A novel study in asthma research posted in ‘Thorax’ shed light on the distinct differences in characteristics and exacerbation rates among children across various age brackets (5-8 years, 9-11 years and adolescents [12-16 years]). Clinical practice guidelines should consider the age of an individual at the time of diagnosis contrary to the conventional approach of grouping adolescents and younger children as this appears to impact asthma severity and management.

Drawing from a comprehensive English dataset, Zainab Khalaf and colleagues investigated how age influences asthma severity, treatment strategies, and exacerbation patterns. Medical records from primary care spanning from 2004 to 2021 were connected with hospital records. The children were grouped considering their age at the time of diagnosis and followed till they entered the next age bracket. The age categories, consistent with management guidelines, were the youngest children (5 to 8 years), 9 to 11 years, and adolescents (12 to 16 years). Various attributes (body mass index, allergies and events occurring before and after diagnosis [including symptoms and medication usage]) were assessed. Additionally, exacerbation incidence was calculated, and associations with exacerbations were determined using multivariable Cox proportional hazards analysis.

Out of 119,611 qualified children, 61,940 (51.8%) were in the age group of 5 to 8 years, 32,316 (27.7%) were in the age group of 9 to 11 years, and 25,355 (21.2%) were adolescents. Many attributes varied by age: The highest percentage with atopic dermatitis, cough and food/drug allergies were observed in the youngest children, on the other hand, obesity, sensitization to aeroallergens, shortness of breath (dyspnoea) and short-acting beta-agonist only use was highest in the adolescents. Variation in the exacerbation rates is shown below (Table 1):

A difference in exacerbation risk factors by age also followed this trend: In children aged 5 to 8 years, males, atopic dermatitis, and food/drug allergies displayed strong associations, whereas obesity and aeroallergen sensitization were strongly linked for children aged 9 years and older.

Additionally, higher socioeconomic disadvantage was suggestively related to exacerbations through all age groups. Delayed diagnosis was most prevalent in younger children and correlated with more exacerbations across all age groups.