Risk factors for asthma in schoolchildren in Southern Brazil

BackgroundDue to the high prevalence of recurrent wheezing in the pediatric population, it is important to be able to identify environmental risk factors that may affect the etiology of asthma in several regions.Objective: to identify possible risk factors associated with asthma in children (9–12 years old) in Passo Fundo, Rio Grande do Sul, Brazil.Material and MethodsA total of 1003 school-age children were selected for the cross-sectional study by applying a standardized written questionnaire from the International Study of Asthma and Allergy, and a supplementary questionnaire (ISAAC phase II) was added to address personal, family and environmental factors. Of these, 125 children were excluded because they did not accept to do the skin prick test, resulting in a sample of 878.ResultsIndependent risk factors associated with asthma were bronchiolitis before two years old [OR] = 3.11; 2.23–4.33, current rhinitis [0R] = 2.07; 1.43–3.0; sharing bedroom during the first year of life [OR] = 2.03; 1.36–3.04; atopy [OR] = 1,82; 1.26–2.50; use of paracetamol more than 12 times a year [OR] = 1.68; 1.20–2.31; use of antibiotics in the first six months of life [OR] = 1,57 1;13–2.17; maternal asthma [OR] = 1.75; 1.05–2.78, having an indoor cat during the first year of life [OR] = 1.73, 1.07–2.78; premature birth [OR] = 1.60,1.02–2.50.Conclusionour results show that genetic backgrounds, environmental factors, premature birth, use of antibiotics before six months of life, using paracetamol once per month and the presence of co-morbidities such as rhinitis are the risk factors associated with asthma in Brazilian children.     

Prevalence of asthma and associated factors in adolescents living in Belem (Amazon region), Para,Brazil

BackgroundThe prevalence of asthma in the Brazilian Amazon region is unknown. We studied the prevalence of asthma and associated factors in adolescents (13–14 years old) living in Belem, a large urban centre in this region.Methods3725 adolescents were evaluated according to the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a random sample of them (126 asthmatics and 254 non-asthmatics) were assessed for possible risk factors by a supplementary questionnaire (ISAAC Phase II) and skin prick tests with aeroallergens. The association between asthma and associated factors was determined by logistic regression analysis.Results3708 adolescents were enrolled, 48% were male. The prevalence of asthma in the last 12 months (identified as asthmatics) and the medical diagnosis of asthma were 20.7% and 29.3%, respectively. Risk factors significantly associated with asthma were: previous diagnosis of tuberculosis (odds ratio [OR] = 38.9; 95% confidence interval [95% CI]: 4.6–328.0) and measles (OR = 4.7; 95% CI: 2.3–9.8), breastfeeding for any length of time (OR = 4.2; 95% CI: 1.1–15.2), current rhinitis (OR = 3.2; 95% CI: 1.8–5.9), exposure to smokers (OR = 2.4; 95% CI: 1.2–4.5), moisture in home (OR = 1.8; 95% CI: 1.1–3.2) and rhinitis diagnosed by physician (OR = 1.7; 95% CI: 1.2–2.9). Sensitisation to at least one aeroallergen was significantly higher among asthmatic adolescents (86.5% vs. 32.4%; p < 0.0001).ConclusionsThe prevalence of asthma was similar to that observed in other Brazilian centres. Physician-diagnosed asthma was more frequent than the presence of symptoms suggestive of asthma. Infectious diseases, nutritional and environmental factors, as well as concomitant allergic rhinitis, were the main risk factors associated with the development of asthma in these adolescents.     

Risk factors for asthma admissions in children.

Bronchial asthma is related to a high morbidity rate, leading to an increasing frequency of emergency room visits and hospital admissions. The aim of this study was to identify severity risk factors for childhood asthma related to hospitalization. The authors studied 124 children admitted to the hospital for asthma, during a 2-year period, correlating the obtained data with a sample of outpatients with asthma matched by age, gender, and socioeconomic status. A standardized questionnaire and skin-prick tests (SPTs) were performed on all children. The significant and independent risk factors identified for hospital admission were prior asthma hospitalization (OR = 7.63; 95% CI = 1.5-39.6; p = 0.01) and last-year admission (OR = 3.18; 95% CI = 1.1-8.9; p = 0.02), environmental tobacco-smoke exposure (OR = 6.63; 95% CI = 2.5-17.8; p = 0.002), allergen sensitization (OR = 3.86; 95% CI = 1.4-10.7; p = 0.009), family history of maternal asthma (OR = 3.58; 95% CI = 1.3-9.6; p = 0.01), and onset of symptoms before 12 months of age (OR = 2.76; 95% CI = 1.0-7.9; p = 0.06). Attendance at day care or kindergarten (OR = 0.38; 95% CI = 0.2-0.9; p = 0.04) and large family size (OR = 0.25; 95% CI = 0.1-0.8; p = 0.01) could be protective factors. Our results stress the importance of early diagnosis and specialized medical care of childhood asthma, mainly in high-risk children, with emphasis on medication planning and the establishment of preventive measures such as environmental tobacco smoke avoidance and limitation of aeroallergen exposure.     

