Determinants of wheezing severity among 6 to 17-year-old asthmatic children: insight from a hospital-based cross-sectional pilot study

Among low-and middle-income countries, Bangladesh is one of the countries with the highest prevalence of symptoms of severe asthma, where around four million children are suffering from asthma-related symptoms. The present study sought to find out the determinants of wheezing severity among six to seventeen-year-old asthmatic children in Bangladesh. A hospital-based cross-sectional study was conducted involving 372 physician-diagnosed asthmatic children aged 6 to 17 years from November 2023 to March 2024. The modified ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire was used to determine the wheezing severity. A multivariable logistic regression was performed to assess the determinants of wheezing severity among asthmatic children. A significant proportion of asthmatic children, approximately 56%, experienced severe wheezing. The primary factors positively correlated with increased wheezing severity were the use of air fresheners/deodorizers (aOR: 2.21, 95% CI: 1.29 to 3.79) and biomass cooking fuel combustion (aOR: 2.23, 95% CI: 1.10 to 4.49). Conversely, several factors were identified as protective against the worsening of wheezing severity like uptake of the pneumococcal vaccine (aOR:0.06, 95% CI:0.01 to 0.60), caregivers' profession specifically non-governmental jobs (aOR:0.29, 95% CI: 0.14 to 0.65) and business occupations (aOR:0.37, 95% CI: 0.14 to 0.97), and a delayed onset of asthma symptoms (aOR:0.38, 95% CI:0.22 to 0.67). To mitigate the severity of wheezing in asthmatic children, stakeholders are advised to implement strategies aimed at reducing exposure to cooking fuel combustion by establishing a separate kitchen. Government-backed subsidy programs for clean fuel interventions and health promotional activities regarding reducing fragmented air fresheners/deodorizers uses could significantly contribute to alleviating the burden of wheezing severity among asthmatic children.