Inducing factors of childhood asthma exacerbation in Shanghai and asthma education
SUN Jingyi1，FANG Dingzhu1，HUA Li1，ZHANG Jianhua1，ZHANG Jun2
1. Department of Pediatric Pulmonology，Xinhua Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai 200092，China; 2. Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health，Shanghai 200092，China
Abstract：Objective To describe the inducing factors and clinical characteristics of childhood asthma exacerbation by conducting a large hospital-based cross-sectional survey，and explore the effects of age，gender，and history of allergic diseases on these inducing factors in order to provide evidence for early identification of inducing factors of childhood asthma exacerbation and individualized patient education. Methods This cross-sectional study was conducted in the Department of Pediatric Pulmonology，Xinhua Hospital，Shanghai Jiao Tong University School of Medicine，from June 2015 to January 2016. The subjects were children aged 12 years and younger with a diagnosed asthma by pediatricians according to the definition of the Global Initiative for Asthma (GINA). The demographic characteristics，inducing factors of asthma exacerbation，and individual and family history of allergic diseases of these children were described and analyzed. Multiple logistic regressions were used to estimate the odds ratios（ORs）. Results of this study were applied to individualized asthma education to the caregivers of asthmatic children who attended the outpatient department for the first time. The attendance of scheduled follow-up for four weeks was evaluated. Results A total of 515 asthmatic children were included in this study. Respiratory tract infection was the most common inducing factor of childhood asthma exacerbation (89.9%)，followed by house dust (47.2%)，food (29.9%)，cold air (28.7%)，pollen (15.5%)，exercise (11.7%)，and chemical odors (8.9%). Boys had a higher proportion of pollen-induced asthma exacerbation compared to girls. School-age children (6 years and older) were more vulnerable to inhaled factors such as house dust and pollen compared to younger children. The proportion of exercise-induced asthma in school-age children was also higher than that of younger children. Asthmatic children with atopic dermatitis (OR=5.046，95%CI: 2.550-9.986)，food allergy (OR=4.386，95%CI: 1.922-10.011)，and drug allergy (OR=2.721，95%CI: 1.284-5.766) were more likely to have asthma attack with exposure to specific chemical odors. Allergic rhinitis was associated with asthma attack due to house dust（OR=2.591，95%CI:1.594-4.213）. Asthmatic children whose caregivers received individualized asthma education had a follow-up rate of 98.0% four weeks later. Conclusion Respiratory tract infection is the main inducing factor of childhood asthma exacerbation. Age，gender，and allergic diseases or allergic status has a significant impact on the distribution of inducing factors. Individualized asthma education based on the clinical characteristics of children may improve asthma control.