Risk factors for goiter in a previously iodine-deficient region.

OBJECTIVE: Little information exists from formerly iodine-deficient areas regarding gender-specific risk factors for goiter and their synergisms. The aim of the present study was to investigate such gender-specific risk factors and their interactions in a large population-based sample. METHODS AND RESULTS: The Study of Health in Pomerania (SHIP) comprised 4310 randomly selected participants, aged 20 - 79 years. SHIP was performed in a previously iodine-deficient region. Data from 3915 participants with no known thyroid disorders were analyzed. Goiter was determined by thyroid ultrasound. Sociodemographic characteristics, smoking and alcohol drinking habits, marital status, education level, urine thiocyanate concentrations, and specifically in women, parity and previous or current use of oral contraceptives and hormone replacement therapy, were considered as candidate risk factors for multivariable statistical tests. Only two variables, an advanced age and current smoking, were independently associated with an increased risk for goiter in both genders. Analyses further revealed specific risk factor profiles for goiter which were different among men, pre- and postmenopausal women. CONCLUSION: We conclude that besides previous iodine deficiency, other risk factors for goiter exist which differ between gender. Among the avoidable risk factors, current smoking was strongly associated with the risk of goiter in men and women. These findings should influence activities which are intended to prevent thyroid disease.     

Risk factors for development of asthma in children and adolescents: findings from a longitudinal population study

Background: The prevalence of asthma appears to be on the increase, and risk factors are not well established. To investigate risk factors for the development of asthma, a population sample of children and adolescents, aged 7–17 years at enrolment, were studied in 1986. Initial examinations were repeated at follow-up in 1992; complete data was available for 408 subjects (199 males).Methods: Obtained case histories were used to assess the presence of asthma; pulmonary function, skin prick test reactivity, total serum IgE and bronchial responsiveness to inhaled histamine were measured using standard techniques.Results: The 12-month period prevalence of asthma increased significantly from the first to the second examination in both males (P<0·001) and females (P<0·001), whereas the number of subjects with a positive histamine challenge test declined in both sexes, although this was only statistically significant in males (P<0·001). The prevalence of a positive skin prick test was higher at the second examination (26% and 44%, respectively, P<0·001); the proportion of subjects with a positive skin reaction to house dust mite (HDM pos) increased from 14% to 26%. Bronchial hyper-responsiveness to inhaled histamine (BHR), HDM allergy, a history of wheezy bronchitis and symptoms of asthma at first examination were more prevalent among subjects reporting asthma at the second examination than among subjects without respiratory symptoms. Confining the analysis to subjects without a history of asthma at the first examination showed that asymptomatic BHR {Odds ratio [OR] 3·8 [95% confidence interval (CI) 2·5–5·1], P=0·0002}, HDM pos [OR 2·6 (95% CI 1·9–3·3), P=0·005], a history of wheezy bronchitis before the age of 2 years [OR 3·8 (95% CI 2·4–5·2), P=0·006] and a history of rhinitis and/or eczema [OR 2·8 (95% CI 1·7–3·9), P=0·007] at first examination were associated with an increased risk for development of symptomatic asthma at some point between the two examinations. No significant relationship could be demonstrated between smoking (passive or active) and the risk for development of asthmatic symptoms.Conclusions: In conclusion, this longitudinal population study showed an increase in the 12-month period prevalence of asthma with sensitization to HDM and asymptomatic BHR as important risk factors for development of asthma; the temporal relationship between sensitization to HDM and presence of airway abnormalities needs to be explored further.     

