Seasonal increase in primary care visits for asthma

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1. In this retrospective analysis of a population of Israeli children, a 2-fold increase in asthma exacerbations was seen in patient visits to pediatric primary care settings in early September as compared to August.

2. Prescriptions for asthma medication also increased 2-fold in September and early October when compared to other calendar months.  

Evidence Rating Level: 2 (Good)

Study Rundown: Seasonality of pediatric asthma exacerbations has been widely reported, with exacerbations most often in the fall, as children return to school. Environmental changes, including environmental allergens, viral respiratory infections, and stress may all contribute to this increase in asthma exacerbation. While previous studies have evaluated this spike in asthma cases in the hospital or emergency department setting, little is known about whether this seasonal variation extends into the primary care setting. Pediatric patients between the ages of 2-15 years old treated under Clalit Health Services (CHS), Israel’s primary health insurer, were identified and evaluated for asthma-related visits between the years of 2005 and 2009. Researchers noted a 2-fold increase in the absolute proportion of primary care asthma-related visits during Gregorian calendar weeks 34-36 (August 20 to September 9). Similarly, overall visits to pediatric primary care offices exhibited seasonality, with a drop in visits during the summer and a 1.26-fold rise during calendar weeks 34-36. The relative proportion of asthma-related visits compared to other primary care visits increased 1.55-fold in early September. A 2-fold increase in asthma medication prescription was also noted in calendar weeks 37 to 39, mirroring the increase in asthma visits. Although this study is limited in its examination of a single pediatric population, the observation that primary care asthma trends indicate a similar asthma seasonality pattern to asthma hospitalizations or ER visits may be useful in the development of preventative interventions such as the prophylactic use of controller medication.

Click to read the study in Pediatrics

Relevant Reading: Epidemiology of asthma exacerbations

In-Depth [retrospective cohort]:  Researchers evaluated pediatric primary care visits for patients 2-15 years of age seen in the CHS network in Israel during 2005-2009. Primary care visits, diagnoses, and treatments were evaluated on a weekly basis. A total of 919 873 patients were included (60.9% male, 8.9% with a baseline diagnosis of asthma or wheezing). During calendar weeks 34 through 36, the absolute number of asthma-related primary care visits increased by 2.15-fold among children 2 to 5 years of age, by 1.91-fold among children aged 6 to 9 years, and by 1.82-fold in children 10-15 years old. The relative proportion of asthma visits as compared to overall primary care visits also increased during weeks 34 through 36 with a 1.59-fold increase for 2-5 year olds, a 1.6-fold increase in children 6-9 years of age, and a 1.4-fold increase for 10-15 years old. Asthma medications were more likely to be dispensed during calendar weeks 37 to 39 as compared to weeks 34 to 36, with a 2.28-fold increase in bronchodilator prescriptions, a 2.04-fold increase in inhaled corticosteroids, and 1.53-fold increase in combination therapies. No significant difference in asthma seasonality was found between urban and rural patients; however, differences between cultural groups were noted with a 62% increase in asthma related visits in September for Arab patients and a 67% increase in asthma visits in ultra-orthodox Jewish patients as compared to a 35% increase in the general Israeli population.

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