Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol

Abstract

Introduction: Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.

Methods and analysis: Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.

Ethics and dissemination: Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

Keywords: COVID-19; asthma; epidemiology.

Figure 1

Impact of the COVID-19 pandemic in the three study centres in Quito, Portoviejo and Cuenca, Ecuador, on recruitment rates into the study and number of potentially eligible subjects identified in collaborating emergency rooms. Red bars show numbers recruited as a proportion (%) of those eligible (blue bars) prior to a legally enforced national lockdown on 16 March 2020.

Figure 2

Study procedures during baseline evaluation and follow-up in phases I (A) and II (B) of study. Follow-up in phase I was for 12 months and in phase II for a minimum of 6 months. ACT, Asthma Control Questionnaire (>11 years); AFCQ, Asthma Family Costs Questionnaire; ARQ, Asthma Recurrence Questionnaire; BaselineQ, general questionnaire based on phase II of the International Study of Asthma and Allergies in Childhood; C-ACT, Child Asthma Control Questionnaire (≥12 years); FeNO, fractional exhaled nitric oxide; NAKQ, Newcastle Asthma Knowledge Questionnaire.