RISK FACTORS, DIAGNOSTIC CHALLENGES, AND MANAGEMENT OUTCOMES IN PEDIATRIC ASTHMA (AGES 1–12 YEARS): A PROSPECTIVE COHORT STUDY ALIGNED WITH THE GINA GUIDELINES

PUSHPARAJ NILKANTH PATIL; ZUBAIR KHAN

doi:10.22159/ajpcr.2025v18i6.54354

Authors

PUSHPARAJ NILKANTH PATIL Department of Pediatrics, Namo Meri Silvassa, India https://orcid.org/0000-0002-4867-8131
ZUBAIR KHAN Department of Pediatrics, Namo Meri Silvassa, India

DOI:

https://doi.org/10.22159/ajpcr.2025v18i6.54354

Keywords:

Childhood Asthma, GINA Guidelines, Spirometry, FEV 1

Abstract

Objective: To identify risk factors for uncontrolled asthma, to evaluate diagnostic alignment with the Global Initiative for Asthma (GINA) criteria, and to assess management outcomes in children aged 1–12 years.

Methods: A prospective cohort study enrolled 378 children (1–12 years) diagnosed with asthma at SVBCH Hospital, Silvassa, from January 2022 to December 2023. GINA criteria defined asthma and uncontrolled disease. Multivariate logistic regression was used to identify risk factors, and management outcomes were analyzed using Cox proportional hazards models.

Results: Of 378 children (57% male, median age 6 years), 36% (n=136) had uncontrolled asthma. Significant risk factors included tobacco smoke exposure (adjusted odds ratio [aOR] 2.2, 95% confidence interval [CI]: 1.4–3.5, p<0.001), medication non-adherence (aOR 3.0, 95% CI: 1.8–4.9, p<0.001), and atopic dermatitis (aOR 1.7, 95% CI: 1.1–2.8, p=0.01). Use of controller medications reduced exacerbation risk by 42% (Hazard ratio [HR] 0.58, 95% CI: 0.42–0.79, p<0.001), and asthma action plans were associated with a 28% reduction in emergency visits (HR 0.72, 95% CI: 0.53–0.97, p=0.03).

Conclusion: Strengthening GINA-compliant diagnosis, caregiver education, and environmental modifications are critical to improving outcomes in young children with asthma.

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References

Zhou W, Tang J. Prevalence and risk factors for childhood asthma: A systematic review and meta-analysis. BMC Pediatr. 2025;25(1):50. doi: 10.1186/s12887-025-05409-x, PMID 39833735

Khan S, Monika. Circadian rhythms regulated asthma treatment by virtue of pulsatile drug delivery system. Int J Appl Pharm. 2022;14(4):1-8. doi: 10.22159/ijap.2022v14i4.44395

Chung HL. Diagnosis and management of asthma in infants and preschoolers. Clin Exp Pediatr. 2022 Dec;65(12):574-84. doi: 10.3345/ cep.2021.01746, PMID 35436814

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention; 2021. Available from: https://ginasthma.org/wpcontent/ uploads/2021/05/gina/pocket/guide/2021/v2/wms.pdf

Salama AA, Mohammed AA, El Okda El SE, Said RM. Quality of care of Egyptian asthmatic children: Clinicians adherence to asthma guidelines. Ital J Pediatr. 2010;36:33. doi: 10.1186/1824-7288-36-33, PMID 20406498

Yang CL, Gaffin JM, Radhakrishnan D. Question 3: Can we diagnose asthma in children under the age of 5 years? Paediatr Respir Rev. 2019 Feb;29:25-30. doi: 10.1016/j.prrv.2018.10.003, PMID 30528365

Stokes JR, Bacharier LB. Prevention and treatment of recurrent viral-induced wheezing in the preschool child. Ann Allergy Asthma Immunol. 2020 Aug;125(2):156-62. doi: 10.1016/j.anai.2020.05.018, PMID 32454096

Zaeh SE, Ramsey R, Bender B, Hommel K, Mosnaim G, Rand C. The impact of adherence and health literacy on difficult-to-control asthma. J Allergy Clin Immunol Pract. 2022;10(2):386-94. doi: 10.1016/j. jaip.2021.11.003, PMID 34788658

Wang Z, May SM, Charoenlap S, Pyle R, Ott NL, Mohammed K, et al. Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2015;115(5):396-401.e2. doi: 10.1016/j. anai.2015.08.005, PMID 26411971

Sankeshwari S, Gangadharappa HV, Asha Spandana KM, Eliyas A, Thirumaleshwar S, Harsha Vardhan PV. A review on the solid oral dosage form for pediatrics, regulatory aspects, challenges involved during the formulation, and toxicity of the excipients used in pediatric formulation. Int J Appl Pharm. 2023;15(3):12-27.

Klok T, Kaptein AA, Brand PL. Non-adherence in children with asthma reviewed: The need for improvement of asthma care and medical education. Pediatr Allergy Immunol. 2015;26(3):197-205. doi: 10.1111/ pai.12362, PMID 25704083

Fitzpatrick AM, Moore WC. Severe asthma phenotypes - how should they guide evaluation and treatment? J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):901-8. doi: 10.1016/j.jaip.2017.05.015, PMID 28689840

Duncan CL, Mentrikoski JM, Wu YP, Fredericks EM. Practice-based approach to assessing and treating non-adherence in pediatric regimens. Clin Pract Pediatr Psychol. 2014 Sep;2(3):322-36. doi: 10.1037/ cpp0000066, PMID 25506046

Paracha R, Lo DK, Montgomery U, Ryan L, Varakantam V, Gaillard EA. Asthma medication adherence and exacerbations and lung function in children managed in Leicester primary care. NPJ Prim Care Respir Med. 2023 Mar 25;33(1):12. doi: 10.1038/s41533-022-00323-6, PMID 36966170

Hill DA, Spergel JM. The atopic march: Critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018 Feb;120(2):131-7. doi: 10.1016/j.anai.2017.10.037, PMID 29413336

Castro-Rodríguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162(4 pt 1):1403-6. doi: 10.1164/ajrccm.162.4.9912111, PMID 11029352

Dombkowski KJ, Hassan F, Wasilevich EA, Clark SJ. Spirometry use among pediatric primary care physicians. Pediatrics. 2010 Oct;126(4):682-7. doi: 10.1542/peds.2010-0362, PMID 20819894

Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, et al. Key recommendations for primary care from the 2022 global initiative for asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33(1):7. doi: 10.1038/s41533-023-00330-1

Pegoraro F, Masini M, Giovannini M, Barni S, Mori F, Du Toit G, et al. Asthma action plans: An international review focused on the pediatric population. Front Pediatr. 2022;10:874935. doi: 10.3389/ fped.2022.874935, PMID 35592848