A South Australian population survey of the ownership of asthma action plans

OBJECTIVE: To examine the relationships between ownership of written asthma action plans, asthma morbidity, use of devices, and patients' perceptions of their asthma management. DESIGN AND SETTING: A random population survey (in 1996) of the South Australian population aged 15 years or over, using interviewers to administer a questionnaire. PARTICIPANTS: People who reported that they had current, doctor-diagnosed asthma. MAIN OUTCOME MEASURES: Prevalence of written asthma action plans; night-time awakenings from asthma; ownership of peak flow meters; and people's perceptions of their asthma management. RESULTS: The ownership of asthma action plans by people with self-reported asthma was 33% and has declined since 1995 (42%; P < 0.001). Fifteen per cent were awakened weekly or more frequently by asthma symptoms. These people were more likely to have a peak flow meter and a written action plan, but less likely to consider they had been provided with enough information about their asthma, to feel comfortable managing their asthma, or to find it easy to see their doctor. Having a written asthma action plan was associated with regular corticosteroid use, understanding asthma, having enough information and owning a peak flow meter. CONCLUSIONS: Ownership of asthma action plans in South Australia is suboptimal. Before we develop new strategies to improve asthma outcomes, we must determine whether there is a need to target people with less severe asthma and/or improve the use of guidelines by health professionals.     

The burden of asthma in Australia

In 1997, 27% of Australian children had current wheeze, and this is increasing by 1.4% per year. The prevalence of wheeze among adults is lower and appears to be stable. The prevalence of persistent asthma (wheezing episodes with abnormal airway function between episodes) in children has increased from 5% to 9% in the past 20 years. In adults, the prevalence is 5%-6%. Up to 80% of adults with persistent asthma have abnormal lung function. Asthma deaths in Australia have fallen 28% since peaking in 1989, but the mortality rate is still twice that of England.     

Asthma and hayfever in Aboriginal and non-Aboriginal children living in non-remote rural towns

OBJECTIVE: To compare the prevalence and risk factors for wheeze, asthma diagnosis and hayfever in Aboriginal and non-Aboriginal children living in rural towns in Australia. DESIGN AND SETTING: Cross-sectional study in two towns in rural NSW, Australia, 1997. PARTICIPANTS: Primary school children (aged 7-12 years) classified by their parents as being of Aboriginal (n = 158) or of non-Aboriginal (n = 1,282) origin. Main outcome measures: Atopy measured by skinprick tests and respiratory symptoms measured by parent-completed questionnaire. RESULTS: Aboriginal children were less likely to be atopic (36.2% v 45.6%; 95% CI for the difference, -17.6 to -1.3) and to have hayfever (23.3% v 35.2%; 95% CI for the difference, -19.1 to -4.6) than non-Aboriginal children, but were equally likely to have had wheeze (31.0% v 27.3%) and asthma (39.4% v 39.3%). Among Aboriginal children, having had bronchitis before age two was a strong risk factor for wheeze (adjusted odds ratio (aOR), 9.3; 95% CI, 2.8-30.2) and asthma (aOR, 19.3; 95% CI, 4.7-79.3) and having a parent with hayfever was a strong risk factor for hayfever (aOR, 17.9; 95% CI, 3.5-90.8), but these risk factors were weaker among non-Aboriginal children. CONCLUSIONS: Asthma and wheeze are equally prevalent in Aboriginal and non-Aboriginal children living in the same towns, but appear to have a different aetiology.     

The prevalence of psychiatric disorders among Vietnamese children and adolescents

OBJECTIVE: To determine the prevalence of psychiatric disorders among Vietnamese children and adolescents living in Perth, Western Australia. DESIGN, PARTICIPANTS AND SETTING: A list of Vietnamese households was drawn from Perth telephone directories. A computer program generated a systematic probability sample of households. All children and adolescents aged 9-17 in these households were invited to participate in the study. Children and their parents were interviewed in their home using the Diagnostic Interview Schedule for Children, version 2.3 (DISC-2.3). The child version (DISC-C) was used for children and the parent version (DISC-P) for adults. The study was conducted between July and December 1997. MAIN OUTCOME MEASURES: The prevalence of psychiatric disorders in children and adolescents, based on DISC-C and DISC-P data. RESULTS: Results were based on the 519 children (89.2%) for whom complete data were available. Twenty-three parents (4.4%) reported that their child had one or more disorders on the DISC-P, 82 children (15.8%) reported one or more disorders on the DISC-C, and 18.3% of children were reported to have a disorder on either the DISC-C or the DISC-P. Parent-child concordance on specific diagnoses was very low (0.6%). The great majority of disorders reported were anxiety disorders, especially simple and social phobias. CONCLUSIONS: The combined prevalence of psychiatric disorders among Vietnamese children aged 9-17 was similar to that found among children in Western Australia's general population. Vietnamese children in our study were much more likely to report symptoms of a psychiatric disorder than were their parents.     

