title: Severe asthma features in children: a case-control online survey.
abstract: BACKGROUND
  Very few studies have explored the distinguishing features of severe asthma in childhood in Europe, and only one study was conducted in Southern Europe. The aim of this study was to provide a detailed characterization of children with severe asthma treated in specialized pediatric asthma centers across Italy.
  
  
  METHODS
  We conducted a web-based data collection of family, environmental, clinical and laboratory characteristics of 41 patients aged 6-17 years with severe asthma, defined according to the recent guidelines of the European Respiratory Society and the American Thoracic Society, and 78 age-matched peers with non-severe persistent asthma. The patients have been enrolled from 16 hospital-based pediatric pulmonology and allergy centers in Northern, Central, and Southern Italy. Logistic regression analysis assessed the relationship between patients' characteristics and severe asthma or non-severe persistent asthma.
  
  
  RESULTS
  Features independently and significantly associated with severe asthma included lifetime sensitization to food allergens [Odds ratio (OR), 4.73; 95 % Confidence Interval (CI), 1.21-18.53; p = 0.03], lifetime hospitalization for asthma (OR, 3.71; 95 % CI, 1.11-12.33; p = 0.03), emergency-department visits for asthma during the past year (OR = 11.98; 95 % CI, 2.70-53.11; p = 0.001), and symptoms triggered by physical activity (OR = 12.78; 95 % CI, 2.66-61.40; p = 0.001). Quality-of-life score was worse in patients with severe asthma than in subjects with non-severe persistent asthma (5.9 versus 6.6, p = 0.005). Self-perception of wellbeing was compromised in more than 40 % of patients in both groups. Children with severe asthma had lower spirometric z scores than non-severe asthmatic peers (all p < 0.001), although 56 % of them had a normal forced expiratory volume in 1 s. No differences were found between the two groups for parental education, home environment, patients' comorbidities, adherence to therapy, exhaled nitric oxide values, and serum eosinophils and IgE .
  
  
  CONCLUSIONS
  As expected, children with severe asthma had more severe clinical course and worse lung function than peers with non-severe persistent asthma. Unlike previous reports, we found greater sensitization to food allergens and similar environmental and personal characteristics in patients with severe asthma compared to those with non-severe persistent asthma. Psychological aspects are compromised in a large number of cases and deserve further investigation.
authors.affiliation: Department of Translational Medical Sciences, Federico II University, Naples, Italy. amina2004@virgilio.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Montella
authors.affiliation: Women's and Children's Health Department, University of Padua, Padua, Italy. baraldi@pediatria.unipd.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. salvatore_cazzato@aosp.bo.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cazzato
authors.affiliation: High Altitude Pediatric Asthma Center-Pio XII Institute, Misurina, Italy. aralla.raffaele@gmail.com.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Aralla
authors.affiliation: Women's and Children's Health Department, University of Padua, Padua, Italy. mariangelaberardi@virgilio.it.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Berardi
authors.affiliation: Department of Pediatrics, University of Bari "Aldo Moro", Bari, Italy. brunetti@pediatria3.uniba.it.
authors.forename: Luigia Maria
authors.initials: LM
authors.lastname: Brunetti
authors.affiliation: Department of Pediatrics, Pediatric Hospital "Giovanni XXIII", University of Bari, Bari, Italy. fabiocardinale@libero.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cardinale
authors.affiliation: Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy. renato.cutrera@opbg.net.
authors.forename: Renato
authors.initials: R
authors.lastname: Cutrera
authors.affiliation: Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy. pediatria@fmdebenedictis.it.
authors.forename: Fernando Maria
authors.initials: FM
authors.lastname: de Benedictis
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. emanuela.dipalmo@gmail.com.
authors.forename: Emanuela
authors.initials: E
authors.lastname: di Palmo
authors.affiliation: Department of Pediatrics, University of Chieti, Chieti, Italy. sabrinadipillo@libero.it.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Di Pillo
authors.affiliation: Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy. g.fenu@meyer.it.
authors.forename: Grazia
authors.initials: G
authors.lastname: Fenu
authors.affiliation: Institute of Biomedicine and Molecular Immunology of National Research Council, University of Palermo, Palermo, Italy. lagrutta@ibim.cnr.it.|Department of Science for Health Promotion and Mother and Child, University of Palermo, Palermo, Italy. lagrutta@ibim.cnr.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: La Grutta
authors.affiliation: Pediatric Pulmonary Unit, A. Meyer Children's University Hospital, Florence, Italy. enrico.lombardi@meyer.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lombardi
authors.affiliation: Pediatric Section, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy. giorgio.piacentini@univr.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Piacentini
authors.affiliation: Department of Translational Medical Sciences, Federico II University, Naples, Italy. santamar@unina.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Santamaria
authors.affiliation: Respiratory Unit, Department of Pediatric Medicine, Bambino Gesù Children Hospital, Rome, Italy. nicola.ullmann@opbg.net.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ullmann
authors.affiliation: Epidemiology Unit, A. Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy. f.rusconi@meyer.it.
authors.forename: Franca
authors.initials: F
authors.lastname: Rusconi
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires