Predictors of asthma control differ from predictors of asthma attacks in children: The Swiss Paediatric Airway Cohort

Background: It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children.Objective: We evaluated predictors for these two outcomes in a clinical cohort study.Methods: 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.Results: 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.Conclusion: 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.