Pet-keeping in early childhood and airway,nose and skin symptoms later in life

BACKGROUND: It is discussed whether exposure to pets during childhood is a risk or a protective factor for sensitization and allergic symptoms. The aim of this study was to investigate the association between pet-keeping at time of birth and allergic symptoms in airways, nose and skin among young children in Sweden. METHOD: A questionnaire was sent to the parents of 14 077 children (1-6 years), the focus being on allergic symptoms, home environment and other background factors including pet-keeping and avoidance behaviour. The response rate was 79%. RESULTS: Almost one-tenth of the population had got rid of pets because of allergy in the family, and 27.3% reported "avoidance" behaviour towards pets. In a cross-sectional analysis current pet-keeping was "protective", but this may be due to the fact that people avoid exposing their child to something that they believe is a risk factor for allergies. Pet-keeping at the time of birth was associated with "wheezing", "asthma" and "rhinitis on pet-exposure" later in life for children from families with an "avoidance" behaviour, and was not "protective" for other children. There was also an indication of a dose-response relationship between the number of types of furred pets at time of birth and later symptoms in analyses adjusted for avoidance behaviour or current pet-keeping. CONCLUSION: The distribution of pet-keeping in the population is largely explained by avoidance behaviour, meaning that those who have pets mainly are those who can stand them, indicating a "healthy pet-keeping effect".     

The prevalence of asthma and allergic symptoms in Manisa, Turkey (A western city from a country bridging Asia and Europe)

The aim of this study was to determine the prevalence of asthma and allergic symptoms in Manisa city center, Turkey, to evaluate the determinants effective on those values, and to review the prevalence rates reported from different parts of the country. Data were collected from 610 households and complete interviews were conducted with 1,336 adults over 18 years of age by using European Community Respiratory Health Survey-ECRHS questionnaire. The prevalences of current asthma, cumulative asthma and asthma-like symptoms were found in 1.2, 1.0 and 25.0%, respectively, of the 20-44 years age group and the prevalences of allergic rhinitis, allergic dermatitis and family atopy were found in 14.5, 10.9, and 15.2%, respectively, in all age group. Wheezing with breathlessness, wheezing without cold, woken up with shortness of breath and woken up with cold were reported by 9.1%, 6.9%, 6% and 16.1% of the study population, respectively. Gender, age, active or passive smoking, family atopy and home condition effect on prevalence of asthma and allergic symptoms. In this study prevalence of asthma correlated with the studies reporting low prevalence rates of Turkey.     

The validity of the ISAAC written questionnaire and the ISAAC video questionnaire (AVQ 3.0) for predicting asthma associated with bronchial hyperreactivity in a group of 13-14 year old Korean schoolchildren

To validate the prevalence rate of symptoms of asthma produced by the phase I ISAAC (International Study of Asthma and Allergies in Childhood) study, hypertonic saline challenge test was carried out during the phase II study at a year after the phase I study. For the phase II study, six middle schools from three cities in the phase I study were selected. Finally, 499 children who responded to both studies were analyzed. All subjects were asked to complete the written questionnaire (WQ) first, followed by a video questionnaire (AVQ 3.0) during the phase I study. Of the 499 children, only 19 (3.8%) were positive to the hypertonic saline bronchial challenge test. The degree of agreement between responses to the two corresponding questions "wheezing at rest" and "nocturnal wheeze" in the AVQ 3.0 and WQ were moderate and weak with a Kappa indices of 0.45 and 0.23, respectively. The question on "severe wheeze" in the AVQ 3.0 had the highest Youden's index among the five questions related to asthma symptoms in the previous 12 months, but its specificity was low whereas its sensitivity was 1.0. There was no consistency of priority between the two questionnaires in predicting bronchial hyperreactivity in a group of Korean schoolchildren. Therefore we need to develop more appropriate WQ or AVQ to compare the prevalences of asthma to other countries.     

Prevalence of asthma and other allergic diseases in an adolescent population: association with gender and race.

