Association Between Environmental Risk Factors and Asthma Control Among Hospitalized Children With Recurrent Wheezing: A Cross-Sectional Study.

BACKGROUND

Asthma is among the most prevalent chronic respiratory conditions in childhood, and environmental causes are suspected mainly to play a role in poor asthma control. Despite the worldwide evidence, localized investigations appraising the ecological risk factors and consequences of asthma among hospitalized children having recurrent episodes of wheezing are unavailable in Pakistan. The current study investigates the relationship between environmental exposures and asthma control in this high-risk pediatric population.

METHODS

This cross-sectional study was conducted between February 2025 and May 2025 in various hospitals across Pakistan. Convenience sampling was used to enroll 385 hospitalized children aged 5-17 years with a history of recurrent wheezing. Three instruments, namely a demographic form, the Asthma Control Questionnaire (ACQ), and the International Study of Asthma and Allergies in Childhood (ISAAC) Environmental Questionnaire, were used to collect data through structured caregiver interviews. IBM SPSS version 26 (Armonk, NY: IBM Corp.) was used in statistical analyses, which included descriptive statistics, t-tests, ANOVA, Pearson correlation, and multiple linear regression, to assess the correlations between environmental exposures and asthma control.

RESULTS

The sample (n=385) included male (206, 53%) and female (179, 47%) participants. Multiple linear regression analysis revealed that poorer asthma control was significantly predicted by higher environmental risk scores (β = -0.120, p=0.006), younger age (β=0.115, p=0.003), and female gender (β=0.110, p=0.009), indicating that females had worse asthma control than males. Other significant predictors included indoor smoking (β=0.140, p=0.003), use of wood/coal fuel (β = -0.170, p=0.003), and pet exposure (β=0.130, p=0.011). A weak but statistically significant positive correlation was found between environmental risk and asthma control scores (r=0.131, p=0.010), suggesting that greater environmental exposure was associated with poorer asthma control.

CONCLUSION

This study found statistically significant but modest associations between environmental exposures, such as indoor smoking, pet presence, and biomass fuel use, and asthma control in hospitalized children with recurrent wheezing. The findings underscore the necessity for targeted public health interventions and culturally sensitive caregiver education programs to mitigate modifiable environmental risk factors in pediatric asthma management in Pakistan.