Developmental Disabilities Linked to Greater Pediatric Asthma Risk

Sarah E. Messiah, PhD, MPH

Risk of developing asthma appears to be greater in US children with developmental disabilities or delays, according to new findings from a team of Texas-based investigators.

In a population-based, cross-sectional assessment of 71,000-plus families from the 2016-17 National Survey of Children’s Health, investigators observed associations between disabilities including ADHD, autism spectrum disorder, cerebral palsy, and increased risk of pediatric asthma.

The findings paint a correlation between asthma and developmental disabilities and delays, a pair of conditions which are each common in approximately just under 10% of all US children—and are both more prevalent in minority populations.

Investigators, led by Sarah E. Messiah, PhD, MPH, of the Center for Pediatric Population Health at the Children’s Health System of Texas, sought to complement growing but lacking evidence showing concurrent prevalence of asthma among children and adolescents with developmental disabilities and delays.

They noted a systematic review and meta-analysis observed patients with ADHD reported a 50% greater odds of having concurrent asthma, when adjusted for confounders. Another meta-analysis specified associations between ADHD and asthma in children and adolescents—though both assessments were limited by their assessment of disabilities and patient demographics.

“In summary, previous studies examining the prevalence of asthma among various disability and delay groups have been generally limited to behavioral and cognitive disorders, with mixed results,” they wrote.

Messiah and colleagues hypothesized their cross-sectional assessment of national survey data—with 10 developmental disability and delay categories and consideration to patient demographics—would show a correlation between the conditions in children and adolescents.

The tea conducted their study using 71,811 families with children or adolescents aged 0-17 years old to have participated in the national survey.

Observed developmental disabilities included ADHD, autism, cerebral palsy, seizure, intellectual and/or learning disability, ad delay of vision, hearing, and/or speech. Delays were defined as not meeting growth milestones with unknown cause.

The surveyed population was a mean 8.6 years old, with slightly majority male (51.1%) and non-Hispanic white (51.4%). Investigators observed 5687 (7.9%) children with asthma, and 11,426 (15.3%) with at least 1 disability.

Overall asthma prevalence estimates were nearly 10 percentage points greater in children with a confirmed disability (16.1%; 95% CI, 14.3-17.8) than those without (6.5%; 95% CI, 6.0-6.9).

Children with a disability reported nearly three-fold greater odds in having asthma (OR, 2.77; 95% CI, 2.39-3.21) than typically-growing children. Children with a delay also reported significantly greater odds of asthma (OR, 2.22; 95% CI, 1.78-2.77).

Pediatric asthma odds was approximately two-fold raised in children with ADHD (OR, 2.36; 95% CI, 1.99-2.78), autism (OR, 2.25; 95% CI, 1.48-3.41), seizures (OR, 2.63; 95% CI, 1.68-4.13), blindness (OR, 1.93l 95% CI, 1.32-2.81), speech problem (OR, 2.19; 95% CI, 1.67-2.87), intellectual disability (OR, 2.17; 95% CI, 1.41-3.35), and learning disability (OR, 2.80; 95% CI, 2.24-3.49).

Ethnic minority children had a greater prevalence of concurrent asthma plus developmental disabilities (19.8%; 95% CI, 16.6-23.0) versus non-Hispanic white children (12.6; 95% CI, 11.1-14.0; P <.001).

Messiah and colleagues wrote the findings may suggest that the unique association—particularly among minority children&mdash;may be intermediated by asthma-related missed school days. They noted that nearly half of all children with asthma report missing days of school in the US&mdash;a factor associated with low academic performance, which is oftentimes misclassified as a learning disability.

“Indeed, a particular challenge to educating children with various cognitive disabilities and concurrent asthma is adequate disease management, such as appropriate use of inhalers, anticipation of an asthmatic episode, and anxiety due to this anticipation,” they wrote.

Current pediatric asthma guidelines do not make mention of disabilities nor delays as risk factors. The team concluded that raised awareness of increased concurrent diagnosis odds among both asthma and disability/delay patient groups could lead to bettered and timely diagnostics, improved respiratory health management, and reduced healthcare costs.

“In the future, longitudinal studies rigorously controlling for possible maternal and child confounders are needed to explore the possible link between asthma and developmental disabilities in a diverse pediatric population,” they wrote.

The study, “Estimated Prevalence of Asthma in US Children With Developmental Disabilities,” was published online in JAMA Network Open.