Prevalence of asthma or respiratory symptoms among children attending primary schools in Paris

The objectives of this study were to determine the prevalence of chronic respiratory symptoms and asthma in 8- to 9-year-old children in Paris, and to analyze their medical management. This cross-sectional study was carried out in 1994 on a randomized sample of 3,756 pupils attending Paris public primary schools. The response rate by parents to an initial standardized self-administered questionnaire was 94.8%. This questionnaire identified 601 children (17%) as having recurrent respiratory symptoms. Of these children, 555 (92.3%) agreed to participate in a follow-up survey that evaluated their medical management; these children were examined by 73 school doctors of the city of Paris. Prevalence of parent-reported doctor-diagnosed asthma was 6.1%. In addition to these 211 children with asthma, 344 other children had recurrent respiratory symptoms: 120 children were “wheezers,” and the remaining 224 children were “coughers.” Among “chesty” pupils not identified as asthmatics, physical education teachers reported exercise-induced cough or respiratory discomfort in 13.7%, and nearly 14% had a peak expiratory flow 20% lower than the predicted values for age and height. In children identified as asthmatic, 25.3% were not under medical supervision, 55.5% had never performed lung function tests, 63.7% did not receive any prophylactic treatment, and 59.7% were receiving no treatment. Bronchodilator prophylactic medication before exercise was used by only 7% of asthmatics, although physical training teachers noted chest discomfort on exercise in 30.4% of these pupils. These results confirm that children with asthma and participating in this study were less than optimally investigated, were underdiagnosed and undertreated, and their medical management was not optimal. In addition to its epidemiologic value, the study has helped Paris school doctors to advise parents to refer their children to their general practitioner when asthma was suspected or undertreated. Pediatr Pulmonol. 1998; 26:106–112. © 1998 Wiley-Liss, Inc.     

Chronic respiratory symptoms, spirometry and knowledge of COPD among general population

RATIONALE: Infradiagnosis of chronic obstructive pulmonary disease (COPD) may be related to the lack of knowledge about the disease and/or the scarce use of diagnostic procedures. This study analyses the frequency of respiratory symptoms and the knowledge about COPD in the general population, together with the use of spirometry in individuals at risk of COPD. POPULATION AND METHOD: A telephone survey was carried out in 6758 subjects older than 40 years, stratified by age, habitat (urban or rural) and region, screened by random-digit dialling. RESULTS: Up to 24% reported having at least one chronic respiratory symptom and 20.9% had a self-reported respiratory diagnosis. A total of 19.2% were active smokers and 40% had never tried to quit. Only 60% of the individuals with chronic symptoms had consulted a physician and, of them, only 45% had undergone spirometry. Spirometry was mentioned more frequently by subjects attended by pulmonologists than by GPs (67.6 vs. 28.6%; P<0.001). The term COPD was identified only by 8.6% of the participants. CONCLUSIONS: Many individuals with respiratory symptoms do not request medical attention and do not attempt to quit smoking. There is a lack of knowledge about COPD. Physicians should more actively inform about the disease and increase the use of spirometry for early detection.     

Household environmental tobacco smoke exposure, respiratory symptoms and asthma in non-smoker adults: a multicentric population study from India

BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a risk factor for childhood asthma. Its association with asthma in adults is less clear. METHODS: In a multicentric population study on asthma prevalence in adults, specific enquiries were made into childhood and adulthood exposure to household ETS, and its relationship with asthma diagnosis were analysed. RESULTS: From a total of 73605 respondents, 62109 were studied after excluding current or past smokers. Overall observed prevalence of asthma was 2.0% (men 1.5%,women 2.5%, p < 0.001). Of all asthma patients, history of ETS exposure was available in 48.6 percent. Prevalence of asthma in the ETS exposed subjects was higher compared to non-exposed individuals (2.2% vs 1.9%, p < 0.05). Multiple logistic regression analysis showed a higher risk of having asthma in persons who were exposed to ETS compared to those not exposed (odds ratio [OR] 1.22, 95% CI 1.08-1.38) after adjusting for age, gender, usual residence, exposure to biomass fuels and atopy. Stratification of ETS exposure revealed that exposure during childhood and both during childhood and adulthood were significantly associated with asthma prevalence. Exposure only in adulthood was not a significant risk factor (OR 1.13, 95% CI 0.95-1.33). Persons reporting combined environmental tobacco smoke exposure from parents during childhood and spouse during adulthood had highest risk of having asthma (OR 1.69, 95% CI 1.38-2.07). Environmental tobacco smoke exposure was also significantly associated with prevalence of respiratory symptoms such as wheezing, cough and breathlessness. CONCLUSIONS: Environmental tobacco smoke exposure during childhood is an important risk factor for asthma and respiratory symptoms in non-smoking adults.     

Incidence of asthma and respiratory symptoms by sex, age and smoking in a community study.

The purpose of this study was to establish incidence rates for a wide range of respiratory symptoms and asthma, and relate them to sex, age, and smoking habits. A cohort established in 1985 as a random sample from the population of Western Norway, aged 15-70 yrs, was followed-up in 1996-1997. Of the initial cohort of 3,786 subjects, a total of 2,819 replied to mailed questionnaires at both baseline and follow-up. The 11-yrs cumulative incidence of asthma was 4.0% in males and 3.5% in females. For respiratory symptoms, the cumulative incidences for both sexes varied between 2.0% (dyspnoea grade 4) and 25.8% (wheezing), being higher in females than males for most symptoms. For calculation of odds ratios (ORs) multivariate logistic regression analyses were used. The sex and smoking-adjusted incidences increased by age for all symptoms except wheezing and attacks of dyspnoea. Those starting to smoke within the follow-up had ORs of 1.9-2.2 for the cough symptoms compared to never-smokers, after adjusting for sex, age, and pack-yrs. To conclude, the 11-yrs incidence of dyspnoea increased with increasing pack-yrs, after adjusting for sex, age, and changes in smoking habits. This indicated that when analysing other risk factors, adjustment has to be made for the risks posed by smoking, sex and age.     

Physician-patient relationships, patient satisfaction, and antiretroviral medication Adherence among HIV-infected adults attending a public health clinic

The goal of this project was to explore the connections between human immunodeficiency virus (HIV)-positive patients adherence to antiretroviral medication treatment regimens and their beliefs about and satisfaction with their primary care physicians. In-depth interviews were conducted with 28 HIV-positive patients. Results showed that most patients were extremely satisfied with their current primary care physicians. When patients were dissatisfied with their care, it was often because there was a mismatch between the patient's expectations of care and the physician's consultation style. Results also showed that good quality physician-patient relationships tended to promote adherence while lesser quality relationships impeded it. Findings suggest that strengthening and promoting the bonds between physicians and HIV/acquired immunodeficiency syndrome (AIDS) patients should be an absolute priority, at both the interpersonal level of physician-patient interactions but also at the organizational level.     

Relationship between tobacco smoking and medical symptoms among cocaine-, alcohol-, and opiate-dependent patients

Despite widespread use of tobacco by alcohol and drug abusers, the medical effects of smoking remain understudied among such individuals. We investigated the relationship between tobacco smoking and medical symptoms among 87 cocaine-, 98 opiate- and 81 alcohol-dependent individuals receiving outpatient treatment. Smoking status was assessed and medical symptoms were recorded using a standardized 134-item self-report instrument (MILCOM). Almost 79% of patients were tobacco smokers. Analysis of variance revealed a main effect of tobacco smoking on medical symptoms. Smokers reported significantly more symptoms on the total scale as well as on the respiratory, cardiovascular, gastrointestinal, and nose/throat subscales compared to non-smokers. Furthermore, we found a significant interaction between tobacco smoking and substance abuse with respect to medical symptoms. While opiate and alcohol patients who smoked reported more symptoms than those who did not, unexpectedly, cocaine users who smoked reported fewer symptoms than those who did not smoke. While the findings support the link between smoking and medical problems among substance abusers, these effects do not seem to be uniform across various substances of abuse. In particular, cocaine patients seem to be affected differently than alcohol and opiate patients.     

Effect of passive smoking,asthma, and respiratory infection on lung function in Australian children

We have calculated normal standards for lung function of Australian children and have estimated the effects on lung function of passive smoking, current asthma, past asthma, and a current respiratory infection. Three cross-sectional samples of children in school years 3–5 (aged 8–11 years) were studied. The 2765 children were from two rural regions of NSW and from the city of Sydney. Details of passive smoking and respiratory illness were collected by a questionnaire sent to parents. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), peak expiratory flow rate (PEFR), and forced mid-expiratory flow rate (FEF_25–75%) were used as measures of lung function. Airway responsiveness was assessed by histamine inhalation test. Data from 1278 “normal” children were used in regression analysis to calculate prediction models for lung function. Passive smoking was associated with reduced FEV₁, PEFR, and FEF_25–75%. Children with current asthma had reduced FEV₁ and FEF_25–75% and children with past asthma had reduced FEF_25–75%. Children with a current respiratory infection had reduced FVC₁, FEV₁, PEFR, and FEF_25–75% The effects of these deficits on the future lung function of these children is not known but is likely to be important. Pediatr Pulmonol. 1994;18:323–329 © Wiley-Liss, Inc.     

Asthma, chronic bronchitis and respiratory symptoms among adults in Estonia according to a postal questionnaire

Epidemiological studies indicate a lower prevalence of asthma in Eastern than Western Europe. This study of the prevalence of asthma, chronic bronchitis, and respiratory symptoms was performed in three different regions of Estonia, a state incorporated in the Soviet Union until 1991. A postal questionnaire was sent to a random sample of 24,307 of the population aged 15-64 years. The response rate was 77.6%. The prevalence of physician-diagnosed asthma was 2.0% or considerably lower than in Northern and Western European countries. The prevalence of wheezing last 12 months, 21.7%, recurrent wheeze, 13.3%, and attacks of shortness of breath, 12.5%, were similar or even higher compared with prevalence rates found in the Nordic countries. The prevalence of physician-diagnosed chronic bronchitis was 10.7%, and was higher among women than in men, although the proportion of current smokers among men, 57%, was considerably greater than in women, 28%. A possible explanation to the high prevalence of respiratory symptoms also among non-smoking women may be exposure to environmental tobacco smoke in small, crowded Estonian homes. Diagnostic criteria based on the Soviet-time definitions is discussed as a possible explanation to the low prevalence of physician-diagnosed asthma and high prevalence of chronic bronchitis in Estonia compared with other Northern European countries.     

Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults

OBJECTIVE: The aim of this study was to assess the prevalence of chronic obstructive pulmonary disease in middle aged and older adults. METHODOLOGY: A random sample of 7,005 adults aged between 45 and 69 years was drawn from electoral rolls for Melbourne, Victoria, Australia. A postal survey was conducted using the European Community Respiratory Health Survey respiratory screening questionnaire with additional questions on chronic bronchitis and emphysema. Participants were asked to return the survey by reply mail. Non-responders were sent a reminder postcard after 2 weeks, a replacement questionnaire after 4 weeks and then contacted by telephone. RESULTS: Completed questionnaires were returned by 4,906 (70.0%) participants. The commonest symptoms were exertional dyspnoea (27.2%) and wheezing (20.5%). Chronic bronchitis was reported by 12.0% and emphysema by 1.2%. Males were significantly more likely to report cough and sputum, while females were more likely to report asthma. The prevalence of exertional dyspnoea, cough and sputum, emphysema and heart disease increased with age. Chronic bronchitis, emphysema and most respiratory symptoms were associated with smoking. CONCLUSIONS: Self-reported chronic bronchitis or emphysema affect one in eight middle aged and older adults. Differences between men and women are partly explained by differences in smoking. These findings require confirmation with lung function tests.     

Prevalence of asthma and chronic respiratory symptoms among Alaska Native children

STUDY OBJECTIVES: To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students. DESIGN: School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms. SETTING: The Yukon-Kuskokwim delta region of western Alaska. PARTICIPANTS: A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children). INTERVENTIONS: No study intervention. RESULTS: Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children. CONCLUSIONS: Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.     

Prevalence of asthma and respiratory symptoms by age, gender and smoking behaviour in Samsun, North Anatolia Turkey

Asthma is a major health problem worldwide. This is the first study determining the prevalence of asthma among adults in Samsun which is situated in the centre of the Black Sea region of Turkey. The aim of our study was to assess the prevalence of asthma and asthmatic symptoms, and the relationships of these with age, gender and smoking behaviour in this region. A questionnaire interview adapted from the European Respiratory Community Health Survey (ERCHS) was performed by health centre officers with selected people between November-December, 2002. The study population included a total of 1.916 [810 men (42.3%) and 1.106 women (57.7%)] inhabitants of Samsun city center, aged 15 years of age or above. The mean age was 37.8 years+/-15.5, the prevalence of asthma was 2.7%, receiving asthma medicine was 2.2%, the prevalence of wheezing in the last 12 months was 15.5% and shortness of breath with wheezing was 11.6%. The frequency of symptoms was higher among the elderly population when compared to other groups (p<0.0001). Asthma diagnosis by a physician was more frequent among women (chi2=5.16, p<0.05). Morning cough, day time cough, chronic cough, phlegmy cough and waking up with cough symptoms were more frequent among the smokers (p<0.001). Asthma diagnosis and asthma treatment are at a very low level compared to reported asthma related symptoms.     

The prevalence of asthma and asthma-like symptoms among adults in rural Beijing, China.

No data have been reported on the prevalence of asthma in rural areas of China. The objective of the present study was to determine the prevalence of asthma-like symptoms, reported asthma and reported asthma attacks in rural Beijing, China, and to compare the prevalence in 20-44-yr-old participants with those reported for Canada and the European Community Respiratory Health Survey (ECRHS). For a cross-sectional survey, 30 villages were randomly selected in the counties of Shunyi and Tongxian, 50 km north and east respectively of the city of Beijing and within the municipality of Beijing. The International Union Against Tuberculosis and Lung Disease questionnaire on bronchial symptoms translated into Chinese was completed by village doctors for each individual of >15 yrs. The survey was completed by 22,561 individuals, representing 98% of the eligible population. The prevalence of asthma-like symptoms and reported asthma attacks was higher in females than in males and increased with age. Smoking significantly increased the prevalence of symptoms; the effect in females was greater than in males. Among the 20-44-yr-olds, the prevalence of reported asthma attacks in the previous 12 months was 0.67% in rural Beijing, very much lower than that reported in ECRHS centres (3.1%), urban Canada (6.9%) and semirural Canada (5.1%), after adjusting for age and sex. The prevalence of asthma-like symptoms was also very low in rural Beijing compared with ECRHS centres and Canada. It is concluded that the prevalence of asthma-like symptoms and reported asthma was low in rural China compared with other countries, consistent with reports of the relative scarcity of asthma in farms and the "hygiene hypothesis".     

The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood

The effects of pre- or postnatal passive smoking on the adult incidence of asthma have not been reported previously. Between 1985 and 1996/1997, we conducted an 11-year community cohort study on the incidence of asthma and respiratory symptoms in Western Norway. The cohort included 3,786 subjects aged 15 to 70 years, of which 2,819 were responders at both baseline and follow-up. The incidence of asthma and five respiratory symptoms by self-reported exposure to maternal smoking in utero and in childhood, as well as smoking by other household members in childhood, was examined. After adjustment for sex, age, education, hay fever, personal smoking, and occupational exposure, maternal smoking was associated with asthma, phlegm cough, chronic cough, dyspnea grade 2, attacks of dyspnea, and wheezing, with odds ratios (95% confidence intervals [CI]) of 3.0 (1.6, 5.6), 1.7 (1.1, 2.6), 1.9 (1.2, 3.0), 1.9 (1.2, 3.0), 2.0 (1.3, 3.0), and 1.4 (0.9, 2.2), respectively. The adjusted attributable fractions (95% CI) of the adult incidence of asthma were 17.3% (5.2, 27.9) caused by maternal smoking and 9.3% (95% CI, -23.2, 33.2) caused by smoking by other household members. Exposure to pre- and postnatal smoking carries a substantial risk for developing adult asthma and respiratory symptoms.     

The relationship of salivary cotinine to respiratory symptoms, spirometry, and exercise-induced bronchospasm in seven-year-old children

The effects of passive tobacco smoke exposure upon respiratory symptoms and lung function were assessed in a cross-sectional survey of 770 children 7 yr of age, using cotinine as a quantitative biochemical marker of exposure. Salivary cotinine levels were strongly related to the number of smokers in the home, but three-quarters of children from nonsmoking households had detectable salivary cotinine, and 10% of this group were in the upper two-fifths of the distribution of measured tobacco smoke exposure. Smoking by persons other than members of the household may deserve greater attention in future studies of young children. After adjustment for housing tenure, most respiratory symptoms were unrelated to salivary cotinine, but a "tendency for colds to go to the chest" was twice as prevalent in the upper two-fifths as in the lower two-fifths of the cotinine distribution. No association was found between salivary cotinine and reports of wheeze or measured reduction in FEV1 after 6 min of free running. After adjustment for sex, height, test conditions, and housing tenure, all baseline spirometric indices except FVC were inversely associated with salivary cotinine. Only FEF75-85 and FEF75 were significantly reduced, the difference for each index between the top and bottom quintiles of the cotinine distribution being about 7%, equivalent to a reduction of 1.1% (95% CL, 0.1 to 2.1%) per doubling of cotinine concentration. These changes may be evidence of small airways damage, which could later progress to more severe respiratory impairment.