Effect of Aging on the Relationship between Asthma Severity and Bronchial Hyperresponsiveness in Children with Asthma

An association between asthma and bronchial hyperresponsiveness (BHR) has been demonstrated. It is possible that the relationship between asthma severity and BHR in children with asthma is different in infants and in adolescents. The aim of this study is therefore to evaluate the effect of aging on the relationship between the severity of asthma and BHR in children with asthma.

We measured BHR in 386 subjects ranging from 2 to 20 years of age. The subjects consisted of 323 children with asthma (boys : girls = 193 : 130, mean age 9.7 years) and 63 age-matched controls (boys : girls = 25 : 38, mean age 8.2 years). BHR was measured using the methacholine inhalation challenge by measuring the transcutaneous oxygen pressure (tcPO₂) in children less than 6 years of age (Dmin-PO₂) and by measuring the respiratory resistance (Rrs) in children 6 years of age and older (Dmin-Rrs). Throughout the whole age range, both the Dmin-PO₂ and Dmin-Rrs in each asthma severity group were higher than those in the controls. In the asthmatics aged 2–5 years, the Dmin-PO₂ levels in the mild asthma group were higher than those in the moderate and severe asthma groups (p < 0.001, p < 0.001, respectively), and the Dmin-PO₂ levels in the moderate asthma group were also higher than those in the severe asthma group. This tendency was also found in the age ranges of 6–9 years and 10–13 years. In the asthmatics aged 14–20 years, the Dmin-Rrs levels were not significantly different among the three groups.

Taken together, these data show that aging has an effect on the relationship between the severity of asthma and BHR during childhood and that BHR may not be the sole determinant for the severity of asthma in adolescence.     

High Prevalence of Depression amongst Mothers of Children with Asthma

Objective. To compare the prevalence of depression among mothers of children with asthma and mothers of children without asthma and to investigate the influence of severity and duration of childhood asthma on maternal depression. Method. A cross-sectional study including 80 mothers of children with asthma and 160 mothers of children without asthma who attended the pediatric outpatient clinics of a teaching hospital in Southern Brazil. The main outcome measure was the presence of depression in these mothers, measured by the Beck Depression Inventory. Results. The prevalence of depression was higher among mothers of asthmatic children compared with mothers of non-asthmatic children (43.8% vs. 17.5%, p < 0.001), with an adjusted prevalence ratio of 2.74 (95% confidence interval [CI] 1.76–4.25). Mothers of children with persistent asthma had a higher prevalence of depression than mothers of children with intermittent asthma (62.8% vs. 21.6%, p < 0.001), with an adjusted prevalence ratio of 2.77 (95% CI: 1.46–5.27). No significant association was observed between duration of childhood asthma and maternal depression. Conclusion. Mothers of children with asthma have a higher prevalence of depression than mothers of children without asthma. The severity but not duration of childhood asthma is associated with maternal depression.     

Food Allergy Is Associated With Potentially Fatal Childhood Asthma

Background. Risk factors for potentially fatal childhood asthma are incompletely understood. Objective. To determine whether self-reported food allergy is significantly associated with potentially fatal childhood asthma. Study design. Medical records from 72 patients admitted to a pediatric intensive care unit (PICU) for asthmatic exacerbation were reviewed and compared in a case-control design with 2 randomly selected groups of 108 patients admitted to a regular nursing floor for asthma and 108 ambulatory patients with asthma. Factors evaluated included self-reported food allergy, gender, age, poverty area residence, race/ethnicity, inhaled steroid exposure, tobacco exposure, length of hospital stay, psychologic comorbidity, and season of admission. Results. At least one food allergy was documented for 13% (38/288) of the patients. Egg, peanut, fish/shellfish, milk, and tree nut accounted for 78.6% of all food allergies. Children admitted to the PICU were significantly more likely to report food allergy (p = 0.004) and 3.3 times more likely to report at least one food allergy compared with children admitted to a regular nursing floor, and significantly more likely to report food allergy (p < 0.001) and 7.4 times more likely to report at least one food allergy compared with children seen in the ambulatory setting. Children admitted to either the PICU or the regular nursing floor were significantly more likely be African-American (p < 0.001) and to be younger (p < 0.01) compared with children seen in the ambulatory setting. Conclusions. Self-reported food allergy is an independent risk factor for potentially fatal childhood asthma. Asthmatic children or adolescents with food allergy are a target population for more aggressive asthma management.     

Are Former Athletes More Prone to Asthma?

Objective: To determine whether obesity among children is associated with an increased incidence of asthma. Design and Method: Five thousand nine hundred eighty‐four children participated in a lung health study in the Ashkelon region, Israel. A lung health questionnaire was completed and they underwent spirometry. Body mass index (BMI) was then calculated for each child. Results: Three hundred two children (5.05%) were above the 95th percentile for BMI and considered obese. Obese children tended to wheeze more than the non‐obese children 14.5% vs. 10.5%, respectively (p < 0.038). Asthma (physician diagnosis) was diagnosed more often among obese children than non‐obese 7.2% vs. 3.9%, respectively (p < 0.008). Inhaler use was more prevalent among obese children than non‐obese 15.9% vs. 8.8%, respectively (p < 0.001). Bronchial hyperreactivity was significantly greater among the non‐obese asthmatic children compared with their obese counterparts, 352 (51.4%) vs. 10 (27.8%), respectively (p < 0.001). Chest symptoms and asthma were more frequent in obese than non‐obese boys. Conclusion: Asthma, wheezing, and inhaler use were more common in obese children than in non‐obese children. Symptoms were more prevalent among obese boys. Increasing BMI among children is a risk factor for asthma, which may in reality be obesity‐related chest symptoms that mimic asthma.     

Relationships among obesity,physical activity and sedentary behavior in young adolescents with and without lifetime asthma

Objective: To examine the inter-relationships among body mass index (BMI), physical activity, sedentary behavior and gender in urban, low-income, primarily African American young adolescents with or without lifetime asthma. Methods: Data were collected in 2002–2004 from 626 12-year old adolescents who were children of women who participated in the New Mother’s Study in Memphis, TN (1990–1991). Adolescents with and without asthma were compared on BMI, physical activity and sedentary behavior. Multiple linear regression models were used to examine the association of asthma, gender and BMI with physical activity and sedentary behavior. Results: Complete data were available for 545 adolescents. Eleven percent of adolescents had lifetime asthma. Asthma and gender were associated with high-intensity physical activity (p?<?0.001). Adolescents with asthma participated in less physical activity and girls participated less than boys. Gender was associated with sedentary behavior (p?<?0.001): boys used personal computer (pc)/video after school more than girls. Girls with asthma had a higher BMI than girls without asthma (p?=?0.027). Boys with asthma were less physically active than boys without asthma (p?<?0.05). Conclusions: Adolescents with asthma are less physically active than those without asthma and girls are less active than boys. Clinicians who provide care for adolescents with asthma are encouraged to assess physical activity/sedentary behavior and provide guidance that promotes active lifestyles. A longitudinal study is needed to shed light on the unique contribution of asthma separated from the effects of overweight/obesity on physical activity and sedentary behaviors.     

Rural Children with Asthma: Impact of a Parent and Child Asthma Education Program

The goal of this study was to determine the effectiveness of an asthma educational intervention in improving asthma knowledge, self-efficacy, and quality of life in rural families. Children 6 to 12 years of age (62% male, 56% white, and 22% Medicaid) with persistent asthma (61%) were recruited from rural elementary schools and randomized into the control standard asthma education (CON) group or an interactive educational intervention (INT) group geared toward rural families.

Parent/caregiver and child asthma knowledge, self-efficacy, and quality of life were assessed at baseline and at 10 months post enrollment. Despite high frequency of symptom reports, only 18% children reported an emergency department visit in the prior 6 months. Significant improvement in asthma knowledge was noted for INT parents and young INT children at follow-up (Parent: CON = 16.3; INT = 17.5, p < 0.001; Young children: CON = 10.8, INT = 12.45, p < 0.001). Child self-efficacy significantly increased in the INT group at follow-up; however, there was no significant difference in parent self-efficacy or parent and child quality of life at follow-up. Asthma symptom reports were significantly lower for the INT group at follow-up. For young rural children, an interactive asthma education intervention was associated with increased asthma knowledge and self-efficacy, decreased symptom reports, but not increased quality of life.     

The Potential Biases in Studying the Relationship between Asthma and Microbial Infection

Objective. To assess bias in parent reports of asthma status of children and detection bias of medical records-based asthma ascertainment and to examine effects of such bias on the association between asthma status and infections.Methods. A prospective cohort study was conducted to compare the correlations between the frequency of acute illnesses and that of medical evaluations between children with or without asthma according to parental report and medical record review by following a group of children who were enrolled in the Mayo Clinic Sick Child Care Program in Rochester, Minnesota. Parents completed a self-administered questionnaire to determine asthma status of their child. Also, comprehensive medical record reviews were conducted to determine asthma status of each subject by applying predetermined criteria for asthma.Results. A convenience sample of 115 parents and their children participated in this study. The mean age of the parents who participated in the study was 32.8 years (standard deviation: 5.4 years); 93% were female (mothers); and 90% were white. Of the 115 children who participated in this study, 84% were reported to be white and 49% were female. The mean age of the children was 2 years (standard deviation: 1.0 year). Parents whose children had asthma by report appeared to be less likely to seek medical evaluations (Spearman's rho: 0.42,p = 0.11) when their children had acute illnesses, compared to those of non-asthmatic children (rho: 0.64,p < 0.001). Concerns that asthmatic patients (rho: 0.62,p < 0.001) are more likely to see health care providers and undergo medical evaluations and laboratory tests when they have acute illnesses than non-asthmatic patients (rho: 0.64,p < 0.001) are not supported by our study.Conclusion. Parental report bias needs to be considered carefully when studying the relationship between asthma and microbial infection.     

Environmental Noise and Asthma in Children: Sex-Specific Differences

Objective. There is evidence that stress increases the risk of asthma. Chronic noise exposure is known to act as an unspecific stressor, but little is known about its effect on the risk of asthma in children. The aim of this study was to compare subjectively reported noise annoyance in 12-year-old asthmatic and non-asthmatic children with special regard to sex-specific differences. Subjects and methods. In a German multi-center birth cohort study we assessed the annoyance by different sources of environmental noise, doctor-diagnosed asthma, and potential confounders by questionnaire. The comparisons between asthmatic and non-asthmatic children were stratified by sex. Results. A total of 336 boys and 316 girls were included in the analysis. Prevalence of doctor-diagnosed asthma was 13% in boys and 5% in girls; 73% of the boys and 74% of the girls reported at least some degree of noise annoyance during the day and night time. In girls, asthma was associated with a significantly increased total noise annoyance at night (adjusted odds ratio aOR 1.5, 95%CI 1.1;2.1), for noise within the home/apartment (aOR 3.5, 95%CI 1.5;8.0), and in or around the house (aOR 3.3, 95%CI 1.7;6.3). No statistical significant effects were seen in boys. Conclusions. Noise annoyance, particularly at night or caused by domestic sources, is associated with increased asthma prevalence in girls but not boys. Further research is needed to identify underlying mechanisms of these sex-specific differences.     

Urbanization and the Risk of Asthma Among Schoolchildren in the Palestinian Authority

The aim of the present survey was to compare the prevalence of symptoms suggestive of asthma in boys and girls aged 6-7 and 13-14 years in a rural and an urban area in the West Bank. For this purpose, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was issued to 970 schoolchildren in the two regions. The response rate was 92.2%. The prevalences of ever wheezing in the urban and rural areas were 16.4% and 12.0%, respectively (p < 0.05); the 12-month prevalences of wheezing were 10.5% and 5.5%, respectively (p < 0.05); the prevalences of more severe wheeze were 4.5% and 1.7%, respectively (p < 0.05); and prevalences of diagnosed asthma were 4.2% and 2.8%, respectively (p = NS). When controlling for age by stratification, the significant association between prevalence rates and place of residence persisted in the 13-14-year age group. These results also show that the prevalence of asthma among Palestinian children is moderately high in comparison with that reported from developing countries, but lower than those reported from Western countries. This survey, the first epidemiological survey on asthma in the West Bank, demonstrates a marked difference between urban and rural areas. The findings emphasize the need for further study of the environmental determinants of the disease among Palestinian children.     

Fractional Exhaled Nitric Oxide Has a Good Correlation with Asthma Control and Lung Function in Latino Children with Asthma

