Asthma: specific clinical and functional characteristics in childhood. Results of a national program in Romanian asthmatic children

Summary Childhood asthma presents with specific clinical and functional characteristics. The aim of our study was the description of a large cohort of asthmatic children. It was also to assess their outcome with maintenance therapy according to guidelines, and to analyze the relationship with baseline’s characteristics. We focused particularly on clinical and functional pediatric specificities. Methods: Prospective study driven on asthmatic children, without treatment, recruited during a hospitalization for exacerbation or a visit for uncontrolled asthma, treated according to GINA guidelines and followed for one year. Results: 412 children (mean age: 11.6 years +/- 2.7), were included. The level of severity was: intermittent asthma for 30% and persistent asthma for 70% (40.5% mild, 28% moderate, 1.5% severe). Mean preβ2-FEV1 was 88.5% +/- 10.5 (PV) with mean β2-reversibility of 10.8% +/- 7.8 (>12% for 42% patients). 374 patients ended the study. After one year, we observed an improvement of clinical symptoms (p<0.0001), rate of hospitalization (p<0.0001), and lung function (mean preβ2FEV1: 91.2% +/- 7.9, p<0.001). Asthma control was obtained for only 24.6%. Multivariate analysis show that decrease of symptoms was significantly related to younger age, higher level of initial severity and number of days of hospitalization. Conclusion: This study confirms pediatric specificities of asthma, as a normal FEV1 level and a limited β2-reversibility of FEV1, and the large part of uncontrolled asthma after one year of treatment. It emphasizes the risk of undertreatment in a strategy based on severity. It argues for the regular assessment of control as now recommended, taking into account the pediatric asthma specificities.