The epidemiology and management of school-age childhood asthma managed in primary care
File(s)
Author(s)
Khalaf, Zainab
Type
Thesis
Abstract
Background
Asthma in school-age UK children is a condition that results in considerable healthcare burden and can significantly impact a child’s quality of life. Although asthma care has evolved greatly, there are gaps in our knowledge of how age at diagnosis and different clinical practices affect asthma outcomes.
Methods
I used data from the Clinical Practice Research Datalink, linked to the Hospital Episode Statistics and the Office of National Statistics, to form a cohort of children aged 5–16 years with asthma. Using logistic regression, inverse probability treatment weighting (IPTW), and a self-controlled case series design, my analysis focused on four primary objectives: (1) examining age-based differences in asthma characteristics, (2) determining factors contributing to exacerbation risks, (3) evaluating the national uptake of good clinical practice activities (GCPA) such as asthma reviews, management plans, and inhaler technique checks, and (4) assessing the effectiveness of these practices in reducing exacerbations.
Results
My findings indicate differences in the characteristics of children based on the age of asthma diagnosis, including the prevalence of males, atopy, and obesity. Younger children experienced higher exacerbation rates than older ones. Other risk factors such as atopy, gender, socioeconomic deprivation, and obesity varied by age. Uptake of good clinical practice activities differed by age, deprivation, and body mass index. Notably, children receiving these activities had fewer exacerbations, especially when used together.
Conclusion
Children’s characteristics, exacerbation risk factors and asthma care differ according to the age their asthma was diagnosed. GCPA are very effective when used in conjunction at reducing asthma exacerbations in real-life clinical practice. These findings suggesting age-specific, comprehensive, guideline-based management would help to reduce asthma exacerbations in children. My results also highlight the need for targeted and equitable approaches to UK asthma care, especially for younger children, obese children, and children from socioeconomically disadvantaged backgrounds.
Asthma in school-age UK children is a condition that results in considerable healthcare burden and can significantly impact a child’s quality of life. Although asthma care has evolved greatly, there are gaps in our knowledge of how age at diagnosis and different clinical practices affect asthma outcomes.
Methods
I used data from the Clinical Practice Research Datalink, linked to the Hospital Episode Statistics and the Office of National Statistics, to form a cohort of children aged 5–16 years with asthma. Using logistic regression, inverse probability treatment weighting (IPTW), and a self-controlled case series design, my analysis focused on four primary objectives: (1) examining age-based differences in asthma characteristics, (2) determining factors contributing to exacerbation risks, (3) evaluating the national uptake of good clinical practice activities (GCPA) such as asthma reviews, management plans, and inhaler technique checks, and (4) assessing the effectiveness of these practices in reducing exacerbations.
Results
My findings indicate differences in the characteristics of children based on the age of asthma diagnosis, including the prevalence of males, atopy, and obesity. Younger children experienced higher exacerbation rates than older ones. Other risk factors such as atopy, gender, socioeconomic deprivation, and obesity varied by age. Uptake of good clinical practice activities differed by age, deprivation, and body mass index. Notably, children receiving these activities had fewer exacerbations, especially when used together.
Conclusion
Children’s characteristics, exacerbation risk factors and asthma care differ according to the age their asthma was diagnosed. GCPA are very effective when used in conjunction at reducing asthma exacerbations in real-life clinical practice. These findings suggesting age-specific, comprehensive, guideline-based management would help to reduce asthma exacerbations in children. My results also highlight the need for targeted and equitable approaches to UK asthma care, especially for younger children, obese children, and children from socioeconomically disadvantaged backgrounds.
Version
Open Access
Date Issued
2024-11-14
Date Awarded
01/07/2025
License URL
Advisor
Bloom, Chloe
Saglani, Sejal
Sponsor
Imperial College London
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)