1 night wheeze/week OR: 3.2; 95% CI: 1.7-6), wheeze triggered by allergens (2.2; 1.4-3.3), colds (2.3; 1.4-3.6) and exercise (3.2; 2-5), a more intense treatment at baseline (2.4; 1.3-4.4 for Step 3 vs. 1), history of preschool (2.6; 1.5-4.4) and persistent wheeze (2; 1.4-3.2), and exposure to tobacco smoke (1.7; 1-2.6). Incident asthma attacks were associated with previous episodes of severe wheeze (2; 1.2-3.3) and asthma attacks (2.8; 1.6-5 for emergency care visits), younger age (0.8; 0.8-0.9 per 1 year) and non-Swiss origin (0.3; 0.2-0.5 for Swiss origin). Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks.
Children at risk of long-term suboptimal asthma control differ from those at risk of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.
Background
Although international guidelines and Cochrane reviews emphasize that therapies do not alter the natural course of acute viral bronchiolitis (AVB), they are still prescribed frequently. ...This survey evaluated self‐reported management of AVB by Swiss pediatricians in 2019 and compared it with previous surveys.
Methods
We performed a cross‐sectional online survey of all board‐certified pediatricians in Switzerland in November 2019 and compared the reported use of therapies with that reported in the 2001 and 2006 surveys. We used multivariable ordered logistic regression to assess factors associated with reported prescription of bronchodilators, corticosteroids, antibiotics, and physiotherapy.
Results
Among 1618 contacted board‐certified pediatricians, 884 returned the questionnaires (55% response rate). After exclusions were applied, 679 were included in the final analysis. Pediatricians working in primary care reported using therapeutics more frequently than those working in a hospital setting, either always or sometimes: bronchodilators 53% versus 38%, corticosteroids 37% versus 23%, and antibiotics 39% versus 22%. The opposite occurred with physiotherapy: 53% reported prescribing it in hospital and 44% in primary care. There was an overall decrease in the prescription of therapeutics and interventions for AVB from 2001 to 2019. The proportion who reported “always” prescribing corticosteroids decreased from 71% to 2% in primary care, and of those “always” prescribing bronchodilators from 55% to 1% in hospitals.
Conclusion
Although we observed a significant decrease since 2001, more effort is required to reduce the use of unnecessary therapies in children with AVB.
Objectives
In epidemiological studies, childhood asthma is usually assessed with questionnaires directed at parents or children, and these may give different answers. We studied how well parents and ...children agreed when asked to report symptoms of wheeze and investigated whose answers were closer to measurable traits of asthma.
Methods
LuftiBus in the school is a cross‐sectional survey of respiratory health among Swiss schoolchildren aged 6–17 years. We applied questionnaires to parents and children asking about wheeze and exertional wheeze in the past year. We assessed agreement between parent–child answers with Cohen's kappa (k), and associations of answers from children and parents with fractional exhaled nitric oxide (FeNO) and forced expiratory volume in 1 s over forced vital capacity (FEV1/FVC), using quantile regression.
Results
We received questionnaires from 3079 children and their parents. Agreement was poor for reported wheeze (k = 0.37) and exertional wheeze (k = 0.36). Median FeNO varied when wheeze was reported by children (19 ppb, interquartile range IQR: 9–44), parents (22 ppb, IQR: 12–46), both (31 ppb, IQR: 16–55), or neither (11 ppb, IQR: 7–19). Median absolute FEV1/FVC was the same when wheeze was reported by children (84%, IQR: 78–89) and by parents (84%, IQR: 78–89), lower when reported by both (82%, IQR: 78–87), and higher when reported by neither (87%, IQR: 82–91). For exertional wheeze findings were similar. Results did not differ by age or sex.
Conclusion
Our findings suggest that surveying both parents and children and combining their responses can help us to better identify children with measurable asthma traits.
Objectives
Population‐based studies of children with dry night cough alone compared with those who also wheeze are few and inconclusive. We compared how children with dry night cough differ from ...those who wheeze.
Methods
LuftiBus in the school is a population‐based study of schoolchildren conducted between 2013 and 2016 in Zurich, Switzerland. We divided children into four mutually exclusive groups based on reported dry night cough (henceforth referred as “cough”) and wheeze and compared parent‐reported symptoms, comorbidities, exposures, FeNO, spirometry, and healthcare use and treatment.
Results
Among 3457 schoolchildren aged 6–17 years, 294 (9%) reported “cough,” 181 (5%) reported “wheeze,” 100 (3%) reported “wheeze and cough,” and 2882 (83%) were “asymptomatic.” Adjusting for confounders in a multinomial regression, children with “cough” reported more frequent colds, rhinitis, and snoring than “asymptomatic” children; children with “wheeze” or “wheeze and cough” more often reported hay fever, eczema, and parental histories of asthma. FeNO and spirometry were similar among “asymptomatic” and children with “cough,” while children with “wheeze” or “wheeze and cough” had higher FeNO and evidence of bronchial obstruction. Children with “cough” used healthcare less often than those with “wheeze,” and they attended mainly primary care. Twenty‐two children (7% of those with “cough”) reported a physician diagnosis of asthma and used inhalers. These had similar characteristics as children with wheeze.
Conclusion
Our representative population‐based study confirms that children with dry night cough without wheeze clearly differed from those with wheeze. This suggests asthma is unlikely, and they should be investigated for alternative aetiologies, particularly upper airway disease.
Introduction
The Predicting Asthma Risk in Children (PARC) tool uses questionnaire‐based respiratory symptoms collected from preschool children to predict asthma risk 5 years later. The tool was ...developed and validated in population cohorts but not validated using a clinical cohort. We aimed to externally validate the PARC tool in a pediatric pulmonology clinic setting.
Methods
The Swiss Paediatric Airway Cohort (SPAC) is a prospective cohort of children seen in pediatric pulmonology clinics across Switzerland. We included children aged 1–6 years with cough or wheeze at baseline who completed the 2‐year follow‐up questionnaire. The outcome was defined as current wheeze plus use of asthma medication. We assessed performance using: sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), area under the curve (AUC), scaled Brier's score, and Nagelkerke's R2 scores. We compared performance in SPAC to that in the original population, the Leicester Respiratory Cohort (LRC).
Results
Among 346 children included, 125 (36%) reported the outcome after 2 years. At a PARC score of 4: sensitivity was higher (95% vs. 79%), specificity lower (14% vs. 57%), and NPV and PPV comparable (0.84 vs. 0.87 and 0.37 vs. 0.42) in SPAC versus LRC. AUC (0.71 vs. 0.78), R2 (0.18 vs. 0.28) and Brier's scores (0.13 vs. 0.22) were lower in SPAC.
Conclusions
The PARC tool shows some clinical utility, particularly for ruling out the development of asthma in young children, but performance limitations highlight the need for new prediction tools to be developed specifically for the clinical setting.
Background
Smoking habits in adolescents are changing. We assessed active smoking of conventional cigarettes, e‐cigarettes and shishas in Swiss schoolchildren, studied risk factors and compared ...respiratory problems between smokers and non‐smokers.
Methods
We used data from LuftiBus in the school (LUIS), a school‐based survey of respiratory health of children carried out 2013 to 2016 in the canton of Zurich, Switzerland. Participants were asked about use of cigarettes, shishas, and electronic smoking devices (ESD), and current respiratory symptoms. We studied associations between smoking and risk factors using logistic regression.
Results
We included 3488 schoolchildren. Among 6 to 12‐year‐olds, 90/1905 (5%) had smoked occasionally (<once/week). Among 13 to 17‐year‐olds, 563/1583 (36%) had smoked occasionally of whom 414 smoked ESDs, 409 shishas, and 276 cigarettes. Among 13 to 17‐year‐olds who smoked frequently (≥once/week), 41/54 (76%) smoked cigarettes. A 22% of 15 to 17‐year‐olds (104/477) had used all three products. Smoking was more common in adolescents who were male (adjusted OR, 2.1; 95% CI, 1.7‐2.6), lived in rural areas (1.8, 95% CI, 1.2‐2.9 vs small urban), and whose mother (1.7, 95% CI, 1.3‐2.3) or father (1.5, 95% CI, 1.2‐1.9) smoked. Current respiratory symptoms like rhinitis, dyspnea, and wheeze were more common among frequent smokers (44%, 30%, 12%, respectively) and occasional smokers (32%, 22%, 13%) than in never smokers (29%,19%, 8%, P for trend <.05).
Conclusion
Smoking of shishas and ESDs is common among Swiss adolescents and often combined with smoking cigarettes. Adolescent smokers reported more respiratory symptoms than never smokers. We recommend smoking preventive strategies that include all forms of smoking.
Objective
Exercise‐induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics ...for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments.
Design
An observational study of respiratory outpatients aged 0–16 years nested in the Swiss Paediatric Airway Cohort (SPAC).
Patients
We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2–17, 54% males) referred for EIS.
Results
The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%‐CI 46%–60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise‐challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.
Conclusions
Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow‐up differed between clinics and diagnostic groups highlighting the need for evidence‐based diagnostic guidelines and harmonized procedures for children seen for EIS.
Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the ...questions parents are asked about their child's cough and how answers to the different questions overlap.
We analysed cross-sectional data from two population-based studies on respiratory health: LuftiBus in the School (LUIS), conducted in 2013-2016 among 6- to 17-year-school children in the Canton of Zurich, Switzerland, and the 1998 Leicester Respiratory Cohort (LRC) study, UK where we used data from 6- to 8-year-old children from the 2003 follow-up survey. Both studies used parental questionnaires that included the same three questions on the child's cough, namely cough without a cold, dry cough at night and coughing more than others. We assessed how the prevalence of cough varied depending on the question and how answers to the different questions on cough overlapped. We also assessed how results were influenced by age, sex, presence of wheeze and parental education.
We included 3457 children aged 6-17 years from LUIS and 2100 children aged 6-8 years from LRC. All respiratory outcomes - cough, wheeze and physician-diagnosed asthma - were reported twice as often in the LRC as in LUIS. We found large differences in the prevalence of parent-reported cough between the three cough questions. In LUIS, 880 (25%) parents reported cough without a cold, 394 (11%) dry night cough, and 159 (5%) reported that their child coughed more than other children. In the LRC, these numbers were 1003 (48%), 527 (25%) and 227 (11%). There was only partial overlap of answers, with 89 (3%) answering yes to all questions in LUIS and 168 (8%) in LRC. Prevalence of all types of cough and overlap between the cough questions was higher in children with current wheeze.
In both population-based studies prevalence estimates of cough depended strongly on the question used to assess cough with only partial overlap of responses to different questions. Epidemiological studies on cough can only be compared if they used exactly the same questions for cough.
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