云南省两城区儿童哮喘患病情况及其危险因素分析

目的 了解云南省城区儿童哮喘的流行现状、危险因素及其治疗情况,为进一步规范儿童哮喘的诊治及预防提供依据。方法 采用随机整群抽样的方法,通过自填式问卷调查与集中调查相结合的方式进行调查。对于初筛问卷中的可疑哮喘患儿按哮喘诊断标准进行诊断,对确诊的哮喘患儿填写哮喘儿童调查表。建立问卷数据库,并对数据进行整理、分析。结果 云南省两城区0~14岁儿童哮喘患病率为1.24%。哮喘患儿中既往诊断为哮喘及咳嗽变异性哮喘的为66.37%。哮喘患儿中使用抗生素治疗的有69.64%,使用支气管舒张剂治疗的有54.76%,吸入激素治疗有60.71%。家族过敏史、早产、房屋装修、烟草烟雾暴露等因素为哮喘发病的独立危险因素。结论 云南省城区0~14岁儿童哮喘患病率较10年前有明显增加。仍需进一步规范哮喘患儿诊治方法。预防早产、减少室内外污染、及时治疗变应性疾病及预防呼吸道感染是减少哮喘患病和预防哮喘发作的有效方法。     

十堰市城区儿童哮喘流行病学调查结果分析

目的了解十堰市城区儿童哮喘流行病学调查结果,明确十堰市城区儿童哮喘的患病率、发病规律及相关影响因素。方法采取随机、整群、不等比抽样方法从十堰市城区抽取0~14岁儿童作为调查对象,向家长发放问卷调查后,将存在可疑相关疾病患儿筛选出来,再由呼吸专科医生进行问诊与查体。结果实际调查人数10 164名,确诊为哮喘患儿438例,累积患病率为4.31%,除去两年以上未发病患儿92例,现患率为3.40%。男童患病率(5.58%)高于女童(3.01%),差异有统计学意义(P0.05);2~10岁儿童患哮喘病概率较高;90.87%患儿首次发病年龄在3岁以下;89.95%患儿哮喘诱因为呼吸道感染;大部分患儿哮喘好发时间无明显规律;发病先兆以鼻痒、打喷嚏为主要表现,发作时以咳嗽为主;发作类型多为缓慢;大部分患儿发作程度较轻;74.89%患儿接受过激素吸入治疗。结论十堰市城区儿童哮喘患病率较高,以婴幼儿时期多发,且患病率与儿童性别有关,并受诸多因素影响。     

连云港市城区儿童哮喘流行病学调查

目的 调查连云港市城区3～14岁儿童支气管哮喘(简称哮喘)的流行现状。方法 整群随机抽样9 612名儿童,发放初筛调查问卷,可疑对象予确诊,采用SPSS 19.0软件统计分析结果。结果 连云港城区3～14岁儿童哮喘患病率为4.2%,其中男5.01%,女3.28%,天气变化或接触冷空气是本地区儿童哮喘恶化的主要原因。哮喘组中家具合成板为主以及父亲吸烟的几率明显大于对照组(P＜0.05)。哮喘诊断前β内酰胺类使用率达80.60%。仅47.01%的家庭表示完全能够承受治疗费用,33.58%的患儿每年影响学习时间超过10d,5.97%的患儿从不参加体育活动。结论 连云港地区3～14岁儿童哮喘患病率高于全国水平,生活环境及方式有待改善,及时诊断、合理用药和规范治疗是防治关键。     

