At-risk children with asthma (ARC): a systematic review. Issue 9 (5th June 2018)

• Record Type: Journal Article
• Authors: Buelo, Audrey; McLean, Susannah; Julious, Steven; Flores-Kim, Javier; Bush, Andy; Henderson, John; Paton, James Y; Sheikh, Aziz; Shields, Michael; Pinnock, Hilary
• Other Names: author non-byline.; Benson Helen author non-byline.; Cunningham Steve author non-byline.; Dalgliesh Victoria author non-byline.; Davies Gwyneth author non-byline.; Goodbourn Melissa author non-byline.; Grieve Susan author non-byline.; Grigg Jonathan author non-byline.; Zislis Hayley author non-byline.; Mcdonnell Erin author non-byline.; Morrow Susan author non-byline.; Peterson Meagan author non-byline.; Russell Daniel author non-byline.; Schwarze Jurgen author non-byline.; Selveindran San author non-byline.; Tagiyeva Nara author non-byline.; Thomas Mike author non-byline.; Ware Marissa author non-byline.; Wilson Andrew author non-byline.
• Is Part Of: Thorax. Volume 73:Issue 9(2018)
• Page Start: 813
• Page End: 824
• Publication Date: 2018-06-05
• Subjects: Paediatric asthma; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210939
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care. Methods: We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. Results: From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. Discussion: Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. Trial registration number: CRD42016037464.