Features of severe asthma in young children from Romania

Background and aim

Asthma is one of the most important chronic disease in children, due to high prevalence and increased direct and indirect costs. A complex effort [GA2LEN, Me-DALL and ARIA groups] was organized to address the area of severe allergic diseases, including severe asthma. The concept of “problematic-severe-asthma” has risen and two major groups of asthmatic children were identified: difficult-to-treat asthma and therapy resistant asthma. There were published few papers on asthmatic children from Romania, only one paper addressing the area of severe asthma in school-age children. We describe features of severe asthma in young and preschool children from Romania.

Materials and methods

Cross-sectional study of patients in tertiary-referral asthma clinic: were included children with previously diagnosed asthma or recurrent-wheezing phenotype, up-to 10-years of age. All these children were referred by GP or pediatrician because of severe/uncontrolled disease. A complex evaluation was performed to exclude alternative diagnostics. At first visit, an extensive training for device use, inhalation technique and trouble-shooting was implemented.

Results

313 referrals (between Oct 2011-Mar 2012) were evaluated. 233 children were evaluated 1-5 times. 216 children were included. They were 56.7 months old (4-125 mo), 153 (70.83%) were boys, 182 (84.26%) were inner-city children. For 202 (93.53%) evaluation per-protocol was completed. 153 (75.74%) had identifiable factors for not achieving control. 49 (24.26%) had severe disease that generated multiple visits or exacerbations. In 6 children (12.24%) asthma was excluded. The remaining 43 (87.76%) had uncontrolled asthma, but really difficult-to-treat or refractory asthma was documented only in 8 (3.7% of included patients, 16.33% of children with more severe disease and no identifiable factors). They didn’t present male dominance (50% girls) were significantly older (83.6 months) had frequently severe rhino-conjunctivitis (75%) and atopic dermatitis (62.5%). In 2 cases severe side effects of medication were documented (severe depression associated with LTRA). High frequency of exacerbations (87.5% with 1-4 episodes) was noted.

Conclusions

1. Problematic-severe-asthma is more frequent than previously described in romanian children (3.7% vs 1.5%).

2. They are older, more often girls, have severe allergic associated-diseases and exacerbate more frequent than other asthmatic children in spite of aggressive treatment.