Article Text
PDF
Abstract
Background Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations.
Methods Primary care medical records, 2004–2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5–8 years, 9–11 years and adolescents (12–16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations.
Results 119 611 children were eligible: 61 940 (51.8%) 5–8 years, 32 316 (27.7%) 9–11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5–8 years had the highest proportion with eczema, food/drug allergy and cough, but adolescents had the highest proportion with overweight/obesity, aeroallergen sensitisation, dyspnoea and short-acting-beta-agonist only use. Exacerbation rates were highest in the youngest children (per 100 person-years (95% CI): 5–8 years =13.7 (13.4–13.9), 9–11 years =10.0 (9.8–10.4), adolescents =6.7 (6.5–7.0)). Exacerbation risk factors also differed by age; 5–8 years: male, eczema and food/drug allergy were strongly associated, but for children ≥9 years old, obesity and aeroallergen sensitisation were strongly associated. For all children, higher socioeconomic deprivation was significantly associated with having an exacerbation. Delayed diagnosis was most common in children aged 5–8 years and was associated with increased exacerbations across all ages.
Conclusion Children’s baseline characteristics and exacerbation rates varied according to their age group. Clinical guidelines should consider age at time of diagnosis more discretely than the broad range, 5–16 years, as this appears to impact on asthma severity and management.
- Asthma
- Paediatric asthma
- Asthma in primary care
- Asthma Epidemiology
Data availability statement
Data may be obtained from a third party and are not publicly available. Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS) data are available on request from CPRD.
Statistics from Altmetric.com
Data availability statement
Data may be obtained from a third party and are not publicly available. Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS) data are available on request from CPRD.
Footnotes
SS and CIB are joint senior authors.
Twitter @sejalsaglani
Contributors CIB conceptualised and designed the study. ZK performed the analysis. CIB and SS supervised the analysis and data interpretation. ZK wrote the original draft. CIB, SS and AB edited the manuscript. All authors approved the final version. CIB is the guarantor (accepts full responsibilty for the work and conduct of the study, had access to the data and controlled the decision to publish).
Funding This study was supported by the National Heart and Lung Institute Foundation Centre for Airways Disease in Children & Young Adults and National Institute for Health Research Imperial Biomedical Research Centre.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.