Prevalence and management of asthma in children under 16 in one practice

The prevalence of childhood asthma in a small town in west Cumbria was studied. Medical records were scrutinised for keywords, children who were entered in the study were examined, and their parents were interviewed. A control group of children who were matched for sex and age was used to estimate the prevalence of asthma for the practice in the town. At the same time treatment was evaluated and improved where necessary. As expected, asthma in children was grossly underdiagnosed. The prevalence of asthma in children aged under 16 years in the practice was 15.6%, although the recorded prevalence before the study was only 7.8%. Treatment was inadequate for 42% of the children. The reasons for this were explored, and recommendations were made on management.     

Disease impact and patient insight--a study on a local population of asthmatics

The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.     

PEF监测在儿童哮喘防治中的作用与现状

目的 :探讨PEF监测在儿童哮喘防治中的作用。方法 :对 2 0例符合诊断标准的哮喘住院患儿及其父母进行调查和分析。结果 :对哮喘防治知识了解程度与患者年龄有关 ,知晓率随年龄增长而增加 ;对每日进行PEF监测 ,90 %的患者及其父母缺乏认识和重视。结论 :PEF作为客观的肺功能简易指标 ,可用于监测与评价哮喘轻重程度 ,对降低哮喘发作的次数有重要意义 ,是实现哮喘家庭自我管理的依据。护理人员应重视对患者及其父母进行有关PEF监测的教育。     

2000年北京城区儿童哮喘患病情况调查分析

目的了解北京儿童哮喘的患病率、发病规律及影响因素,并进行10年前后的对比研究.方法采取整群抽样调查方法,按照10年前的调查范围,在北京市朝阳区及西城区2～4个街区内,向家长发放初筛问卷,筛选出相关疾病的可疑患者,再经哮喘中心医师统一问诊查体,填写调查表.所有数据经sas/pc统计软件分析.结果实际调查人数10 163人,2年内有喘息发作的哮喘现患率为2.05%,男女患病率分别为2.80%及1.24%,既往有哮喘的累计患病率为2.69%.性别、首次发作年龄、呼吸道感染、过敏及遗传因素与哮喘发作有关.早期正确诊断及应用吸入治疗的比率仍较低.对比1990年哮喘现患率的0.78%,2000年哮喘现患率是10年前的2.6倍.结论本次调查0～14岁儿童哮喘的患病率较10年前显著升高,且主要发生于学龄期.哮喘发作受诸多因素的影响,目前按GINA方案在哮喘的规范化治疗上仍有明显差距.     

Skills amongst parents of children with asthma: a pilot interventional study in primary care setting

The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.     

我市哮喘患儿的控制现状及对本病认知程度的调查分析

目的了解哮喘患儿的控制现状和对疾病的认知程度。方法对我市城乡来我院就诊的支气管哮喘患儿进行调查,参与调查的医师是我院坐诊的儿科医师,采用与患者及家长面对面询问或笔试。结果200例患者中曾因严重喘息住院的有56例占28％,曾进行过肺功能测定的有76例占38．0％,专科医生为患者制定长期治疗计划的有79例占39．5％。67．0％的患者家属渴望举办哮喘知识讲座。结论我市城乡儿童支气管哮喘总体控制水平良好,认知程度有待进一步提高。对支气管哮喘患儿教育和管理仍是我们儿科医生工作中的重点。     

Prevalence of asthma in regional Victorian schoolchildren.

