ArticleThe journal of allergy and clinical immunology. In practice2026
Timing of High-Risk Asthma Specialist Enrollment and Severe Asthma Exacerbations in Children.
Article in The journal of allergy and clinical immunology. In practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlthough specialist care reduces acute health care utilization among children with uncontrolled asthma, the timeliness of enrollment and consequences of delayed specialty care remain poorly characterized.
objectiveTo characterize correlates of delayed enrollment in specialty asthma care and evaluate whether pre-post changes in childhood severe asthma exacerbation (SAE) incidence differed by patient characteristics.
methodsWe conducted a pre-post, quasiexperimental longitudinal cohort study of 229 children (<11 years) with moderate-to-severe asthma enrolled in a high-risk asthma (HRA) clinic between January 2010 and December 2021, with follow-up through 2024. Early childhood asthma risk burden was quantified using predefined risk factors. Cox proportional hazards models examined correlates of delayed enrollment. Piecewise generalized linear mixed-effects models estimated changes in SAE odds before and after HRA enrollment, adjusting for demographic characteristics and time-varying treatments.
resultsThe cohort was 66% male and 61% African American, with a mean (standard deviation) age of 4 (3) years at HRA enrollment. Despite earlier asthma diagnosis, children with a high (vs low) burden of early childhood risk factors experienced delayed HRA enrollment and 2 to 3 years of increasing annual SAE odds before enrollment (adjusted odds ratio [OR] per year, 1.54; 95% confidence interval [CI], 1.31-1.80). HRA enrollment was associated with a 36% reduction in SAE odds (adjusted OR, 0.64; 95% CI, 0.51-0.80). Reductions were greater among children who initiated inhaled corticosteroids within 12 months of diagnosis (adjusted OR, 0.61; 95% CI, 0.48-0.78).
conclusionsEnrollment in specialty asthma care was associated with reduced SAE risk; however, high-risk children experienced substantial delays in HRA enrollment despite escalating exacerbations. Early risk stratification may facilitate timely enrollment into specialty care and improve outcomes.
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