Prevalence of asthma using clinical diagnosis in a Primary Care setting, and prognostic factors of hospital emergency department utilization

Objective: to asses the cumulative prevalence of asthma and of active asthma in our setting using the clinical diagnosis, and to build a predictive index of utilization of hospital services by acute crisis of asthma.

Material and methods: cross sectional study in a Primary Care setting attending 2,300 children less than 15 years of age. Cumulative prevalence of asthma was measured. Children presenting with symptoms in the previous 12 months were considered as having active asthma. A predictive model of utilization of hospital services was build using logistic regression analysis.

Results: 195 children were diagnosed of asthma (8.5%; 95% confidence interval [95% CI]: 7.4-9.7%), figure that corresponds to the cumulative prevalence. Ninety one presented active asthma (46.7%; CI 95%: 39.5-53.9%). Forty eight visited the emergency department of the reference hospital (24.6%; CI 95%: 18.7-31.3%). Twelve (6.2%; CI 95%: 3.2-10.5%) were admitted. In the multivariate analysis, age (odds ratio [OR]: 0.85 [CI 95%]: 0.74-0.99), active asthma (OR: 5.7 [CI 95%]: 1.5-21.6) and level of severity (OR: 3.6 (CI 95%: 1.3-10.6) were significantly associated to utilization of hospital services.

Conclusions: the asthma prevalence in our setting is situated in an intermediate range compared to other studies. The active asthma is strongly associated to a higher use of hospital services, so it is necessary to reconsider the treatment in this subgroup of patients. It is necessary to implement a big multicentric study, in Primary Care, in order to build a predictive model of utilization of the hospital services in Spain.