C S Murray1, G Poletti, T Kebadze, J Morris, A Woodcock, S L Johnston, A Custovic. 1. Academic Division of Medicine and Surgery South, The University of Manchester, North West Lung Centre, South Manchester University Hospitals NHS Trust, Manchester M23 9LT, UK. clare.murray@manchester.ac.uk
Abstract
BACKGROUND: Asthma exacerbation is the most common cause of hospital admission in children. A study was undertaken to investigate the importance of allergen exposure in sensitised individuals in combination with viral infections and other potentially modifiable risk factors precipitating asthma hospital admission in children. METHODS: Eighty four children aged 3-17 years admitted to hospital over a 1 year period with an acute asthma exacerbation (AA) were matched for age and sex with two control groups: stable asthmatics (SA) and children admitted to hospital with non-respiratory conditions (IC). Risk factors were assessed by questionnaires and determination of allergen sensitisation, home allergen exposure, pollen exposure, and respiratory virus infection. RESULTS: Several non-modifiable factors (atopy, duration of asthma) were associated with increased risk. Among the modifiable factors, pet ownership, housing characteristics, and parental smoking did not differ between the groups. Regular inhaled corticosteroid treatment was significantly less common in the AA group than in the SA group (OR 0.2, 95% CI 0.1 to 0.6; p = 0.002). A significantly higher proportion of the AA group were virus infected (44%) and sensitised and highly exposed to sensitising allergen (76%) compared with the SA (18% and 48%) and IC groups (17% and 28%; both p<0.001). In a multiple conditional logistic regression (AA v SA), allergen sensitisation and exposure or virus detection alone were no longer independently associated with hospital admission. However, the combination of virus detection and sensitisation with high allergen exposure substantially increased the risk of admission to hospital (OR 19.4, 95% CI 3.7 to 101.5, p<0.001). CONCLUSIONS: Natural virus infection and real life allergen exposure in allergic asthmatic children increase the risk of hospital admission. Strategies for preventing exacerbations will need to address these factors.
BACKGROUND:Asthma exacerbation is the most common cause of hospital admission in children. A study was undertaken to investigate the importance of allergen exposure in sensitised individuals in combination with viral infections and other potentially modifiable risk factors precipitating asthma hospital admission in children. METHODS: Eighty four children aged 3-17 years admitted to hospital over a 1 year period with an acute asthma exacerbation (AA) were matched for age and sex with two control groups: stable asthmatics (SA) and children admitted to hospital with non-respiratory conditions (IC). Risk factors were assessed by questionnaires and determination of allergen sensitisation, home allergen exposure, pollen exposure, and respiratory virus infection. RESULTS: Several non-modifiable factors (atopy, duration of asthma) were associated with increased risk. Among the modifiable factors, pet ownership, housing characteristics, and parental smoking did not differ between the groups. Regular inhaled corticosteroid treatment was significantly less common in the AA group than in the SA group (OR 0.2, 95% CI 0.1 to 0.6; p = 0.002). A significantly higher proportion of the AA group were virus infected (44%) and sensitised and highly exposed to sensitising allergen (76%) compared with the SA (18% and 48%) and IC groups (17% and 28%; both p<0.001). In a multiple conditional logistic regression (AA v SA), allergen sensitisation and exposure or virus detection alone were no longer independently associated with hospital admission. However, the combination of virus detection and sensitisation with high allergen exposure substantially increased the risk of admission to hospital (OR 19.4, 95% CI 3.7 to 101.5, p<0.001). CONCLUSIONS:Natural virus infection and real life allergen exposure in allergic asthmatic children increase the risk of hospital admission. Strategies for preventing exacerbations will need to address these factors.
Authors: D L Rosenstreich; P Eggleston; M Kattan; D Baker; R G Slavin; P Gergen; H Mitchell; K McNiff-Mortimer; H Lynn; D Ownby; F Malveaux Journal: N Engl J Med Date: 1997-05-08 Impact factor: 91.245
Authors: G P Rakes; E Arruda; J M Ingram; G E Hoover; J C Zambrano; F G Hayden; T A Platts-Mills; P W Heymann Journal: Am J Respir Crit Care Med Date: 1999-03 Impact factor: 21.405
Authors: S L Johnston; P K Pattemore; G Sanderson; S Smith; M J Campbell; L K Josephs; A Cunningham; B S Robinson; S H Myint; M E Ward; D A Tyrrell; S T Holgate Journal: Am J Respir Crit Care Med Date: 1996-09 Impact factor: 21.405
Authors: S L Johnston; P K Pattemore; G Sanderson; S Smith; F Lampe; L Josephs; P Symington; S O'Toole; S H Myint; D A Tyrrell Journal: BMJ Date: 1995-05-13
Authors: F Freymuth; A Vabret; J Brouard; F Toutain; R Verdon; J Petitjean; S Gouarin; J F Duhamel; B Guillois Journal: J Clin Virol Date: 1999-08 Impact factor: 3.168
Authors: Cristan Herbert; Melissa M Scott; Kim H Scruton; Rylie P Keogh; Kristy C Yuan; Kenneth Hsu; Jessica S Siegle; Nicodemus Tedla; Paul S Foster; Rakesh K Kumar Journal: Am J Pathol Date: 2010-08-19 Impact factor: 4.307
Authors: Rosalind M Eggo; James G Scott; Alison P Galvani; Lauren Ancel Meyers Journal: Proc Natl Acad Sci U S A Date: 2016-02-08 Impact factor: 11.205
Authors: Yasuhiro Nakagami; Silvio Favoreto; Guohua Zhen; Sung-Woo Park; Louis T Nguyenvu; Douglas A Kuperman; Gregory M Dolganov; Xiaozhu Huang; Homer A Boushey; Pedro C Avila; David J Erle Journal: J Immunol Date: 2008-08-01 Impact factor: 5.422