儿童哮喘筛查问卷与肺功能检查在儿童哮喘诊断中的应用价值

目的探讨儿童哮喘筛查问卷与肺功能检查在儿童哮喘诊断中的应用价值,为儿童哮喘的临床诊断方法选择提供参考。方法选取2017年6月-2018年12月在该院诊断为哮喘的患儿60例(哮喘组),以同期健康体检儿童60例作为对照组,行肺功能检查及哮喘筛查问卷调查,分析结果。结果哮喘组急性发作期患儿用力肺活量(FCV)、1秒用力呼气容积(FEV1)、FEV1/FCV、最高呼气流速(PEF)均明显低于临床缓解期及对照组,残气量(RV)/肺总量(TCL)、RV高于临床缓解期及对照组,差异有统计学意义(P0. 05),临床缓解期与对照组比较,差异无统计学意义(P0. 05)。肺功能检查诊断哮喘的灵敏度为93. 33%(56/60)、特异度为98. 33%(59/60)、诊断符合率为95. 83%(115/120),哮喘筛查问卷诊断哮喘的灵敏度为88. 33%(53/60)、特异度为91. 67%(55/60)、诊断符合率为90. 00%(108/120)。结论哮喘患儿急性发作期可明显表现为肺功能异常,临床缓解期患儿肺功能与正常水平接近,儿童哮喘筛查问卷与肺功能检查用于诊断儿童哮喘有较高的灵敏度及特异度,对儿童哮喘的筛查及辅助诊断有较高的临床价值。     

宝鸡市城区0～14岁儿童哮喘流行病调查分析

【目的】　了解宝鸡市城区儿童哮喘患病率及相关因素。　【方法】　以整群随机抽样法 ,对城区 114 70例 0～ 14岁儿童进行调查 ,对可疑患儿通过病史体检做出诊断 ,并探讨相关因素。　【结果】　 0～ 14岁儿童哮喘患病率为 1.98%,不同年龄段患病率有差异 (P <0 .0 0 1)。　【结论】　哮喘是危害儿童健康的重要问题之一 ,我市儿童哮喘防治水平有待提高     

厦门市同安区儿童哮喘患病情况调查分析

目的 调查2012-2013年厦门市同安区0~14 岁儿童哮喘患病情况及哮喘发病的危险因素, 为今后儿童哮喘的防治工作提供科学依据。方法 通过多阶段分层随机整群抽样方法, 采用2010年第三次全国儿童哮喘流行病学调查问卷, 调查厦门市同安区10 168名0~14岁儿童哮喘患病情况;其次采用1∶1病例对照研究方法和Logistic 回归分析法对哮喘患儿的发病危险因素进行研究。结果 在调查的10 168人中, 哮喘患儿428人, 总患病率为4.21%。男性患病率(5.88%)高于女性(2.28%)(P＜0.001)。哮喘患儿中, 首次发病以3岁内居多占74.76%;发作诱因最常见的为呼吸道感染占85.61%;发作先兆最常见的为打喷嚏占95.20%;经常发作强度以轻度最常见占68.25%;发作类型以突然发作最多占78.50%;好发季节为换季占50.60%;好发时间为夜间和清晨占71.45%。通过对428例哮喘患儿及428例非哮喘儿童的病例对照研究并且经Logistic 回归分析显示, 哮喘发病的独立危险因素包括:个人过敏史、过敏性鼻炎、家族过敏史、家族哮喘史(P＜0.001)。结论 厦门市同安区0~14岁儿童哮喘患病率高于10年前厦门市区哮喘发病率。男性哮喘患病率高于女性。个人过敏史、过敏性鼻炎、家族哮喘史及家族过敏史是该地区儿童哮喘发病的独立危险因素。     

临朐县0~14岁儿童哮喘流行病学调查分析

目的 研究临朐县0~14岁儿童哮喘的危险因素以及患病率,为本病的治疗及预防提供有力依据。方法 利用整群随机抽样的方法,在临朐县幼儿园、学校、防疫站抽取10 000名0~14岁儿童进行哮喘流行病学调查。结果 总共调查0~14岁儿童10 000人,收到9 765份有效问卷,有效率为97.65%。哮喘儿童152例,患病率为1.56%;患病率最高的是学龄前期的儿童,男童患病率高于女童,男女比例为1.50∶1,差异有统计学意义(χ²=5.648,P<0.05)。家族过敏或哮喘史、过敏性鼻炎史、皮肤过敏史、食物过敏史、个人药物过敏史、早产、超体重、使用抗生素可能为哮喘发病的危险因素。结论 2012年临朐县0~14岁儿童哮喘患病率较10年前全国哮喘患病率有所升高,儿童哮喘患病率最高的年龄段是学龄前期。儿童哮喘的发病与多种因素相关。     