Risk factors affecting asthma prevalence in adolescents living in Istanbul,Turkey

BackgroundAsthma is one of the most important diseases of childhood. The aim of this study was to evaluate the prevalence of asthma symptoms and risk factors affecting asthma.MethodsIn a cross-sectional study design, 9991 children, aged 13–14 years in 61 primary schools in 32 districts of Istanbul were evaluated. Asthma prevalence among the children was assessed using the ISAAC protocol.ResultsIn our study, a total of 10,894 questionnaires were distributed to 13–14 years old children, and of these 9991 questionnaires were suitable for analysis with an overall response rate of 91.7%. The rates of wheeze ever, wheezing in last 12 months and lifetime doctor diagnosed asthma prevalence were 17.4%, 9.0%, and 11.8%, respectively. There were 4746 boys (47.9%) and 5166 girls (52.1%) with M/F ratio of 0.92. Atopic family history, fewer than three siblings living at home, tonsillectomy or adenoidectomy history, consumption of fermented foods, mixed pickles, margarine and meat were found to be associated with an increased asthma risk. Use of paracetamol in the last 12 months, consumption of fruit and animal fats acted as a protective factor against asthma. The Mediterranean-style diet was not associated with the prevalence of asthma.ConclusionsLifetime doctor diagnosed asthma prevalence was found to be 11.8% in 13–14 year olds. History of tonsillectomy and/or adenoidectomy and consumption of fermented foods, mixed pickles, margarine and meat may increase the symptoms of asthma. Usage of paracetamol and consumption of animal fats may be investigated as a protective factor against asthma.     

Risk factors for near-fatal asthma

BACKGROUND: There is a paucity of lung function data in patients, both before and after episodes of near-fatal asthma (NFA), requiring transient endotracheal intubation and mechanical ventilation. METHODS: Lung function was initially measured in 43 asthmatic patients (age range, 16 to 49 years), who were observed and treated in a tertiary referral asthma clinic and were clinically stable at the time of study. Subsequently, clinical and physiologic follow-up studies were obtained over > 5 years. The primary outcomes were to determine (1) the integrity of lung elastic recoil and (2) the severity of expiratory airflow limitation, and (3) to correlate these outcomes with adverse clinical complications. RESULTS: Fourteen of 26 asthmatic patients (54%) [age range, 30 to 49 years] had significantly reduced lung elastic recoil pressures at all lung volumes compared to 3 of 17 asthmatic patients (18%); p = 0.02 [chi(2) test and Fisher exact test] [age range, 16 to 26 years]. In asthmatic patients between the ages of 30 and 49 years, significant loss of lung elastic recoil was noted in 4 of 10 patients with mild reduction in FEV(1) (FEV(1), > 79% predicted), 6 of 12 patients with moderate reduction in FEV(1) (FEV(1), 61 to 79% predicted), and all 4 patients with severe reduction in FEV(1) (FEV(1), < 61% predicted). In asthmatic patients between the ages of 16 and 26 years, significant loss of lung elastic recoil was noted in 0 of 11 patients with mild reduction in FEV(1), 2 of 5 patients with moderate reduction in FEV(1), and 1 of 1 patient with severe reduction in FEV(1). A subgroup of 10 asthmatic patients (7 men) [mean (+/- SD) age, 37 +/- 11 years] were studied when clinically stable, both before and after an episode of NFA in 8 cases and only after an episode of NFA in 2 additional cases. In 1 of 10 cases, the FEV(1) was mildly reduced, in 4 cases it was moderately reduced, and in 5 cases it was severely reduced, both before and after an episode of NFA. The sensitivity was 90%, the specificity was 61%, the positive predictive value was 41%, and the negative predictive value was 95% for NFA with an FEV(1) < or = 79% predicted or FEV(1)/FVC ratio of < 75%. Prior to an episode of NFA, all 8 asthmatic patients had significant loss of lung elastic recoil pressure, and afterward all 10 had significant loss of lung elastic recoil pressure (ie, less than the predicted normal mean minus 1.64 SD at a total lung capacity [TLC] of 100 to 70% predicted). The sensitivity was 100%, the specificity was 79%, the positive predictive value was 59%, and the negative predictive value was 100% for NFA with the loss of lung elastic recoil. The mean TLC measured with a plethysmograph in 10 patients with NFA was 7.2 +/- 1.41 (124 +/- 16% predicted). The sensitivity for TLC of > 115% predicted was 70%, the specificity was 70%, the positive predictive value was 88%, and the negative predictive value was 41% for NFA. CONCLUSION: A persistent reduction in FEV(1) of < or = 79% predicted or an FEV(1)/FVC ratio of < 75%, and, especially, the loss of lung elastic recoil and hyperinflation at TLC are risk factors for NFA. The loss of lung elastic recoil in asthmatic patients was associated with increased age, duration of disease, and progressive expiratory airflow limitation.     

Risk factors in allergy/asthma.

The incidence of allergic rhinitis and asthma is increasing. Nobody knows why with certainty, but there are many theories including better diagnosis, urban living, higher exposure to dust mites, atmospheric pollution, nutrition, lifestyle changes, maternal smoking, diesel fumes, geography, the "hygiene hypothesis," and several others. It has been known that atopic disease runs in families and a family history is the strongest risk factor for the development of allergies/asthma. Molecular studies also have identified some specific atopic entities that are determined genetically (eosinophils, interleukin-5, etc.). Environmental issues and lifestyle changes are becoming increasingly more important as significant risk factors but the evidence can be confusing, controversial, and even contradictory. There is overwhelming evidence that sensitization to indoor allergens is a major risk factor for the development of clinical atopic disease in genetically susceptible individuals. Not everyone agrees and there are newer data to suggest that early exposure to endotoxin and/or living on a farm and even early exposure to cats and dogs protects against sensitization by driving the immune system to a TH1 lymphocyte response. To this point, the new data are impressive if not compelling. The "hygiene hypothesis" suggests that lack of exposure to a childhood infection, endotoxin, and bacterial products is an important determinant regarding development of atopic disease. It is clear that a family history (genetics) is the strongest risk factor for the development of clinic atopic disease but it is also clear that environmental issues play a significant role and that there is a lot we still do not know.     

Risk factors for myocardial infarction in Brazil

Background

Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management.

Methods

The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI.

Results

A total of 1279 pairs, matched by age (± 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: ≥5 cigarettes per day (odds ratio [OR] 4.90, P < .00001); glucose ≥126 mg/dL (OR 2.82, P < .00001); waist/hip ratio ≥0.94 (OR 2.45, P < .00001); family history of CAD (OR 2.29, P < .00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P < .00001); reported hypertension (OR 2.09, P < .00001); <5 cigarettes per day (OR 2.07, P = .0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P < .00001); reported diabetes mellitus (OR 1.70, P = .0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P = .0212); alcohol intake (up to 2 days/week) (OR 0.75, P < .0309); alcohol intake (3-7 days/week) (OR 0.60, P = .0085); family income R$600 to R$1200 and college education (OR 2.92, P = .0499); family income >R$1200 and college education (OR 0.68, P = 0.0239)

Conclusions

The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.     

Risk factors for asthma in adult twins

Introduction: This PhD thesis was conducted at the Respiratory and Allergy Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. Objective: This study was conducted in a population of adult twins to: (i) determine the incidence of asthma; (ii) identify the risk factors for asthma; and (iii) estimate to what extent genetic and environmental factors influence asthma, wheeze, rhinitis, positive skin‐prick test (posSPT) and airway hyper‐responsiveness (AHR). Materials and Methods: The study population was based on the twin cohorts born between 1953 and 1982 that were ascertained from the nationwide Danish Twin Registry. Questionnaire data on multiple traits including asthma and possible risk factors for asthma was collected in 1994 and 2002, defining a population of 19 349 subjects (6090 intact twin pairs) at risk of new asthma. Furthermore, a total of 575 subjects (256 intact pairs and 63 single twins), who either themselves and/or their co‐twins reported a history of asthma at the 2002 questionnaire, were clinically examined. Results: The incidence of asthma was 4.5 and 6.4 per 1000 person‐years, respectively, among males and females (Odds Ratio (OR) = 1.49, P < 0.001). There was a positive association between increasing body mass index (BMI) and risk of asthma for both sexes (OR = 1.05 per unit, P < 0.001). A history of hay fever (OR = 4.2 for males and OR = 3.7 for females, P < 0.001), eczema (OR = 3.5 for males and OR = 2.0 for females, P < 0.001) and both (OR = 6.9 for males and OR = 8.0 for females, P < 0.001) were significant predictors of asthma. Physical exercise was weakly associated with asthma (OR for inactivity = 0.35, P = 0.02), whereas smoking and educational status was not significantly associated with asthma. There was a high genetic similarity between asthma and wheeze (genetic correlation, ρ_A = 0.96), asthma and rhinitis (ρ_A = 0.94), wheeze and rhinitis (ρ_A = 0.95), wheeze and AHR (ρ_A = 0.85), and rhinitis and posSPT (ρ_A = 0.92), whereas lower genetic correlations were observed between rhinitis and AHR (ρ_A = 0.43) and between AHR and posSPT (ρ_A = 0.59). Traits with a high degree of environmental sharing were asthma and wheeze (environmental correlation, ρ_E = 0.82), rhinitis and posSPT (ρ_E = 0.92), and wheeze and posSPT (ρ_E = 0.71), whereas lower environmental correlations were observed between asthma and rhinitis (ρ_E = 0.19) and between wheeze and rhinitis (ρ_E = 0.25). Conclusions: The incidence of asthma in adulthood is high, especially among females. In both sexes, increasing levels of BMI increase the risk of asthma. A substantial portion of adult‐onset asthma is preceded by hay fever and eczema. Asthma, wheeze, rhinitis, AHR and posSPT share, to a large extent, a common genetic aetiology. In particular, asthma and rhinitis are genetically similar, but environmentally distinct. Furthermore, genetic factors mainly explain the co‐occurrence of asthma and posSPT, and rhinitis and posSPT, whereas asthma, but not rhinitis, is closely genetically related to AHR. Finally, asthma and posSPT, and rhinitis and posSPT show similar environmental architectures. These results provide new insights into the aetiology of asthma and may be used to guide the choice of traits for genetic linkage analysis.     

Risk factors associated with allergic and non‐allergic asthma in adolescents

Introduction: Risk factors for asthma have been investigated in a large number of studies in adults and children, with little progress in the primary and secondary prevention of asthma. The aim of this investigation was to investigate risk factors associated with allergic and non‐allergic asthma in adolescents. Methods: In this study, 959 schoolchildren (13–14 years old) answered a questionnaire and performed exhaled nitric oxide (NO) measurements. All children (n = 238) with reported asthma, asthma‐related symptoms and/or increased NO levels were invited to a clinical follow‐up which included a physician evaluation and skin‐prick testing. Results: Asthma was diagnosed in 96 adolescents, whereof half had allergic and half non‐allergic asthma. Children with both allergic and non‐allergic asthma had a significantly higher body mass index (BMI) (20.8 and 20.7 vs. 19.8 kg/m²) (p < 0.05) and a higher prevalence of parental asthma (30% and 32% vs. 16%) (p < 0.05). Early‐life infection (otitis and croup) [adjusted odds ratio (OR) (95% confidence interval (CI)): 1.99 (1.02–3.88) and 2.80 (1.44–5.42), respectively], pets during the first year of life [2.17 (1.16–4.04)], window pane condensation [2.45 (1.11–5.40)] and unsatisfactory school cleaning [(2.50 (1.28–4.89)] was associated with non‐allergic but not with allergic asthma. Conclusion: This study indicates the importance of distinguishing between subtypes of asthma when assessing the effect of different risk factors. While the risk of both allergic and non‐allergic asthma increased with increasing BMI, associations between early‐life and current environmental exposure were primarily found in relation to non‐allergic asthma. Please cite this paper as: Janson C, Kalm‐Stephens P, Foucard T, Alving, K and Nordvall SL. Risk factors associated with allergic and non‐allergic asthma in adolescents. The Clinical Respiratory Journal 2007;1:16–22.     

Risk factors for toxoplasmic encephalitis in HIV-infected patients: a case-control study in Brazil.

A case-control study to identify the risk factors for toxoplasmic encephalitis (TE) among HIV-infected patients with latent Toxoplasma gondii infection was performed in a teaching hospital in south-eastern Brazil. Although the subjects were all positive for serum IgG antibodies to Toxoplasma, some (the cases) developed TE during routine follow-up at the hospital whereas others (the controls) did not. Adjusted odds ratios (aOR) were estimated by multiple logistic regression after controlling for potential confounders. Only 46 (22%) of the 210 cases but 93 (45%) of the 205 controls were on prophylactic regimens with co-trimoxazole [aOR = 0.30; 95% confidence interval (CI) = 0.15-0.60]. Subjects with fewer than 100 (aOR = 37.09; CI =7.49-183.67) or between 100 and 200 CD4 cells/microl (aOR = 10.20; CI =2.00-51.90) were at substantially increased risk of developing TE than those with >400 CD4 cells/microl. Although the results of preliminary, unadjusted data analysis indicated that male sex and homosexual or bisexual activity might be additional risk factors, these associations were not found to be statistically significant by multiple regression analysis. In conclusion, no risk factors for TE other than low CD4 cell counts and failure to receive prophylaxis were found among HIV-infected Brazilian patients with past exposure to Toxoplasma. Seropositive patients with CD4 cell counts above 100/microl (the point at which specific prophylaxis is usually recommended) but below 200/microl might also benefit from effective anti-TE prophylaxis.     

Risk factors of frequent exacerbations in difficult-to-treat asthma.

Recurrent exacerbations are a major cause of morbidity and medical expenditure in patients with asthma. Various exogenous and endogenous factors are thought to influence the level of asthma control, but systematical data on the involvement of these factors in the recurrence of asthma exacerbations are scarce. In this study, 13 clinical and environmental factors potentially associated with recurrent exacerbations were investigated in 136 patients with difficult-to-treat asthma. Patients with more than three severe exacerbations (n = 39) in the previous year were compared with those with only one exacerbation per year (n = 24). A systematic diagnostic protocol was used to assess 13 potential risk factors. Factors significantly associated with frequent exacerbations included: severe nasal sinus disease (adjusted odds ratio (OR) 3.7); gastro-oesophageal reflux (OR 4.9); recurrent respiratory infections (OR 6.9); psychological dysfunctioning (OR 10.8); and obstructive sleep apnoea (OR 3.4). Severe chronic sinus disease and psychological dysfunctioning were the only independently associated factors (adjusted OR 5.5 and 11.7, respectively). All patients with frequent exacerbations exhibited at least one of these five factors, whilst 52% showed three or more factors. In conclusion, the results show that recurrent exacerbations in asthma are associated with specific co-morbid factors that are easy to detect and that are treatable. Therapeutic interventions aimed at correcting these factors are likely to reduce morbidity and medical expenditure in these patients.     

Risk factors associated with hospitalizations for asthma attacks in Turkey.

The detection of factors associated with hospitalizations for asthma attacks should have a great value in the development of intervention strategies. However, these factors are unknown in Turkey. Our aim was to investigate the factors associated with hospital admissions by comparing hospitalized patients with the community control asthma patients and the relationships between serum eosinophilic cationic protein (ECP) levels and the disease severity. Eighty-one subjects hospitalized with asthma (69 women and 12 men) and 300 community control asthma patients (227 women and 73 men) were enrolled in this cross-sectional study. A questionnaire including detailed demographic and clinical data was compiled by all patients. Serum ECP levels were measured in 76, 14, and 9 patients of community control, hospitalized asthma patients, and healthy controls, respectively. Hospitalized patients were older and had longer asthma duration (p < 0.001). The significant risk factors for hospital admission for acute asthma attacks were previous severe asthma (odds ratio [OR], 12.26; 95% confidence interval [CI], 5.17-29.0), aspirin (acetylsalicylic acid) and nonsteroidal anti-inflammatory drug intolerance (OR, 3.63; 95% CI, 1.70-7.74), chronic rhinosinusitis (OR, 2.24; 95% CI, 1.16-4.33), lower educational level (OR, 2.24; 95% CI, 1.33-4.18), and lower atopy ratio (OR, 1.99; 95% CI, 1.13-3.50). These parameters were similar in patients who were hospitalized and in patients who had severe asthma of the community control. ECP levels were significantly higher in hospitalized and severe asthma patients compared with healthy controls. In conclusion, the factors associated with hospitalizations were advanced age, prolonged asthma duration, presence of severe asthma, "nonatopy," acetylsalicylic acid-nonsteroidal anti-inflammatory drug intolerance, sinusitis, and lower educational level. Further intervention strategies are needed to address these markers to prevent hospitalizations from asthma attacks.     

Risk factors for childhood asthma in Costa Rica

BACKGROUND: Little is known about factors determining the pathogenesis and severity of asthma in Latin American countries. Costa Rica, one of the most prosperous Latin American nations, has a very high asthma prevalence. OBJECTIVE: To examine the relation between potential risk factors and childhood asthma in Costa Rica. METHODS: Cross-sectional study of 214 schoolchildren aged 10 to 13 years participating in phase II of the International Study of Asthma and Allergies in Childhood. RESULTS: After adjustment for age, gender, area of residence, maternal smoking during pregnancy, and airway responsiveness to hypertonic saline solution, sensitization to house dust mites was associated with asthma (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1 to 4.4; p = 0.02). In the multivariate analysis, parental education no higher than high school (OR, 3.0; 95% CI, 1.4 to 6.4; p < 0.01) and parental history of asthma (OR, 2.6; 95% CI, 1.3 to 5.2; p < 0.01) were also independent predictors of childhood asthma. CONCLUSIONS: Sensitization to house dust mites, low parental education, and parental history of asthma are associated with asthma in Costa Rica.