Practical tool to predict severe asthma exacerbations in children

Published: September 7, 2021

Asthma exacerbations commonly lead to costly unplanned emergency department visits and hospitalizations. Early identification of children at increased risk of asthma exacerbations would allow early intervention and possible reduction in the severity of these episodes. However, predicting which children are at highest risk of asthma exacerbation is challenging given the wide variety of clinical presentations and triggers. Currently, no tool exists that accurately predicts exacerbation risk using electronic health record data.

Niu et al in The Journal of Allergy and Clinical Immunology: In Practice analyzed longitudinal EMR data for over 3,000 participants with asthma seen at Cincinnati Children’s Hospital Medical Center over a 7-year period. The cohort included three age groups: 0-4, 5-11 and 12-21 years. Each age group was divided into an original group of children used to build the risk score model to predict exacerbation in the next 12 months and another to confirm the results of the original group of children. A clinical tool to determine exacerbation risk was created based on this model.
 
Race, allergic sensitization, and smoke exposure were significantly associated with an increased risk of asthma exacerbations across all age groups.  Black race and allergic sensitization were the highest in the 5-11 year age group. Abnormal spirometry and obesity were more sensitive predictors of exacerbation in children > 12 years. For each age group, a higher score was associated with a higher risk of an asthma exacerbation in the subsequent year. This study provides a practical tool that may be used in the clinical setting to determine risk of exacerbations in children with asthma based on a variety of clinical characteristics and laboratory findings found in the electronic health record. This clinical tool may assist clinicians to identify children at high risk for exacerbation that may benefit from more aggressive management.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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