西宁地区0～14岁儿童哮喘流行病学调查

【目的】　探讨西宁 (亚高原地区 ) 0～ 14岁儿童哮喘患病情况及相关因素。　【方法】　根据不同年龄段采取整群抽样和分散家访相结合的方式。　【结果】　共调查 0～ 14岁儿童 10 714人 ,检出哮喘儿童 80人 ,患病率为 0 .74% ,其中儿童哮喘 12人 ( 15 .0 0 % ) ,婴幼儿哮喘 (包括婴幼儿哮喘既往 >2年缓解 ) 14人 ( 17.5 0 % ) ,咳嗽变异性哮喘 11人 ( 13 .75 % ) ,可疑哮喘 43人 ( 5 3 .75 % )。儿童哮喘和婴幼儿哮喘现患 13人 ,患病率为 0 .12 % ,男女患病之比为 1.1∶1,两者差异不显著。首次发病年龄小于 1岁者占 75 .0 0 %。好发季节以不定期和换季节为主 ,发病时辰以无规律者多 ,发病诱因主要是呼吸道感染、有个人过敏史 ,一、二级亲属有哮喘史占 11.2 5 %。　【结论】　西宁地区 0～ 14岁儿童哮喘患病率低 ,但诊断治疗儿童哮喘存在较大问题 ,亟待推广和普及儿童哮喘的GINA方案     

舟山海岛儿童哮喘患病率及其相关因素分析

【目的】调查舟山海岛地区儿童哮喘发病率、哮喘相关因素及对儿童、家庭和社会的影响。【方法】采用抽样调查的方法,调查舟山海岛城乡3～15岁哮喘患病率及相关因素。【结果】共调查1436名儿童,男742名,女694名,现患病率男∶女为1.93∶1,累计患病率男∶女为1.80∶1,最后确诊哮喘59例,近12月有喘息发作44例,哮喘现患病率3.06%,累计患病率4.11%。25例(42.37%)3岁以前发病,52.54%有家族过敏性疾病史,89.83%以受凉感冒为起病诱因,有4例(6.78%)为进食海鲜诱发,其中35例进行吸入性过敏原筛查阳性率68.57%。仅10例(16.94%)的患儿正规激素吸入治疗,1例(1.69%)进行脱敏治疗。16.94%的患儿因哮喘影响家庭成员请假10d以上。常食海鲜,煤气煮饭,油漆等气味刺激,使用海绵枕头等是哮喘的危险因素。【结论】舟山海岛属儿童哮喘的高发地区,应大力推广哮喘的规范化治疗和诊断。     

苏州市0~14岁儿童哮喘患病率及防治现状的调查

【目的】 了解苏州市儿童哮喘患病率、起病年龄、发病诱因及防治现状,为进一步制定儿童哮喘防治措施提供科学依据。 【方法】 采用整群抽样调查,分两步:第一步问卷筛查得到疑似哮喘儿童资料,第二步对疑似病例进行临床确诊,同时了解其发病诱因及防治情况。 【结果】 收回初筛问卷10 805份,筛出喘息相关儿童622例,经临床确诊哮喘540例,咳嗽变异性哮喘5例,可疑哮喘77例。哮喘累计患病率为5%,男女患病率分别为6.22%、3.51%。过敏性鼻炎1 130例,患病率为10.46%,男女患病率分别为12.37%、8.13%。湿疹884例,患病率为8.18%,男女患病率分别为8.85%、7.35%。哮喘在3岁以内起病占77.17%。98.23%哮喘儿童反复应用过抗生素,59.97%在急性发作期接受吸入治疗,但在缓解期进行维持治疗的仅为8.89%。 【结论】 2010年苏州市0~14岁儿童哮喘累计患病率为5%,较10年前有增加,男性高于女性。儿童哮喘起病年龄大多数在3岁以内,发病高峰在春秋换季时,上呼吸道感染为最常见诱发因素。大多数哮喘患儿治疗不规范,正确、合理、规范治疗儿童哮喘的新知识、新药物要宣传、普及。     

Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach

The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria, for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.     

