Risk factors of relapse within eight weeks after an acute asthma exacerbation in Thai children.
BACKGROUND
Acute asthma relapse following treatment and discharge from hospital remains a substantial problem. Various potential risk factors for relapse have been reported including age, sex, frequency of hospitalization and emergency medications. All these factors, however, may not be generalized for all patients because of difference in prevalence, trigger factors, types of allergens, medical accessibility and psychosocial problems.


OBJECTIVE
To identify factors associated with relapse following treatment for acute asthma within the next 8 weeks in Thai children.


METHODS
The authors prospectively followed 91 children discharged from Ramathibodi Hospital after treatment of an asthma attack from June 1999 to December 2000. Parents were surveyed concerning their child's medical history, trigger factors, psychosocial and economic variables. Data on severity of the attack, asthma scores, emergency treatment, and response to treatment were recorded. Investigations included eosinophil count, total IgE, serum eosinophil cationic protein (ECP), skin test, methacholine bronchial challenge test, and IQ test were performed and recorded.


RESULTS
Within the first week, only 6.6 per cent had relapsed and increased to 29.7 per cent by 8 weeks. Patients who suffered relapse were more likely associated with age at asthma diagnosis (OR, 2.90; 95% CI, 1.1-7.5) and 6 years of age or under (OR 4.49, CI 1.22-16.54). From the investigation results including eosinophil count, total IgE, serum ECP, skin test, methacholine bronchial challenge test, and IQ test, there was no significant difference in the factors between patients who suffered relapse and those who did not. From the psychosocial evaluation, 18 out 39 (46.2%) studied cases had significant psychosocial disorders. They were 4 cases with delayed development and mental retardation, 9 cases with parent-child relation problems, and 2 cases with serious intrafamilial disorders. Most of these patients were non-relapse cases. However, the relationship between asthma relapse and psychosocial disorders could not be ascertained since psychosocial evaluation was only performed in one-third of the study population.


CONCLUSIONS
Among patients following acute asthma therapy, 29.7 per cent will have a relapse. The authors identified the age at onset of asthma before the age of 6 years as an important risk factor. This may help to decrease the relapse rate by more intensive and comprehensive management among patients at high risk.
Benjaponpitak
Suwat
S
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Benjaponpitak
Amporn
A
Kamchaisatian
Vasu
V
Sasisakulporn
Cherapat
C
Santikul
Kanitta
K
Direkwattanachai
Charerat
C
D000208:Acute Disease; D000367:Age Factors; D001249:Asthma / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors