Timing of High-Risk Asthma Specialist Enrollment and Severe Asthma Exacerbations in Children.

Authors

Arthur H Owora, Samuel Strunk, Bowen Jiang, Yash Shah, Nadia L Krupp

Published in

The journal of allergy and clinical immunology. In practice. Jun 19, 2026. Epub Jun 19, 2026.

Abstract

Although specialist care reduces acute healthcare utilization among children with uncontrolled asthma, the timeliness of enrollment and consequences of delayed specialty care remain poorly characterized.
To 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.
We conducted a pre-post, quasi-experimental 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.
The cohort was 66% male and 61% African American, with a mean (SD) 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 2-3 years of increasing annual SAE odds before enrollment (adjusted OR per year 1.54; 95% 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).
Enrollment 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.

PMID:
42320839
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.

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