Factors impacting asthma control in children in a low-to-middle income country setting: a retrospective study.
1) To assess asthma control and its evolution over time among children in a low-to-middle-income country, and 2) to explore whether demographics, type of asthma medication, comorbidities or exacerbations impact asthma control.



In a retrospective study in children with asthma aged 6-18 years conducted between 2005 and 2010, we collected clinical and demographic data and used Global Initiative for Asthma (GINA) criteria to assess asthma control. Proportions of children with well-controlled, partially controlled and uncontrolled asthma were calculated. Associations between different time points for lung function were investigated using Pearson correlation coefficients. Mixed effect regression analysis was used to investigate the effect of demographics, medication, comorbidity and exacerbations on lung function.



According to GINA criteria, asthma was well controlled in 44.9% of 189 enrolled children. Choice of add-on treatment and doubling the dose of inhaled corticosteroids, long-acting β-agonist or leukotriene receptor antagonists did not affect lung function tests (all P > 0.05). On mixed-model analysis, there was a correlation between duration of asthma treatment and forced expiratory volume in 1 s (FEV1) % predicted (P < 0.05). Exacerbations and uncontrolled asthma had a negative impact on FEV1 % predicted (P < 0.05). Therapeutic decisions were guided by spirometry results in only 21% of cases.



Asthma control was not achieved in the majority of the children. Choice of step-up therapy did not impact asthma control or lung function.
Department of Paediatrics and Child Health, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
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Monene
Department of Maternal and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Masekela
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D015992:Body Mass Index; D002648:Child; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists