Risk Factors of Relapse within Eight Weeks After an Acute Asthma Exacerbation in Thai Children
SUWAT BENJAPONPITA K, M.D.*, AMPORN BENJAPONPITAK, M.D.**, VASU KAMCHAISATIAN,M.D.*, CHERAPAT SASISAKULPORN,B.Sc.*, KANITT A SANTIKUL, M.Sc*, CHARERAT DIREKWATTANACHAI, M.D.*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, **Institute of Child and Adolescent Mental Health, Ministry of Public Health, Bangkok 10400, Thailand.
Objective : To identify factors associated with relapse following treatment for acute asthma within the next 8 weeks in Thai children.
Materials and Methods : 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 treat ment 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 diag nosis (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 manage ment among patients at high risk.
Keywords : Acute Asthma, Relapse Asthma
