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Original ArticleOpen Access
Risk Factors of Relapse within Eight Weeks After an Acute Asthma Exacerbation in Thai Children
Benjaponpitak S ,
Benjaponpitak A ,
Kamchaisatian V ,
Sasisakulporn C ,
Santikul K ,
Direkwattanachai C
Background : Acute asthma relapse following treatment and discharge from hospital remains
a substantial problem. Various potential risk factors for relapse have been reported including age,
sex, frequency of hospitalization and emergency medications. All these factors, however, may not be
generalized for all patients because of difference in prevalence, trigger factors, types of allergens,
medical accessibility and psychosocial problems.
Objective : To identify factors associated with relapse following treatment for acute asthma
within the next 8 weeks in Thai children.
Material and method : The authors prospectively followed 91 children discharged from
Ramathibodi Hospital after treatment of an asthma attack from June 1999 to December 2000. Parents
were surveyed concerning their child's medical history, trigger factors, psychosocial and economic
variables. Data on severity of the attack, asthma scores, emergency treatment, and response to treatment
were recorded. Investigations included eosinophil count, total IgE, serum eosinophil cationic
protein (ECP), skin test, methacholine bronchial challenge test, and IQ test were performed and
recorded.
Results : Within the first week, only 6.6 per cent had relapsed and increased to 29.7 per
cent by 8 weeks. Patients who suffered relapse were more likely associated with age at asthma diagnosis
(OR, 2.90; 95% CI, l.l-7.5) and 6 years of age or under (OR 4.49, CI 1.22-16.54). From
the investigation results including eosinophil count, total IgE, serum ECP, skin test, methacholine
bronchial challenge test, and IQ test, there was no significant difference in the factors between patients
who suffered relapse and those who did not. From the psychosocial evaluation, 18 out 39 (46.2%)
studied cases had significant psychosocial disorders. They were 4 cases with delayed development and
mental retardation, 9 cases with parent-child relation problems, and 2 cases with serious intrafamilial
disorders. Most of these patients were non-relapse cases. However, the relationship between asthma
relapse and psychosocial disorders could not be ascertained since psychosocial evaluation was only
performed in one-third of the study population.
Conclusion : Among patients following acute asthma therapy, 29.7 per cent will have a
relapse. The authors identified the age at onset of asthma before the age of 6 years as an important
risk factor. This may help to decrease the relapse rate by more intensive and comprehensive management
among patients at high risk.
Key word : Acute Asthma, Relapse Asthma
a substantial problem. Various potential risk factors for relapse have been reported including age,
sex, frequency of hospitalization and emergency medications. All these factors, however, may not be
generalized for all patients because of difference in prevalence, trigger factors, types of allergens,
medical accessibility and psychosocial problems.
Objective : To identify factors associated with relapse following treatment for acute asthma
within the next 8 weeks in Thai children.
Material and method : The authors prospectively followed 91 children discharged from
Ramathibodi Hospital after treatment of an asthma attack from June 1999 to December 2000. Parents
were surveyed concerning their child's medical history, trigger factors, psychosocial and economic
variables. Data on severity of the attack, asthma scores, emergency treatment, and response to treatment
were recorded. Investigations included eosinophil count, total IgE, serum eosinophil cationic
protein (ECP), skin test, methacholine bronchial challenge test, and IQ test were performed and
recorded.
Results : Within the first week, only 6.6 per cent had relapsed and increased to 29.7 per
cent by 8 weeks. Patients who suffered relapse were more likely associated with age at asthma diagnosis
(OR, 2.90; 95% CI, l.l-7.5) and 6 years of age or under (OR 4.49, CI 1.22-16.54). From
the investigation results including eosinophil count, total IgE, serum ECP, skin test, methacholine
bronchial challenge test, and IQ test, there was no significant difference in the factors between patients
who suffered relapse and those who did not. From the psychosocial evaluation, 18 out 39 (46.2%)
studied cases had significant psychosocial disorders. They were 4 cases with delayed development and
mental retardation, 9 cases with parent-child relation problems, and 2 cases with serious intrafamilial
disorders. Most of these patients were non-relapse cases. However, the relationship between asthma
relapse and psychosocial disorders could not be ascertained since psychosocial evaluation was only
performed in one-third of the study population.
Conclusion : Among patients following acute asthma therapy, 29.7 per cent will have a
relapse. The authors identified the age at onset of asthma before the age of 6 years as an important
risk factor. This may help to decrease the relapse rate by more intensive and comprehensive management
among patients at high risk.
Key word : Acute Asthma, Relapse Asthma
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