Risk Factors for Moderate-Severe Asthma in Children Ages 5-11 Years With Early-Onset Atopic Dermatitis.

Abstract

Knowledge of risk factors in early childhood predisposing to moderate-severe persistent asthma (MS-Asthma) in later childhood is needed. To identify the risk factors for MS-Asthma at age 5 to 11 years in children with early-onset atopic dermatitis. Electronic health records identified a birth cohort to 11 years of 10,688 children with AD onset between birth and age 36 months. International Classification of Diseases, Ninth Revision/Tenth Revision-coded visits and laboratory data to 36 months were used to detect potential child and maternal risk factors for MS-Asthma. MS-Asthma was defined as Global Initiative for Asthma-step-care level of 3 or higher for a minimum of 4 years from ages 5 to 11 years. Robust Poisson regression determined risk ratios for MS-Asthma. Compared with children who did not develop MS-Asthma (N = 10,168), those developing MS-Asthma (N = 520 [4.9%]) from age 5 to 11 years were significantly (P ≤.01) more likely to be male, of non-Hispanic Black ethnicity, preterm, not-exclusively breast-fed for 1 month, and up to age 3 years have more perinatal respiratory disorders and respiratory infections, food allergy, allergic rhinitis, asthma, allergic sensitizations, and elevated blood eosinophil levels. Mothers of children with MS-Asthma had significantly more comorbidities and antibiotics dispensed, and less preexisting diabetes (P < .001). Significant adjusted risk factors observed before 36 months associated with increased MS-Asthma at age 5 to 11 years included food allergy; 6 or more atopic dermatitis medication dispensings; nasal corticosteroid dispensing; and number of dispensings of inhaled short-acting beta-agonists, montelukast, and inhaled corticosteroids. Significant protective risk factors were 1-month exclusive breast-feeding and preexisting maternal diabetes. Risk models for MS-Asthma in later childhood were developed on the basis of early childhood and maternal factors using administrative data.