Role of Family History in Pediatric Asthma Control

As many diseases are increasingly looking to genetics and family trees for answers, a team of investigators led by Shahid Sheikh, MD, of Nationwide Children’s Hospital, attempted to do the same for asthma in pediatric patients.

Data from the 3-year prospective cohort study were presented at the 2018 CHEST Annual Meeting in San Antonio, TX.

Children enrolled in the study first required an Institutional Review Board (IRB) approval. Subsequently, they were referred by primary care physicians with an uncontrolled asthma diagnosis, which granted them enrollment into the Nationwide Children’s Hospital pediatric asthma center circa 2011. Asthma care, per the National Asthma Education and Prevention Program [NAEPP (EPR-3)] guidelines, was provided.

Questionnaires that included acute care need, symptom control, and Asthma Control Test (ACT) were completed by families at each visit (3-6 months), which also assessed asthma control.

Data were compared between patients with or without family history of asthma (parents, siblings). Mean, standard deviation, median, and interquartile range (depending on the normality of the data) measured the distribution scores.

Change in asthma indicators over 3-6-month increments were evaluated by Poisson Mixed Effects Model. The alpha level of significance was less than or equal to .05.

The collected data included information from 395 children aged 2 to 17 years, [median 6 (3, 9)]; 61% was male. The duration of symptoms in years at diagnosis was 3 (1, 6), and the median age in years was 1.5 (1, 3). In 285 (72%) of children, a family history of asthma was reported.

Among children with or without a family history of asthma, there was no significant difference in demographics.

By the 3-6 month follow-up visit, acute care need scores, which included hospital admissions, emergency department visits, urgent care visits, primary care visits, school days missed, short courses of oral steroids, and the number of days requiring albuterol and mean percent predicted FEV1, mean ACT and asthma symptoms (number of days with wheezing and night time cough improved in the total cohort (n=395, p<.001 for all). Improvement continued for the 3-years follow-up period.

Over time, a family history of asthma did not prove to be a significant covariate in asthma improvement.

Between groups with and without a family history of asthma, no significance difference was observed, despite improvement with time in all parameters.

From their data, study authors concluded that asthma management in line with the NAEEP (EPR-3) guidelines can help pediatric patients with asthma achieve better disease control.

Authors noted that the clinical implication shows family history of asthma is not a key factor in asthma control once the guidelines are followed.

The NAEEP (EPR-3) guidelines, which were updated in 2002, include variability on the pattern of inflammation as phenotypic differences may influence treatment responses; criteria regarding the considerable variability in the pattern of inflammation; gene-by environmental interactions; pattern of the disease risk factors (like atopic disease, recurrent wheezing, and parental history of asthma); and current treatment with anti-inflammatory and underlying disease severity.

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The abstract, “Impact of Genetic Factors (Family History of Asthma) on Long-Term Asthma Control in Patients” was presented at the CHEST 2018 annual meeting.