Asthma prevalence and management in Australian adolescents: Results from three community surveys

Three population surveys of asthma, conducted as part of a community-based asthma education program in southwestern Sydney, Australia, illustrate the relationship between health behaviors and asthma morbidity. The first survey was carried out in five secondary schools (n = 2514, 52% participation rate); the second survey, in eight schools (n = 4550, 82% participation rate); and, the third survey was conducted among patients who attended 38 general practices in the region (n = 633 adolescents, 72% participation rate). The prevalence of diagnosed asthma in Australian adolescents across all three studies was 16.5% (95% CI, 15.7%–17.3%). Asthma prevalence declined in males, but increased in females from ages 12–15 years. It was noted that smoking prevalence was similar in asthmatic adolescents, compared with non-asthmatics, and that the adoption of smoking occurred at similar ages. Further, behavioral self-management of asthma was infrequent in this group, with low levels of preventive practice and preventive medication use. We present a conceptual model of the barriers to optimal asthma management among asthmatic adolescents. The results of these surveys have led to community-wide efforts to improve asthma management and decrease smoking prevalence among these adolescents.     

Effects of changing risk factors on increasing asthma prevalence in southern Taiwan

The study sought to identify factors with consistent relationships with the prevalence of asthma and postulate causes for the increasing prevalence. Reduplication of prevalence surveys was conducted among children of similar ages (6-12 years) from the same area (Tainan City, Taiwan). A total of 7523 primary school children from 1993 and 7224 from 1997 participated in the study. The reported prevalence of diagnosed asthma increased from 6.46% in 1993 to 8.45% in 1997 (relative risk 1.31, 95% CI 1.16, 1.47). Among all environment- and heredity-related factors examined, only four showed consistent relationships with childhood asthma, and all appeared to be a related hereditary condition. Dander allergy is the only factor that increased correspondingly with the prevalence of childhood asthma; therefore, it seems to be the most likely key factor responsible for the increasing trend. The investigation of the interactive effects imposed by the environment- (dander exposure) and heredity-related (atopic sensitisation) factors are recommended for further studies.     

Underdiagnosis of childhood asthma: A comparison of survey estimates to clinical evaluation

Objectives

Diagnostic patterns play a role in asthma prevalence estimates and could have implications for disease management. We sought to determine the extent to which questionnaire-derived estimates of childhood asthma reflect the disease’s true occurrence.

Materials and Methods

Children aged 6–12 years from Katowice, Poland, were recruited from a cross-sectional survey (N = 1822) via primary schools. Students were categorized into three mutually exclusive groups based on survey responses: “Asthma” (previously diagnosed asthma); “Respiratory symptoms” (no previous diagnosis of asthma and one or more respiratory symptoms during last year), “No respiratory symptoms” (no previous diagnosis of asthma or respiratory symptoms). A sample of children from each group (total N = 456) completed clinical testing to determine asthma presence according to GINA recommendations.

Results

Based on the survey, 5.4% of children were classified with asthma, 27.9% with respiratory symptoms, and 66.7% with no respiratory symptoms or asthma. All previously known 41 cases of asthma were confirmed. New diagnoses of asthma were made in 21 (10.9%) and 8 (3.6%) of subjects from the “Respiratory symptoms” (N = 192) and “No respiratory symptoms” (N = 223) groups, respectively. The overall prevalence of childhood asthma, incorporating the results of clinical examination, was 10.8% (95% CI: 9.4–12.2), compared to the questionnaire-derived figure of 5.4% (95% CI: 4.4–6.5%) and affected females more than males.

