Risk Factors for Uncontrolled Asthma in a Pediatric Population with Severe Asthma: FRAMAG Study

Severe asthma (SA) in children is associated with significant morbidity, increased healthcare utilization, and reduced quality of life. Despite appropriate treatment, achieving optimal asthma control remains challenging, particularly in pediatric populations. This study aimed to identify factors associated with poor asthma control in children with SA, focusing on clinical, functional, and caregiver-related variables. This retrospective cohort study included children aged 6-17 years with SA followed for up to three years in the Asmaire-Rexpira Program in Bogota, Colombia. Asthma control was defined using a comprehensive composite score integrating symptom questionnaires, exacerbation history, corticosteroid use, hospitalizations, and spirometry. Multivariable logistic regression was used to identify independent risk factors for uncontrolled asthma. Results: Of the 228 children included, 35.5% had uncontrolled asthma. Obstructive sleep apnea (OR: 2.16; 95% CI: 1.13-4.11; p = 0.019) and moderate to severe impairment in caregiver quality of life (OR: 12.35; 95% CI: 4.15-36.80; p < 0.001) were independently associated with uncontrolled asthma. Systemic corticosteroid use and hospitalization in the prior year were significantly more common in this group. Lung function was preserved in most children; however, those with uncontrolled asthma exhibited significantly greater bronchodilator reversibility (5.8% vs. 4.1%; p = 0.015) and higher functional variability over time based on conditional FEV1 change scores (≥ +1.96 z-score in 18.9% vs. 8.5%). Conclusions: uncontrolled asthma in children with SA is associated with comorbid sleep apnea, caregiver burden, and functional variability despite normal spirometric values. These findings underscore the need for multidimensional evaluation, caregiver support, and longitudinal monitoring to optimize asthma control in high-risk pediatric populations.