Background. Although the measurement of fractional exhaled nitric oxide (FE_NO) has been recommended for observational studies and clinical trials of asthma, FE_NO has not been examined in studies of childhood asthma in Latin America, Objective. To examine the relationship between FE_NO and indicators of disease control or severity [asthma control test/childhood asthma control test (ACT/C-ACT), lung function, and exercise challenge test (ECT)] in Mexican children with persistent asthma, Methods. Children (6–18 years of age) with persistent asthma were consecutively recruited in a tertiary asthma clinic and divided into two groups, e.g. FE_NO < 20 parts per billion (ppb) and ≥20 ppb.Adequate FE_NO measurements were obtained in 134 (83.2%) of 161 eligible children, Results. Children with FE_NO<20 ppb had significantly higher scores on the ACT/C-ACT than those with FE_NO ≥ 20 ppb (median [interquartile range] :23 [20.8–25] vs. 21 [18–24], p = .002, respectively). Compared to children with FE_NO ≥20 ppb, those with FE_NO <20 ppb had a higher baseline predicted forced expiratory volume (FEV₁₎ [94% (92.5%–99.4%) vs. 83% (81%–89.9%), p = .001] and a lower probability of having a positive ECT (42.7% vs. 71.2%, p = .001). In addition, FE_NO was significantly inversely correlated with the participants’ ACT/C-ACT score and predicted FEV₁, and directly correlated with positive ECT, Conclusion. Among Mexican children with persistent asthma, low levels of FE_NO ( <20 ppb) are associated with better asthma control, and higher lung function.     

Serum Eosinophil-Derived Neurotoxin (EDN) in Diagnosis and Evaluation of Severity and Bronchial Hyperresponsiveness in Childhood Asthma

This study sought to evaluate the use of serum eosinophil-derived neurotoxin (EDN), which has been proposed as a marker of airway inflammation in asthma in the diagnosis and evaluation of the severity and bronchial hyperresponsiveness in childhood asthma. We studied 72 children with atopic asthma, 36 children with nonatopic asthma, and 43 healthy controls. Skin prick tests, pulmonary function tests, and methacholine challenge tests were performed, in addition to total eosinophil count, serum ECP, and EDN being measured in all subjects. EDN levels were significantly higher in the atopic asthma group than those in the nonatopic asthma group or control group (p < 0.001), as were ECP levels (p < 0.001). EDN levels differed more significantly among groups divided by asthma severity (p < 0.001) than did ECP levels for these groups (p < 0.05). For the groups divided according to bronchial hyperresponsiveness, both EDN and ECP levels were significantly different (p < 0.005 and p < 0.01, respectively). Significant correlations were found between EDN and PC₂₀ (γ = −0.281; p < 0.001), between ECP and PC₂₀ (γ = −0.274; p < 0.005), and between EDN and ECP (γ = 0.443; p < 0.001). In conclusion, serum EDN, as another marker of eosinophilic inflammation together with ECP, may aid in the diagnosis of asthma, especially atopic asthma, and in the evaluation of the severity and bronchial hyperresponsiveness in childhood asthma.     

The Impact of Uncontrolled Asthma on Absenteeism and Health-Related Quality of Life

Objective. To evaluate the impact of uncontrolled asthma on the absenteeism and health-related quality of life (HRQOL) of adults and children with asthma and the caregivers of pediatric patients. Patients and methods. Patient information was obtained from datasets maintained by National Jewish Health for this cross-sectional study. Participants in the study were 12 years of age or older. Participants younger than 18 years had their information provided by caregivers. Caregivers also provided 6 months of absenteeism and QOL data. Participants were classified as having uncontrolled asthma based on a treatment and symptom guideline-based algorithm. Absenteeism was assessed from the self-reported number of work or school days missed due to asthma during the previous 6 months. HRQOL among adults was measured using the validated Marks Asthma Quality of Life Questionnaire (Marks-AQLQ) and among caregivers using the validated Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ). To account for the positive skew in absenteeism data, a zero-inflated Poisson regression model was used to compare group differences. HRQOL was analyzed for adults and caregivers using the Wilcoxon-Mann-Whitney test. Results. A total of 15,149 patients met the inclusion criteria for the study and were included in the analysis. Adults with uncontrolled asthma and caregivers of children with uncontrolled asthma reported significantly higher absenteeism than their controlled counterparts: 43% vs 24% adults reported missing days of work, with a median 6 days vs 3 days missed; 31% vs 16% of caregivers reported missing days of work, with 4 days vs 2 days missed; and caregivers reported that more than 70% vs 45% pediatric patients missed school, with a median of 6 days vs 4 days missed (uncontrolled vs controlled asthma, respectively). Adult uncontrolled asthmatics and caregivers of uncontrolled pediatric patients had significantly lower HRQOL as indicated by the Marks-AQLQ (scores 1.5 points higher, p < 0.001) and PACQLQ (scores < 0.5 points lower, p < 0.001), respectively. Conclusions. Uncontrolled asthma has far-reaching impact on the productivity and quality of life of asthma patients and their caregivers. Proper assessment, treatment, and disease management to improve asthma control may reduce the impact of uncontrolled asthma on asthmatic adults, children, and the caretakers of pediatric asthmatic patients.     

Association of Hepatitis A Exposure and TIM-1 with Childhood Allergic Asthma

Background. Hepatitis A virus (HAV) receptor (TIM-1) polymorphism plays an important role in asthma and autoimmune diseases. Objective. To analyze the association of TIM-1 polymorphism and HAV infection with childhood allergic asthma in Southwest China. Methods. TIM-1 exon 4 (157insMTTTVP) and two polymorphism loci, ?416G>C and ?1454G>A, in the HAV receptor promoter region were studied. Polymerase chain reaction (PCR) was used to test the genotypes of three polymorphism loci among 579 cases of asthma and 524 controls. The HAV infection status was determined in a case–control study with stratified analysis. Results. HAV exposure associated with childhood allergic asthma in the study population was compared with controls (odds ratio (OR) = 0.181, 95% confidence interval (CI) 0.126–0.260, p < .001). The ?416G>C polymorphism was associated with asthma (OR = 1.384, 95% CI 1.148–1.669, p < .001), but the insertion variant 157delMTTTVP of exon 4 and the ?1454G>A polymorphism were not. Conclusion. Our results indicated that the ?416G>C polymorphism of the TIM-1 gene is associated with childhood allergic asthma, providing a better understanding of the pathogenesis of the allergic asthma among children aged below 15 years in Southwest China.     

Prevalence of Allergic Diseases of Schoolchildren in Central Taiwan

The prevalence of allergic disorders is increasing around the world. This study used the standardized written questionnaire from International Study of Asthma and Allergies in Childhood (ISAAC, phase III) to collect two cross-sectional appraisals of schoolchildren 5 years apart–one performed 2002 and another on 2007, to focus on the secular trends in prevalence of allergies in central Taiwan. This questionnaire was administered to schoolchildren from over 46 schools across Changhwa County in 2002, and again in 2007. The present study is a follow-up study and uses data collected from a previously reported study conducted in the year 2002 of the same location using the same methodology. Although the repeated cross-sectional survey after a 5-year lapse suggests a mere increase of diagnosed asthma cases from 7.1% to 7.4%, the prevalence of its related symptoms–nocturnal cough, rhinitis, and eczema–was found to increase significantly by 2.6% (p < 0.0001), 6.8% (p < 0.001), and 5.9% (p < 0.001), respectively. Additionally, comparing the secular trends in asthma prevalence, rhinitis, and eczema between several polluted areas in Changhwa County with its less polluted neighbors in 2002 and 2007 indicates that schoolchildren in TaiHao area, which is noted to be polluted by a petrochemical company, has a significantly increased prevalence of wheezing (3.7%, p < 0.05) and nocturnal cough (3.6%, p < 0.05). For schoolchildren living in the coastal areas, a 6% (p < 0.05) increase in the prevalence of rhinitis is noted. The prevalence of eczema uniformly increased for all areas of Changhwa County (p < 0.01). In the downtown areas, besides eczema, the prevalence of asthma and rhinitis also increased significantly (p < 0.05). Of note is the consistent finding in these two periods of the higher prevalence of childhood asthma, rhinitis, and eczema in the downtown areas compared with that from both the polluted and coastal areas. The secular trends in prevalence of asthma, rhinitis, and eczema in these two periods seem to correlate to environmental factors. While the symptoms of asthma, rhinitis, and eczema in schoolchildren affected boys more than girls, it is observed that affected girls have more marked manifestations, although it did not reach statistical significance.     

Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.     

Prevalence of Self-Reported Asthma in Urban and Rural Areas of Turkey

Background and purpose. The risk factors for asthma in rural and urban population of Turkey are not well known. In this study we examined the effects of risk factors on the prevalence of asthma in adults living in rural and urban areas using data from a representative sample. Methods. Parents and grandparents of students from 20 randomly selected primary schools in urban and rural areas of Kirikkale, Turkey, were asked about respiratory diseases using the respiratory questionnaire, which were returned to us by their children. Results. Out of 13,225 parents and grandparents of primary school students 12,270 returned the questionnaires, for an overall response rate of 92.7%. The prevalence of asthma was more common in adults living in rural areas than in urban areas (10.8% vs. 6.2%, p < .0001, respectively). Asthma was more prevalent in women exposed to biomass smoke than those who were not exposed to it in rural areas (14.8% vs. 6.6%, p = .0001, respectively). Frequent childhood respiratory infections were more common in adults living in rural areas than in urban areas (18.2% vs. 10.9%, p < .0001, respectively). Exposure to biomass smoke and frequent childhood respiratory infections were associated with an increased risk of asthma, after adjusting for possible confounding factors in the logistic model for rural subjects. Chronic rhinitis (p = .0001) and frequent childhood respiratory infections (p = .0001) were associated with an increased risk of asthma, after adjusting for possible confounding factors in the logistic model for urban subjects. Conclusions. The prevalence of asthma in adults living in the rural areas of the Kirikkale Region in Central Turkey was significantly higher than that in the urban population. Exposure to biomass smoke and childhood respiratory infections were more common in adults living in rural areas. The higher rate of asthma in adults living in rural areas may be due to a higher frequency of childhood respiratory infections and exposure to biomass smoke.     

Middle Lobe Syndrome in Children with Asthma: Review of 56 Cases

Objective. Middle lobe syndrome (MLS) is one of the complications of asthma. Its signs and symptoms are often nonspecific, causing delay in appropriate treatment. We aimed to review our pediatric asthmatic patients and provide differential characteristics between MLS and asthma worsening in order to target early diagnosis. Method. File records of all asthmatics (n = 3528) seen in our clinic during the last 2 years were retrospectively reviewed to identify the patients with MLS, and a case‐control study was undertaken. Files of 56 asthmatic children diagnosed as MLS, with a total of 63 episodes, and 63 matched controls with asthma worsening were analyzed and compared. Results. The incidence of MLS was 1.62% and half were below or at the age of 6. All cases with MLS were documented radiologically, and only 5 of the 63 episodes had physical findings suspicious for MLS. The most affected segments were right middle lobe (50%) and left lingula (26.2%). Although in all cases symptoms cleared, in 23 (36.5%) cases, atelectasis persisted radiologically. Compared to controls, patients with MLS included less atopics (34.9% vs. 59.4%, p < 0.05) and fewer boys (52.4% vs. 71.4%, p < 0.05), and they reported less frequent dyspnea (57.1% vs. 85.9%), more frequent sputum production (49.2% vs. 7.8%), and longer duration of complaints (22.0 ± 6.23 vs. 2.4 ± 0.31 days) (p < 0.001, for each). Furthermore, the resolution of symptoms took significantly longer (45.2 ± 9.3 vs. 3.3 ± 0.4 days, p < 0.001). Conclusion. We conclude that complicating MLS in childhood asthma is more frequent in younger ages, girls, and nonatopics. In most cases, physical findings are not informative, and chest radiographs diagnose most but not all cases. The most suggestive symptoms are unresolving/persisting symptoms during admission and/or following treatment.     

Patterns of Asthma Control Perception in Adolescents: Associations with Psychosocial Functioning

Objective. The purpose was to identify and describe the patterns of asthma control perception in relation to actual symptom reports in adolescents and to compare the group with accurate control perception with those of inaccurate perception in relationship to sociodemographic characteristics, illness-related factors, and psychosocial factors. Methods. A sample of 126 adolescents from 13 through 20 years of age participated in the study. Patterns of control perception were constructed based on participants' rating of their perception of asthma control and self-reported asthma symptoms using Latent Class Analysis. Analyses of variance (ANOVAs) and multinomial logistic regressions were computed for group comparisons. Results. Participants were classified into four groups according to the patterns of control perception. Accurate groups were divided into either the well-controlled (62%) or the poorly-controlled group (7%), and inaccurate groups were manifested inaccuracy either with nighttime symptoms (25%) or daytime symptoms (6%). Minority participants (p < 0.001) or those with low socioeconomic status (p < 0.001) were more likely to be represented in the inaccurate group than their counterparts. The well-controlled accurate group consistently reported higher asthma-related knowledge (p = 0.02), more positive attitude toward asthma (p < 0.001), fewer barriers to self-management (p = 0.04), and higher quality of life (p < 0.001) than the inaccurate group. Conclusion. This study demonstrated that accuracy of asthma control perception can be classified into four criteria based on patterns of various asthma symptoms. Adolescents' tendency toward underperception was evident. The inaccurate groups are at greater risk for psychosocial impairments. This study underscores the importance of an intervention that improves the accuracy of asthma control perception in adolescents while promoting psychosocial well-being among adolescents with inaccurate perception.