Abstract / Summary
Background: Achieving adequate asthma control remains a major challenge in pediatric patients, even among those followed in specialist clinics.Real-world data describing asthma control in routine clinical practice are limited.Objective: To describe asthma control assessed by the Asthma Control Test (ACT) in children followed in a tertiary pediatric pulmonology clinic and, as exploratory secondary aims, to describe the distribution of age, exacerbation frequency, controller treatment step, and total immunoglobulin E (IgE) in relation to asthma control.Methods: This retrospective, descriptive observational study included children with physician-diagnosed asthma followed in a tertiary pediatric pulmonology clinic between January 2023 and December 2024.Asthma control was assessed with the standard ACT, administered to all children, and defined as controlled (ACT ≥20) or uncontrolled (ACT <20).Variables included age, number of exacerbations during the previous year, controller treatment step according to the Global Initiative for Asthma (GINA), and total IgE.Continuous variables were summarized as median and interquartile range (IQR).Group comparisons were performed with the Mann-Whitney U and Fisher's exact tests, correlations with Spearman's rank correlation, and 95% confidence intervals (CIs) were reported for all estimates.Results: A total of 36 children were included; an ACT score was available for 34 (94%), who formed the analysed sample.Twenty children (58.8%) had controlled asthma, and 14 (41.2%,95% CI 26.4% to 57.8%) had uncontrolled asthma.Children with uncontrolled asthma tended to be older than those with controlled asthma (median age 8.5 vs 6.5 years; median difference 2.0 years, 95% CI -0.5 to 5.0), although this difference did not reach statistical significance (p = 0.052).Step 3 or higher controller therapy was recorded in 8 of 14 children with uncontrolled asthma (57.1%) and 8 of 20 with controlled asthma (40.0%; p = 0.49).In an exploratory analysis, ACT score was inversely correlated with controller treatment step (Spearman ρ = -0.36,95% CI -0.62 to -0.02; p = 0.04), consistent with treatment escalation in children with more difficult asthma.Exploratory correlation analyses showed a moderate negative correlation between ACT score and total IgE (Spearman ρ = -0.42,95% CI -0.79 to 0.17; p = 0.15; n = 13) and a weak negative correlation between ACT score and exacerbation frequency (ρ = -0.29,95% CI -0.57 to 0.05; p = 0.09; n = 34), neither of which reached statistical significance.Conclusions: A substantial proportion of children followed in a tertiary pediatric pulmonology clinic had suboptimal asthma control despite specialist care.Older children tended to have poorer asthma control, although this difference did not reach statistical significance, and lower ACT scores were associated with higher-intensity controller therapy, most plausibly reflecting treatment escalation in children with more difficult asthma rather than a treatment effect.These exploratory findings highlight the need for ageappropriate asthma management strategies in real-world practice.