Association between asthma control trajectories in preschoolers and disease remission
Cristina Longo, Lucie Blais, Marni Brownell, Jacqueline M. Quail, Mohsen Sadatsafavi, Amélie Forget, Marc-André Turcot, Yao Nie, Wenbin Li, Hamid Tavakoli, Qier Tan, Yuxin Fan, Robert W. Platt, Francine M. Ducharme
Source: Eur Respir J, 57 (5) 2001897; 10.1183/13993003.01897-2020
Abstract
Introduction
Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission.
Methods
We conducted a multicentre population-based retrospective cohort study consisting of 48?687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as one or more medical visits or medications for asthma every 6-month period for at least four of the six periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as 2 consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: “controlled throughout”, “improving control”, “worsening control”, “out of control throughout” and “fluctuating control”. Adjusted Cox models estimated associations between asthma control trajectories and time to remission. A random effects meta-analysis summarised province-specific hazard ratios (HRs).
Results
The pooled remission rate was 8.91 (95% CI 8.80–9.02) per 100 person-years. Compared with children controlled throughout, poorer asthma control was associated with incrementally lower hazard ratios of remission in four other trajectories: improving control (HR 0.89, 95% CI 0.82–0.96), fluctuating control (HR 0.78, 95% CI 0.71–0.85), worsening control (HR 0.68, 95% CI 0.62–0.75) and out of control throughout (HR 0.52, 95% CI 0.45–0.59).
Conclusions
Asthma control trajectories 2 years following a diagnosis in preschoolers were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life.
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Cristina Longo, Lucie Blais, Marni Brownell, Jacqueline M. Quail, Mohsen Sadatsafavi, Amélie Forget, Marc-André Turcot, Yao Nie, Wenbin Li, Hamid Tavakoli, Qier Tan, Yuxin Fan, Robert W. Platt, Francine M. Ducharme. Association between asthma control trajectories in preschoolers and disease remission. Eur Respir J, 57 (5) 2001897; 10.1183/13993003.01897-2020
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