Background

Children with uncontrolled asthma despite step 1-3 treatment are under-treated. Although these patients are easily classified according to international guidelines, they are seldom characterized in studies.

Objective

To characterize uncontrolled, severe and under-treated asthma.

Methods

We performed a nationwide cross-sectional study of 5497 children (6-17 years) with secondary care recordings from 2019 in the Swedish National Airway Register. Uncontrolled asthma was defined as Asthma Control Test (ACT) ?19 and/or ?2 exacerbations last year and/or FEV1<80% predicted. Asthma severity was defined according to the Global Initiative for Asthma (GINA) and under-treated asthma was defined as uncontrolled asthma with GINA steps 1-3 treatment.

Results

Uncontrolled asthma was identified in 1824 children (33%), 59% had ACT?19, 18% had recurrent exacerbations and 40% had FEV1<80%. Uncontrolled asthma was associated with females (OR 1.19, (CI 1.06-1.33)), older age (OR 1.03, (CI 1.01-1.05)) and obesity (OR 1.33, (CI 133-1.79)). Asthma severity was classified into mild (40%), moderate (19%) and severe asthma (13%) and the latter was associated with higher age (OR 1.17, (CI 1.14-120)) and obesity (OR 1.55, (CI 1.1-2.19)). Under-treated asthma was identified in 28% and was associated with adolescent girls (OR 1.57(CI 1.31-1.9)). ACT and FEV1 were lower and exacerbations were four-fold more common in under-treated compared to severe asthma

Conclusion

Under-treated childhood asthma is easy to identify, common and should be minimized. We propose that the prevalence of under-treated patients in any asthma cohort is an important outcome to benchmark the quality of healthcare for asthmatics