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Asthma
Original article
At-risk children with asthma (ARC): a systematic review
  1. Audrey Buelo1,
  2. Susannah McLean1,
  3. Steven Julious2,
  4. Javier Flores-Kim1,
  5. Andy Bush3,
  6. John Henderson4,
  7. James Y Paton5,
  8. Aziz Sheikh1,
  9. Michael Shields6,
  10. Hilary Pinnock1
  11. the ARC Group
    1. 1 Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
    2. 2 Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
    3. 3 Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
    4. 4 Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
    5. 5 School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
    6. 6 Centre for Experimental Medicine, Queen’s University, Belfast, UK
    1. Correspondence to Dr Hilary Pinnock, Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, Scotland; hilary.pinnock{at}ed.ac.uk

    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.

    • Paediatric asthma

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/thoraxjnl-2017-210939

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      Footnotes

      • Contributors HP led the development of the protocol, securing of funding, study administration, expert panel, workshop and writing of the paper. AS, SJ, AB, JH and MS contributed to the development of the protocol. SJ provided statistical advice. AudB and SMcL undertook the screening, data extraction and presentation of results. HP, JYP, JH, MS, AudB and JFK formed the expert panel. All authors contributed to the interpretation of the findings. AudB wrote the initial draft of the paper with SMcL and HP, to which all the authors contributed. HP is the study guarantor.

      • Funding This research was supported by Asthma UK (Ref: AUK-SR-2015-01), with contributions from the Asthma UK Centre for Applied Research (AUK-AC-2012-01). AS is supported by the Farr Institute which is funded by a consortium of funders headed by the MRC.

      • Competing interests None declared.

      • Patient consent Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement All data are provided in the manuscript and online supplementary tables.

      • Collaborators The ARC group members: Helen Benson; Steve Cunningham; Victoria Dalgliesh; Gwyneth Davies; Melissa Goodbourn; Susan Grieve; Jonathan Grigg; Hayley K Zislis; Erin McDonnell; Susan Morrow; Meagan Peterson; Daniel Russell; Jurgen Schwarze; San Selveindran; Nara Tagiyeva; Mike Thomas; Marissa Ware; Andrew Wilson.