Asthma control in children is associated with nasal symptoms, obesity, and health insurance: a nationwide survey.
BACKGROUND
This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma-related healthcare services and medication use.


METHODS
Data of 98 children with current asthma, from the second phase of a nationwide population-based telephone survey (INAsma study), were analyzed. Asthma control definition was based on GINA criteria, grouping partially controlled and uncontrolled asthma as 'not-controlled asthma' (NCA). We used multivariate logistic regression to study factors associated with NCA and with unscheduled medical visits for asthma.


RESULTS
About half of the children had NCA (49%, 95% CI 39-59%). In the multivariate model, risk factors for NCA were as follows: substantial nasal symptoms (a OR 6.80), overweight/obesity (a OR 3.44), and not having health insurance (a OR 3.78). All the children with NCA had nasal symptoms, and the lack of asthma control was also associated with the increasing number of nasal symptoms (p < 0.001). In the previous year, 90% (95% CI 84-96%) of children with current asthma had healthcare visits and 67% (95% CI 58-77%) used medication for asthma. The risk of unscheduled medical visits was higher in children with nasal symptoms (a OR 3.63) and in those without health insurance (a OR 2.79), and lower in adolescents (a OR 0.19).


CONCLUSIONS
Half of the children with asthma were poorly controlled. Nasal symptoms and obesity are important determinants of asthma control. Children without health insurance are at greater risk of poor asthma outcomes; this association is reported for the first time in a European country.
Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.|CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.|Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal.
Manuel
M
Ferreira-Magalhães
CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.|Allergy Unit, CUF Institute & Hospital, Porto, Portugal.
Ana Margarida
AM
Pereira
CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.
Ana
A
Sa-Sousa
Allergy and Clinical Immunology Division Unit, CUF Descobertas and CUF Infante Santo Hospital, Lisbon, Portugal.|Sociedade Portuguesa de Alergologia e Imunologia Clínica, Lisbon, Portugal.
Mário
M
Morais-Almeida
Department of Pediatrics, Centro Hospitalar de S. João, Porto, Portugal.|Department of Pediatrics - Faculty of Medicine, University of Porto, Porto, Portugal.
Inês
I
Azevedo
CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.|Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal.
Luís Filipe
LF
Azevedo
CINTESIS - Center for Research in Health Technologies and Information Systems - Faculty of Medicine, University of Porto, Porto, Portugal.|Allergy Unit, CUF Institute & Hospital, Porto, Portugal.|Health Information and Decision Sciences Department - Faculty of Medicine, Porto University, Porto, Portugal.
João Almeida
JA
Fonseca
D000293:Adolescent; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits; D063766:Pediatric Obesity / Q000175:diagnosis / Q000453:epidemiology*; D011174:Portugal / Q000453:epidemiology; D012220:Rhinitis / Q000175:diagnosis / Q000453:epidemiology*; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents
asthma; control; delivery of health care; health insurance; obesity; rhinitis; wheezing