OBJECTIVE: To determine whether the high prevalence of reported asthma in Melbourne schoolchildren is seen in rural Victoria. DESIGN: A questionnaire on respiratory symptoms was distributed to children to be completed by parents and returned to the school. Results were compared with a previous Melbourne study. SETTING: Two hundred and twenty-seven government and non-government primary schools in five rural regions of Victoria: coast, wheatbelt, riverland, highland and Latrobe valley. SUBJECTS: All children enrolled in grade 2 were invited to join the study. Parents completed questionnaires for 4661 children after 4886 questionnaires were distributed (response rate, 95%). MAIN OUTCOME MEASURE: History of wheeze in the past 12 months. RESULTS: The overall prevalence of wheeze in the last 12 months was 23.6%. There was a significant difference overall in this rate across the five rural areas and Melbourne, with the Latrobe Valley (26.2%) and highland areas (25.0%) having the highest rate, and the wheatbelt the lowest (19.6%). The spectrum of severity of asthma was similarly distributed across rural regions, although severe episodes were significantly more frequently reported by parents from rural areas than by parents in Melbourne. The reported use of bronchodilators and diagnosis of asthma showed a similar pattern of variation to that of the 12-month prevalence of wheeze. CONCLUSION: The prevalence of asthma in 7-year-old children is similar for rural Victoria as a whole compared with Melbourne, but there is variability in asthma prevalence in individual rural areas which is difficult to account for in terms of known environmental precipitants.     

The influence of altitude in bronchial asthma

BACKGROUND: Some asthmatic children living in mountain areas experience significant improvement in daily symptoms and in the degree of bronchial obstruction. The aim of this study is to investigate the effect of altitude on the prevalence and morbidity of childhood bronchial asthma. METHODS: A questionnaire regarding the history and symptoms of asthma was distributed to 874 children aged 6-12 years, to be completed by their parents with the help of their pediatrician. A total of 583 children lived at sea level, 180 at an altitude between 501 and 800 meters, and 111 at an altitude between 801 and 1,200 meters. All children with recurrent cough, shortness of breath, wheezing, and a history of bronchial asthma were considered to have bronchial asthma. RESULTS: The prevalence of childhood bronchial asthma in the mountains (800-1,200 meters) was twice as low as that at sea level (15.8% of children) (p <0.01). Parental smoking was more frequent in children who lived at sea level than in the mountains. Additionally, consumption of fish and oranges was more frequent at sea level. Children with asthma who lived in the mountains were absent fewer days from school per year (0.2) and had fewer nights with dyspnea per year (0.5) than asthmatic children who lived at sea level (1.6 days and 25 nights, respectively). CONCLUSIONS: Bronchial asthma in children who live at high altitudes is characterized by low prevalence and low morbidity.     

海口市秀英区学龄前儿童哮喘初筛问卷调查分析

目的 初筛海口市秀英区学龄前儿童哮喘的患病率,为儿童哮喘防治和管理提供流行病学依据.方法 采用2010年全国哮喘防治协作组制定儿童哮喘流行病学调查初筛表,整群抽样,2010年9～12月对海口市秀英区学龄前儿童进行问卷调查.由家长与孩子共同完成问卷.由课题组成员收回并进行统计分析.结果 海口市秀英区共发放1 280份调查...     

Current trends of the prevalence of childhood asthma in three Chinese cities: a multicenter epidemiological survey

Objective To analyze the prevalence of asthma and asthma related symptoms among children aged 0-14 years in three Chinese cities and to obtain a crude estimation of the trend of childhood asthma prevalence in China. Methods A cross-sectional, population-based survey of prevalence of asthrna was conducted in children aged from 0 to 14 years in 3 major cities of China （Beijing, Chongqing, and Guangzhou） with different geographic locations. All the subjects were randomly selected by a multi-stage sampling method. Three to five schools and kindergartens in 2 urban districts in each city were randomly selected for the survey, and a validated questionnaire that included the core questions of the International Study of Asthma and Allergies in Childhood, Phase III questionnaire and several additional questions were used. All questionnaires were completed by parents or guardians of the selected children. Children whose parents responded affirmatively to the question＂ Has your child ever been diagnosed as asthma by a doctor＂ were recognized as victims of asthma. Results The prevalence of asthma in Beijing, Chongqing, and Guangzhou was 3.15%, 7.45%, and 2.09%, respectively. These values were significantly higher than those obtained 10 years ago in the national epidemiological survey in 2000 which used the same method of investigation and the same diagnotic criteria （x^2=3.938, P=-0.047; 22=73.506, P≤0.001; x^2=11.956, P=0.001, in each city）. Of the asthmatic children 57.21%, 69.91%, and 60.00% had their first attack before the age of 3 in Beijing, Chongqing, and Guangzhou, respectively. Wheezing was the primary clinical manifestation for all asthmatic children, followed by persistent cough and repeated respiratory infections. Both the prevalence of asthma and asthma-related symptoms were statistically higher in males than in females. Conclusion The prevalence of childhood asthma is statistically higher than that 10 years ago in the three Chinese cities.     

1860 例畲族儿童支气管哮喘流行病学调查分析

目的了解畲族儿童支气管哮喘流行现状、分布特征及影响因素,为今后畲族儿童支气管哮喘诊治工作提供科学依据。方法根据全国儿童哮喘协作组制定的统一方案,采取整群抽样的方法,对宁德市1860名0～14岁畲族儿童进行哮喘流行病学调查。结果宁德市1860名0-14岁畲族儿童哮喘患病率为3．17％,发病季节以冬（25．4％）、春季（28．8％）为主,哮喘发作与性别（男、女患病率分别为3．45％和2．81％）、呼吸道感染（81．4％）及遗传因素（39．0％）等有关。结论支气管哮喘是儿童最常见的呼吸系统慢性疾病之一,是环境因素和遗传因素共同作用诱导的复杂疾病,对畲族哮喘患儿及其家长进行有关哮喘基础知识的普及和教育是提高哮喘诊治水平的重要措施。     

Observations on the management of childhood acute asthma in a large hospital.

OBJECTIVE: To study the documentation of assessment, the treatment and the follow-up arrangements for children admitted to hospital with acute asthma. DESIGN: A retrospective audit of case notes. SETTING: Tertiary level teaching hospital. MAIN OUTCOME MEASURES: A comparison with the asthma management plan issued by the Thoracic Society of Australia and New Zealand. RESULTS: We found poor documentation of assessment of asthma severity, low referral rates for asthma education, and inappropriate use of chest radiography. Bronchodilator therapy did not follow published guidelines. Good follow-up arrangements were achieved. CONCLUSIONS: The proportion of children with documentation of the assessment of acute asthma was unacceptably low.     

2000年苏州市区6174名儿童哮喘患病情况调查

目的 了解苏州市儿童哮喘的患病率、发病规律及影响因素。方法 采取整群抽样的调查方法，在苏州市的金阊区所抽取的街区内，向家长发放初筛问卷，筛选出相关疾病的可疑患者，再经哮喘中心医师统一问诊查体，填写调查表。所有数据经asa/pc统计软件分析。结果 实际调查6174人中，哮喘（婴幼儿及儿童哮喘）累计患病率为4．5％，两年内有喘息发作的哮喘近患率为3．74％，男女患病率分别为4．81％与2．64％。两年内有近患的广义哮喘（包括婴幼儿哮喘、儿童哮喘及咳嗽变异性哮喘）患病率为4．32％。性别、首次发作年龄、呼吸道感染、过敏及遗传因素与哮喘发作有关。发作季节主要为春秋季及季节更迭期。早期正确诊断及应用吸入治疗的比率仍较低。结论 苏州市0－14岁儿童哮喘的患病率较10年前显著升高，且主要发生于学龄期。生活模式的改变可能与哮喘的发病上升有关；哮喘发作受诸多因素的影响，目前按GINA方案在哮喘的规范化治疗上仍有明显差距。     

Adequacy of management and severity of asthma in children attending a summer camp

To assess the adequacy of therapy in asthma, 46 children with asthma attending a summer camp were asked to complete a questionnaire about their symptoms and the treatment that they had received. Each child's height, weight, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured. According to defined criteria of symptom severity the children were categorized as suffering from severe (48%) or mild (52%) asthma. The mean FEV1/FVC ratio (P less than 0.05) and the mean FEV1 were lower (P less than 0.02) in the children with severe asthma compared with those with mild asthma. In the group with severe asthma, 68% of the children were considered to be receiving suboptimal therapy; 45% had never had their FEV1 or FVC measured. Among those who were receiving suboptimal therapy, 40% had measurable airflow obstruction compared with 17% of children with mild asthma. Because poor management of asthma remains common in children, the need to make doctors and parents aware of the fact that suboptimal therapy may contribute significantly to the morbidity of the condition is emphasized.