Atmospheric environment and persistence of pediatric asthma: A population-based cohort study

Background: Asthma is a heterogeneous disease with different outcomes. For children with asthma at the age of 7 years, 67–75% are symptom-free as adults. Data on the important link between childhood and adult asthma are sparse. Objective: We aimed to investigate factors associated with persistence of childhood asthma over three years of follow-up by linking data between Korea childhood Asthma Study (KAS) and their matched claims data from Health Insurance Review and Assessment Service (HIRA). Methods: We analyzed data from 450 preadolescent children aged 7 to 10 years and classified them into remission or persistence groups. Baseline clinical characteristics and exposure to air pollution materials including PM2.5 and PM10 during three years of follow-up were compared. The main outcome was asthma persistence which was defined as the presence of asthma episodes with healthcare utilization and prescription of asthma medications within three years after KAS enrollment. Results: At the third year of follow-up, after stepwise regression analysis, lower age at enrollment (adjusted odds ratio (aOR): 0.79; 95% confidence interval (CI): 0.64–0.96), male sex (aOR: 1.66; 95%CI: 1.05–2.63), proximity from an air-polluting facility (aOR: 2.4; 95%CI: 1.34–4.29), higher level outdoor PM2.5 (aOR: 1.1; 95%CI: 1.02–1.20), and higher rate of doctor-diagnosed food allergy (FA) (aOR: 2.33; 95%CI: 1.06–5.12) were significantly associated with persistence. Conclusion: We discovered various independent risk factors for the persistence of childhood asthma. By linking HIRA claims data, we could clarify risk factors for persistence in a well-defined study population.