Conclusions

Asthma prevalence was underestimated in this population possibly resulting from under-presentation or under-diagnosis. This could have potential implications for proper management and well-being of children. Questionnaire estimates of prevalence should be considered carefully in the context of regional diagnostic patterns.     

Rethinking race/ethnicity, income, and childhood asthma: racial/ethnic disparities concentrated among the very poor

OBJECTIVE: Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata. METHODS: Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma. RESULTS: Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1%) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR]=1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children. CONCLUSIONS: Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.     

Childhood asthma in the Highlands of Scotland--morbidity and school absence

BACKGROUND: The prevalence of childhood asthma in Scotland is one of the highest in the world. The morbidity secondary to allergic diseases is significant in terms of costs to the nation and effects on the family including the child. AIMS: The aims of this study were to describe the prevalence of asthma, eczema and hay fever in the Highlands of Scotland and in the Shetland Isles and to examine factors in relation to quality of life and social deprivation. METHOD: A total population survey of 12 year old children using a parent completed questionnaire. RESULTS: 86.3% (2658/3080) returned questionnaires. Of the 2549 questionnaires analysed, 476 (18.7%) reported asthma ever, 362 (14.2%) wheeze in last 12 months, 508 (19.9%) reported hay fever ever and 555 (21.8%) reported eczema ever. Of the children reporting asthma or wheeze, 35.4% (229/647) had missed school because of asthma or wheeze, 38.0% (246/647) had missed physical education. 62.5% (354/566) of subjects with wheeze ever reported sleep disturbance. Deprivation measured by DEPCAT scores was associated with maternal smoking and bronchitis in the child but not with allergic diseases. CONCLUSION: Compared with previous studies, the prevalence of asthma was unchanged but eczema has increased in Highland adolescents. Allergic disease has a significant impact on school attendance and physical activity. Deprivation was associated with maternal smoking and bronchitis in the child but not with allergic diseases. The impact of allergic diseases in rural areas may be different from urban areas.     

Increase in prevalence of childhood asthma in Budapest between 1995 and 2003: correlation with air pollution data and total pollen count

INTRODUCTION: According to the data of the Hungarian pulmonological network, the prevalence of asthma in the last 15 years has increased (almost linearly) in Hungary. In 2004 it was 1.8%. There are only a few data about the prevalence of childhood asthma. AIMS: The aim of the authors was to measure the prevalence of bronchial asthma in childhood in Budapest in 1995, 1999 and 2003, using questionnaires directed to district pediatricians. METHODS: There were only two questions in these questionnaires: how many children are in their districts, and how many are suffering from asthma? Besides of this survey the dust, CO, NO(2) and SO(2) concentrations in the air were measured on-line at 8 points in Budapest, while ozone level measurements were also made at 2 stations. The counts of pollen and of fungal elements in the air were calculated separately for Buda and for Pest. RESULTS: In 1995, replies were received from 118 pediatricians in 11 districts, who were responsible for the supervision of 104,060 children, out of these 1.88+/-0.87% had been diagnosed as having asthma. In 1999 replies were sent by 153 physicians in 22 of the 23 districts, who had a total of 142,679 children under their care. These included 3228 asthmatics, i.e. a prevalence of 2.26+/-0.95%. In 2003 the authors received answers from all of the 23 districts of Budapest. The 204 pediatricians were responsible for the supervision of 176 049 children. The number of patients with the diagnosis of asthma was 4712 (corresponding for a prevalence of 2.68+/-1.3%). The increase between 1995 and 1999, and between 1999 and 2003 was highly significant (p < 0.0001). This significant increase was valid even when the authors analysed only those 11 districts, which answered already in 1995. The level of air pollution in Budapest did not deteriorate in the period in question, and the concentration of pollen grains of plants causing allergy did not increase compared to previous years. CONCLUSIONS: On the basis of the results of more than 100 thousand children, the authors conclude that between 1995 and 2003 the proportion of asthmatic children increased by 50% in Budapest, while the air pollution did not deteriorate and the pollen concentration from sensitizing plants did not increase.