OBJECTIVES: To estimate the prevalence and severity of asthma in an adolescent population by sex and race. METHODS: Cross-sectional, population-based survey of school children. SETTING: Midwestern city experiencing damage from the 1993 Mississippi River flood. Participants: 2,693 children attending grades 7 to 12. MEASUREMENTS: Questions from the International Study of Asthma and Allergies in Childhood (ISAAC). RESULTS: Two thousand six hundred ninety-three children were surveyed, for a response rate of 90%. In this population, 16.4% reported having ever been diagnosed with asthma; 25% reported wheezing in the last 12 months; 32% reported symptoms of rhinitis in the last 12 months; and 22% reported ever having hay fever. The prevalence rate for current asthma was 12.6%. Female students had significantly greater prevalence rates for current asthma (16.4% vs 9.0%, OR = 1.85); ever-diagnosed asthma (18.5% vs 14.3%, OR = 1.36); wheezing > or = 4 times in the last 12 months (12.0% vs 5.6%, OR = 1.95); current rhinitis (38.7% vs 25.4%, OR = 1.73); and hay fever (26.4% vs 18.4%, OR = 1.57). All associations with sex remained significant, except ever-diagnosed asthma, after controlling for other known risk factors in logistic regression. African-Americans had higher prevalence rates than other races with differences reaching statistical significance for ever-diagnosed asthma and current asthma; however, these relationships did not remain significant after controlling for other known risk factors in logistic regression. CONCLUSIONS: Our prevalence rates were similar to those reported by other studies that used the ISAAC questionnaire. Female students reported significantly more asthma, wheezing, rhinitis, and hay fever than male students. Female students also reported more severe symptoms and a greater number of emergency room and hospital admissions.     

Development of a Questionnaire for the Assessment of Quality of Life in Korean Children With Allergic Rhinitis

Purpose

Korean children have their own unique lifestyle based on their living environment and culture. This study aimed to develop a questionnaire to evaluate the quality of life in Korean children with allergic rhinitis.

Methods

After a preliminary survey, an initial questionnaire was developed. Questions were modified to be easily understood by young children aged 6 to 7 years. The modified questionnaire was tested on children aged 6 to 12 years old. Item scores, defined as the proportion of children whose answer score was 1 point or higher was multiplied by the average answer score of each question, were used to identify questions that have practical application to the quality of life in Korean children with allergic rhinitis. Differences in answer scores between children with allergic rhinitis and those who were healthy were assessed by a Wilcoxon rank-sum test. The relationship between nasal index scores and quality of life scores was determined by a Spearman rank order test.

Results

An initial questionnaire was composed of 21 items. We identified 19 questions with item scores above 0.5 in children with allergic rhinitis, many of which were related to nasal symptoms and 10 questions that were different between the allergic rhinitis group and the control group. The final questionnaire included the 10 questions that had both high item scores and a significant difference in the answer scores between the two groups.

Conclusions

The developed questionnaire is essential and practical for assessing discomfort related to the symptoms felt by Korean children with allergic rhinitis.     

Prevalence and severity of asthma, rhinitis, and atopic eczema in 13- to 14-year-old schoolchildren from the northeast of England.

OBJECTIVE: To investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from the northeast of England. METHODS: We randomly selected 3,000 children from 80 schools. We used the ISAAC (International Study of Asthma and Allergies in Childhood) written questionnaire. RESULTS: The lifetime prevalence rates of symptoms were: rhinitis, 32.8%; wheezing, 31.3%; hay fever, 23.7%; and self-reported asthma, 22.3%. Rhinitis was reported by 53% and 61% of boys and girls with asthma, respectively. Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema symptoms than boys; a reverse sex ratio has been shown in this age group. Atopic eczema was reported by 32% of boys with asthma and 37% of girls with asthma. CONCLUSIONS: The prevalence rates of reported asthma, and symptoms suggestive of asthma, were higher than those previously reported in UK children. The present study would be a suitable baseline for monitoring future trends in the prevalence and severity of asthma and allergic disorders among these children, and provides a framework for further etiologic research into the genetics, lifestyle, environmental, and medical care factors affecting these conditions.     

Development and validation of school-based asthma and allergy screening instruments for parents and students.

BACKGROUND: The increasing morbidity attributable to asthma among school-aged children suggests the potential utility of school-based asthma screening programs. OBJECTIVE: We report our efforts to develop and validate culturally sensitive and clinically useful screening questionnaires (parent and child versions) for asthma and allergies among urban US school children. METHODS: Instrument development was accomplished through literature review, expert medical and child developmental input, focus group feedback, and a rigorous trial of the instruments in a public school setting. Questionnaires were distributed to 2,800 children and their families in an urban public school system (grades kindergarten through 6). Validity was evaluated by blinded comparison of results against a standardized clinical evaluation in 107 children, with final designations determined by an expert panel. RESULTS: Questionnaires pertaining to 2,083 children were returned (participation rate of 74%). A moderate level of agreement was observed between parent and student questionnaire responses (r values = 0.36 to 0.50; P values < 0.001). The highest frequency of asthma-like symptoms was reported for African-American boys and the lowest for Caucasian girls. The items from the parent questionnaire that best predicted asthma were "breathing problems" (occurring rarely or more; odds ratio 12.8; 95% confidence interval, 4.5 to 36.1) and "problems coughing" (sometimes or more; odds ratio 9.7; 95% confidence interval, 3.6 to 26.5). Considering the presence of cough (sometimes or more) and/or breathing problem (rarely or more) yielded a sensitivity of 80%; a specificity of 75%, a positive predictive value of 50%, and a negative predictive value of 92%. Similar levels of prediction were observed for the items "trouble breathing" and "noisy breathing" as directly reported by the students. Allergic rhinitis was best predicted by report of a runny/stuffy no se (sometimes or more; sensitivity of 83%, specificity of 61%).Allergic conjunctivitis was best predicted by "itchy eyes." CONCLUSIONS: Administration of a school-based questionnaire is feasible, with a high response rate and excellent internal consistency. A high sensitivity and acceptable specificity was achieved by using one to two questions for asthma, allergic rhinitis, and allergic conjunctivitis. Among the children in grades 2 or above, comparable levels of prediction could be achieved with the student or parent version.     

