Acute Asthma Exacerbations and the Recovery Phase in Children

Abstract

Acute asthma exacerbations are common in children, and many have prolonged morbidity beyond the acute phase. The overall aim of my thesis was to improve the knowledge of asthma in children relating to the management of acute exacerbations, with focus on the post-acute phase and its impact on parents/caregivers

My PhD addressed several clinical gaps. In addressing the lack of a systematic review evaluating the effectiveness of inhaled anticholinergic agents alone in children with acute asthma, my Cochrane review found that inhaled anticholinergics as single agent bronchodilators were less efficacious than beta2-agonists or inhaled anticholinergics combined with beta2-agonists.

Prior to my PhD work, there was little data on the determinants affecting acute asthma severity and recovery nor the impact of respiratory pathogens on severity or symptom resolution and the ongoing morbidity and recovery phase post-asthma exacerbation. My PhD work involved a cohort study in 2 hospitals that enrolled 244 children with acute asthma who were followed up. The principal findings from the cohort study (3 publications) were:

1. Atopic children were significantly more likely to represent for asthma by day-14 but upper airway microorganisms had minimal impact on acute asthma or the recovery.

2. Children on inhaled corticosteroids were more likely to have prolonged cough on day-14.

3. Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores correlated with Asthma Diary Scale and Paediatric Asthma Caregiver’s Quality-of-Life (QoL) scores. However, the presence of respiratory viruses did not influence CARIFS scores.

In conclusion, persistent symptoms beyond the acute asthma phase are common and impact substantially on parental/caregiver burden and the QoL of children and their families. Identifying the key factors is vital to optimise clinical management in order to reduce the burden on the child and parent/caregiver, improve future respiratory health and prevent potential impairment in airway development and lung function

Date of Award	2021
Original language	English
Supervisor	Anne Chang (Supervisor) & Gabrielle McCallum (Supervisor)