Wheezing illnesses are extremely common in preschool children under five years old. Most episodes get better on their own, but many children continue to have frequent wheezing illnesses. These can lead to emergency hospital visits, missed preschool and continuous symptoms that stop them doing the things they enjoy.
In children with frequent wheezing, regular “preventer” medications can help. One such medicine type, called “inhaled corticosteroids”, can reduce wheezing attacks by up to half if given regularly. Despite wheeze attacks increasing, there has not been an increase in the use of preventer medications. This is worrying, and means many children suffering from wheezing illnesses are not on appropriate treatments. Although there may be many reasons for this, in older children, social deprivation is a risk factor for poorer symptoms control, and differences in care is seen in people from different ethnic backgrounds. We do not know if this is also true in preschool children.
This study aims to understand if preschool children from different ethnic and social backgrounds present differently to healthcare providers, and whether there are differences in how soon they are referred to a hospital specialist, or started on a regular preventer medication to try to reduce how often they wheeze.
This will help us to recognise groups of children who are at risk of poorer treatment for their preschool wheezing illnesses.
Our objective is to better understand the burden of wheezing illnesses in preschool children, and to explore whether health seeking behaviour and treatment decisions for preschool wheeze differ between children from different socioeconomic and ethnic backgrounds. In addition, we will investigate which independent factors may be associated with an increased frequency of preschool wheezing episodes in children.
By defining groups of preschool children with the highest frequency of preschool wheeze episodes, the highest risk of subsequent wheezing episodes, and those where treatment and/or referrals for specialist care are not initiated despite having frequent/severe episodes of wheeze, future interventions to improve management of recurrent preschool wheeze can be designed to specifically target these groups.
For this study we will include a cohort of preschool children presenting to primary or secondary care with at least one episode of a wheeze related illness (identified by SNOMED CT, ICD10, A&E codes) between their 1st and 5th birthdays. We will use CPRD Aurum data linked with HES APC, HES A&E, HES OP, Mother-Baby Link, Rural Urban Classification and patient level IMD data. The study period will be 1st January 2009 to 31st December 2013, and follow up for each child will be up to their sixth birthday.
We will describe where children from different ethnic and socioeconomic backgrounds seek help for their preschool wheeze illnesses, and the number of episodes of wheeze they experience before they are either trialled on a preventer medication or referred to a hospital specialist. We will conduct separate Cox regression analyses to estimate hazard ratios for referral to hospital specialist, and for initiation of regular preventer medications. We will also conduct a Poisson regression analysis to determine factors associated with an increasing number of episodes of wheeze in preschool children.
- Presentations to the accident and emergency department (A&E) and to general practice (GP) with episodes of wheeze in preschool children, overall number and by IMD quintile and ethnic group;
- Number of healthcare attendances for preschool wheeze episodes until escalation of care (referral to specialist clinic or prescription of asthma preventer medications), overall number and by IMD quintile and ethnic group;
- Patient factors associated with increasing number of episodes of preschool wheeze (defined by number of healthcare presentations with wheeze).
- Predictors for further attacks of wheeze following an acute presentation with wheeze
David Lo - Chief Investigator - University of Leicester
David Lo - Corresponding Applicant - University of Leicester
Claire Lawson - Collaborator - University of Leicester
Clare Gillies - Collaborator - University of Leicester
Erol Gaillard - Collaborator - University of Leicester
Hilary Pinnock - Collaborator - University of Edinburgh
Jennifer Quint - Collaborator - Imperial College London
Sharmin Shabnam - Collaborator - University of Leicester
Clare Gillies - Collaborator - University of Leicester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;Rural-Urban Classification