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Applying UK real-world primary care data to predict asthma attacks in 3776 well-characterised children: a retrospective cohort study

Steve Turner, Clare Murray, Mike Thomas, et al.
NPJ Prim Care Respir Med 2018;28:28
doi: 10.1038/s41533-018-0095-5

One million children in the UK have asthma, and asthma attacks are very common, affecting 50% of these children every year. Attacks result in morbidity and mortality, and are disruptive to the child and to their parents’ economic activity. As at least one-third of healthcare expenditure on childhood asthma is spent managing asthma attacks, preventing these attacks is a priority. It is therefore surprising that there have been no studies in the UK that describe the risk factors for future asthma attacks.

This retrospective cohort study used a large (n=3776) dataset of routinely acquired real-world patient information to address the question ‘what factors available in primary care practice can be used to predict asthma attacks in children aged 5–12 years?’

Variables included oral corticosteroid treatment for a previous attack, current control, severity, age, sex, obesity, peak flow and blood eosinophilia. The mean age was 9.0 years, and 57% were male.

Of all the outcomes collected in this study, a previous asthma attack (and especially two attacks) was the best predictor of children who might benefit from intervention aimed at reducing their risk of future asthma attacks. Blood eosinophilia, reduced peak expiratory flow, lower respiratory tract infection and younger age were also associated with increased risk, but only weakly. Guidelines recommend that the review held in primary care within two working days of discharge from hospital includes checking inhaler technique, as well as re-examining the asthma action plan; the authors of this study suggest that further research is needed to determine if an early review after an asthma attack could reduce future asthma attacks.

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