Risk factors for recurrent attacks of wheeze in preschool children: a population-based cohort study in England.

Abstract

To determine factors associated with recurrent attacks of acute wheeze in preschool children. Retrospective cohort study. English primary electronic health data from the Clinical Practice Research Datalink linked with hospital data from Hospital Episode Statistics. 42 820 children aged 5 years or under with at least one acute wheeze presentation between 1 January 2013 and 31 December 2014. Demographic and clinical variables including age, sex, ethnicity, deprivation quintile, clinical comorbidities and previous asthma medication prescriptions and acute attacks were included in multivariable analyses. Further healthcare presentation with an acute wheeze/asthma attack within 12 months. Almost 40% (16 962/42 820) of children had a further attack within 12 months. The strongest predictors were hospitalisation with the index episode (RR 1.42; 95% CI 1.39 to 1.45) and an attack in the previous year (1.27; 1.22 to 1.32). Male sex (RR 1.06; 95% CI 1.03 to 1.08), South Asian ethnicity (1.08; 1.04 to 1.12), atopy (1.21; 1.18 to 1.24), prematurity (1.09; 1.04 to 1.14), increasing reliever prescriptions (1.04; 1.03 to 1.04), number of previous attacks (1.03; 1.02 to 1.04) and previous hospitalisation with wheeze (1.09; 1.05 to 1.14) were also associated with further attacks.Older age at presentation (RR 0.92; 0.91 to 0.93) and number of prescriptions for inhaled corticosteroids (0.96; 0.95 to 0.97) in the previous year were associated with lower risk for further attacks. Our findings can be used to aid clinical risk prediction for further attacks of wheeze in preschool children.