Does your child have asthma? Parent reports and medication use for pediatric asthma

OBJECTIVE: To assess parental reporting of diagnosis used in surveys as an indicator of pediatric asthma prevalence. METHODS: Analysis of the Medical Expenditure Panel Survey, 1996 and 1997 (10 404 children aged from 0 to 17 years). All values are expressed as mean (SE). RESULTS: Asthma medications were purchased for 2.5% (0.2%) of children. Parents of 45.4% (4.0%) of these children failed to report asthma, including 41.3 (10.5%) of those for whom maintenance medications were purchased. These findings remained unchanged when very young children were excluded from the sample. Controlling for insurance coverage, no racial, ethnic, or socioeconomic disparities in reported asthma were found; however, poor children were more likely to have maintenance medications purchased (odds ratio, 4.9; 95% confidence interval, 2.3-10.4). CONCLUSIONS: Surveys of parental reports of asthma overlook many children with active disease. Dependence on parental reports may underestimate the prevalence of serious asthma among poor children. The parents in this study who fail to report asthma may represent a group that perceives their children's disease as less serious a problem despite active purchasing of medications.     

Persistent cough: is it asthma?

The aim of this study was to determine if children in the community with persistent cough can be considered to have asthma. A validated questionnaire was given to the parents of 1245 randomly selected children aged 6-12 years. Atopy was measured with skin prick tests. Children with persistent cough had less morbidity and less atopy compared with children with wheeze. Although the syndrome commonly referred to as "cough variant asthma" could not be shown in this study, a significant number of children with persistent cough had been diagnosed as having asthma and were treated with asthma medications including inhaled corticosteroids. Studies are urgently needed to determine the appropriate treatment for children with persistent cough.     

Infant wheeze: Is asthma a possibility?

Most infant wheeze is not asthma. Nonetheless, infants are able to develop reversible airway obstruction with or without allergic sensitisation, and asthma does occur at this age. The many other causes of infant wheeze, however, make asthma more difficult to distinguish from the background ‘noise’. Consideration of risk factors and clinical features can enable some infants to be given a provisional diagnosis and, if their symptoms are disabling, a cautious trial of asthma treatment.     

Is prevention of allergy and asthma possible?

Allergy and asthma are common diseases today. Ways to stop the ongoing increase in incidence of these diseases are highly desired. In this review the scientific basis for allergy and asthma prevention is discussed. RESULTS: Although secondary preventive measures are generally regarded as important, the views regarding the possibility of primary prevention vary. There is today only weak evidence that breastfeeding may reduce the risk of developing allergy, and if it does the effect is limited in degree and duration. There is some evidence that prolonged breastfeeding reduces the risk of developing asthma, at least in allergy-risk infants. There is also some evidence indicating that withholding solid foods in children at risk may have a beneficial effect. A dose-dependent risk of becoming sensitized to house dust mite and pet animal allergens has clearly been shown, but to what extent this sensitization is combined with asthma or clinical allergy is less well elucidated. Passive smoking increases the risk of wheezing problems and the indoor environment in damp houses seems to act synergistically with passive smoke. CONCLUSION: Primary prevention is rarely possible, but the risk of developing asthma and allergy may to some extent be reduced by taking certain measures, such as avoidance of tobacco smoke and damp houses. Breastfeeding seems to reduce the risk of wheezing, but as allergy-preventive measures, breastfeeding and avoiding pet animals have only marginal effects.     

Does remodelling of the airway wall precede asthma?

Bronchial asthma is very common in childhood but the occurrence of wheeze with viral infections makes asthma difficult to diagnose in the pre-school child. Longitudinal studies suggest that there is a loss of airway function associated with early childhood asthma. Extrapolating from adult disease and the few tissue-based studies of children, this would appear to be related to abnormal postnatal development or remodelling of the airway walls. This appears to be associated with persistent airway inflammation without clinical evidence of airways obstruction. Abnormally thickened airways may be the mechanism underlying both bronchial hyper-responsiveness and fixed loss of respiratory function. The challenges for the future are to identify those children among the pre-school wheezers who will become asthmatic and to construct trials of therapies that may potentially prevent the development of clinical asthma or ameliorate the associated loss of airway function.     

Does influenza vaccination prevent asthma exacerbations in children?

OBJECTIVE: Influenza can exacerbate asthma, particularly in children. The effectiveness of influenza vaccine in preventing influenza-related asthma exacerbations, however, is not known. We evaluated influenza vaccine effectiveness in protecting children against influenza-related asthma exacerbations. STUDY DESIGN: We conducted a population-based retrospective cohort study with medical and vaccination records in 4 large health maintenance organizations in the United States during the 1993-1994, 1994-1995, and 1995-1996 influenza seasons. We studied children with asthma who were 1 through 6 years of age and who were identified by search of computerized databases of medical encounters and pharmacy dispensings. Main outcome measures were exacerbations of asthma evaluated in the emergency department or hospital. RESULTS: Unadjusted rates of asthma exacerbations were higher after influenza vaccination than before vaccination. After adjustment was done for asthma severity by means of a self-control method, however, the incidence rate ratios of asthma exacerbations after vaccination were 0.78 (95% CI: 0.55 to 1.10), 0.59 (0.43 to 0.81), and 0.65 (0.52 to 0.80) compared with the period before vaccination during the 3 influenza seasons. CONCLUSIONS: After controlling for asthma severity, we found that influenza vaccination protects against acute asthma exacerbations in children.     

Is obesity associated with asthma in young children?

OBJECTIVE: The aim of this study was to evaluate the association between obesity and asthma in a population-based sample of Canadian children. STUDY DESIGN: Baseline data from the National Longitudinal Survey of Children and Youth were used in this cross-sectional study. We included 11199 children age 4 to 11 years whose biological mother reported data on asthma, height, and weight. Body mass index was categorized, and obesity was defined as body mass index >or=85th percentile. Children with asthma had parents who reported the diagnosis, and they took prescribed inhalants, had wheezing or an attack in the previous year, or had their activities limited by asthma. Multiple logistic regression was used. RESULTS: The prevalence of asthma was 9.9%. Maternal history of asthma was a risk factor for asthma among all children. Single child status and maternal depression were risk factors for girls. The odds ratio for asthma, comparing highest and lowest body mass index categories, was 1.02 (99% confidence interval, 0.70-1.46) for boys and 1.06 (99% confidence interval, 0.67-1.69) for girls. CONCLUSION: This study suggests that there is no statistical association between obesity and asthma among Canadian children age 4 to 11 years.     

What is new in the management of childhood asthma?

The prevalence of asthma has increased in developed countries. The efficacy of available drugs in those with severe persistent disease is limited. This has led to a renewed search for the reasons for failures of the existing treatment and for novel concepts. Treatment with inhaled corticosteroids, and to a much lesser extent theophylline, can reduce the survival of inflammatory cells including esinophils. Emerging trends in treatments for asthma could include strategies to alter the cytokine/chemokine balance. It is evident that the current ICS are already very efficient and safe, it will be difficult to introduce further improved formulations. Perhaps the most fruitful effort shall be in developing patient friendly easy to use targeted delivery systems. The newer therapies are planned for the several upstream targets and may have potential to prevent the disease. Various potential therapies are being worked upon like-targeting prevention of T cell activation, modulation of Th-1/Th-2 differentiation, inhibition of Th-2 related cytokines, Th-1/Th-2 modulation, inhibition of downstream mediators etc. The new strategy shall perhaps lie with matching the patients and their disease with the most suitable therapy.     

Relationship between BCG scar size and asthma in children?

OBJECTIVE: This case control study was conducted to evaluate any association between the BCG scar size and occurrence of asthma among children between 6-14 years of age. METHODS: Cases consisted of 90 asthmatic children. Control group included 90 non-asthmatic children from the emergency room service of the same hospital. The BCG scar was measured as the average of the transverse and longitudinal diameters. RESULTS: The results showed that asthmatic subjects have a 3.2 times greater risk exhibiting a scar diameter of less than 5mm than non- asthmatic subjects (CI 95 percent = 1.40 - 7.63 P < 0.01). CONCLUSION: It was concluded that asthmatic children and adolescents exhibited a greater frequency of an BCG scar diameter of less than 5mm than non-asthmatics. Clinical significance of this observation is uncertain.