Risk factors for exacerbations and hospital admissions in asthma of early childhood

Hospital admissions and readmissions for asthma in early childhood remain c auses for concern. The purpose of this study was to identify predisposing r isk factors related to asthma exacerbations and precursors of hospital admi ssions in young children. Subjects were patients with doctor-diagnosed asth ma from a clinical registration study, aged 0-4 years, and followed up for 2 years. Data from histories and laboratory tests for atopic status at init ial presentation, and the patient's condition at visits over the 2-year fol low-up period were evaluated. Exacerbation was defined as increases in coug h and/or wheeze and/or breathlessness, increase in beta(2)-agonist use, and a clinical need for a short course of oral corticosteroids. Age groups 0-1 year and 2-4 years, based on age at initial presentation, were analyzed se parately. In the age group 0-1 year, 71/113 (63%) patients had at least one exacerbat ion, and 20 experienced recurrent exacerbations (greater than or equal to 3 ). Predisposing risk factors for exacerbation were damp housing (odds ratio (OR) 7.6 (2.0-28.6)) and colds (OR 3.6 (1.4-9.6)), and for recurrent exace rbations sensitization to inhalant allergens (Phadiatop(R)) (OR 8.1 (1.6-40 .5)) and damp housing (OR 3.8 (1.1-12.8)). Hospital admissions were signifi cantly associated with number of exacerbations. In the age group 2-4 years, 58/144 (40%) patients had at least one exacerbation, and 21 experienced re current exacerbations (greater than or equal to 2). Predisposing risk facto rs for exacerbation were mean age at initial presentation (OR 0.92 (0.88-0. 97)) and level of total IgE (OR 2.3 (1.4-3.9)), whereas for recurrent exace rbations no predictor variables were found. Hospital admissions were signif icantly associated with damp housing. Results from this study may facilitate recognition of young asthmatic patie nts at risk of (recurrent) exacerbations, and help to identify those in who m early intervention with antiinflammatory therapy may be necessary. We als o emphasize the importance of preventive measures in decreasing damp housin g. (C) 2000 Wiley-Liss. Inc.