Prevalence of adult asthma and allergic rhinitis in Kamishihoro town, Hokkaido--associations with smoking habit and obesity

PURPOSE: To investigate the prevalence of adult asthma and allergic rhinitis, and to analyze associations between smoking habit, obesity and disease in Kamishihoro town, Hokkaido. METHODS: The Japanese edition of the European Community Respiratory Health Survey (ECRHS) Questionnaire was completed by 3096 residents (men: 1520, women: 1576) who ranged in age from 18 to 81. RESULTS: Among the respondents, 12.9% of the males and 9.8% of the females responded "Yes" to the questionnaire item, "Wheezing at any time in the last 12 months" (defined as having asthma) and 17.6% of the males and 23.0% of the females responded "Yes" to the question, "Do you have any nasal allergies including hay fever?" (defined as having allergic rhinitis). This prevalence tended to be higher among younger respondents. Smoking habit and obesity were significantly associated with wheezing over the last 12 months, but not with allergic rhinitis. CONCLUSION: Smoking habit and obesity are significantly associated with asthma in Kamishihoro town, located in a rural area of Hokkaido, Japan.     

Day-care attendance and increased risk for respiratory and allergic symptoms in preschool age

BACKGROUND: The reported impact of day-care attendance on respiratory and atopic symptoms has varied between studies from different countries. Regarding to the 'hygiene-hypothesis', day-care attendance may lead to less sensitization later in life, but the question still is whether day-care attendance and subsequent exposure to more frequent early infections is a risk or a protection against future allergic disease or asthma (atopic and nonatopic). METHODS: A cross-sectional postal questionnaire was replied by parents of 10,851 children, aged 1-6 years, in the year 2000 in a Swedish region (DBH-phase 1). The questionnaire focused on respiratory and atopic symptoms, the home environment and information on day care of the children. RESULTS: Children in day care were reported to have more symptoms than children in home care: adjusted odds ratio (AOR) for wheezing last 12 months, AOR 1.33 (CI 95%: 1.12-1.58), cough at night apart from colds last 12 months AOR 1.56 (CI: 1.17-2.07), doctor diagnosed asthma AOR 1.23 (CI: 0.88-1.71), rhinitis last 12 months AOR 1.15 (CI: 0.92-1.44), doctor diagnosed hay fever AOR 1.75 (CI: 0.94-3.23), eczema last 12 months, AOR 1.49 (CI: 1.24-1.79), allergic reactions to foods, AOR 1.27 (CI: 1.07-1.52), >6 colds last 12 months of 2.57 (CI: 2.12-3.12) and ear infection ever AOR 2.14 (CI: 1.87-2.45). The increased risks were mainly seen and reached significance in the youngest group of children, aged 1-4 years. Adjusting and stratification for the number of airway infections last year did not change the risk associated with day-care attendance for allergic diseases. CONCLUSIONS: Attending day care was associated with an increased risk of symptoms related to airways infections as well with eczema and allergic reactions to food. No sign of protection from day-care attendance for allergic diseases was found up to 6 years of age. Multiple airway infections and day-care attendance were found to be independently associated with asthma and allergic symptoms.     

Time trends in asthma and wheeze in Swedish children 1996–2006: prevalence and risk factors by sex

Background:  Recent data suggest that the previously rising trend in childhood wheezing symptoms has plateaued in some regions. We sought to investigate sex-specific trends in wheeze, asthma, allergic conditions, allergic sensitization and risk factors for wheeze.
Methods:  We compared two population-based cohorts of 7 to 8-year olds from the same Swedish towns in 1996 and 2006 using parental expanded ISAAC questionnaires. In 1996, 3430 (97%) and in 2006, 2585 (96%) questionnaires were completed. A subset was skin prick tested: in 1996, 2148 (88%) and in 2006, 1700 (90%) children participated.
Results:  No significant change in the prevalence of current wheeze ( P  = 0.13), allergic rhinitis ( P  = 0.18) or eczema ( P  = 0.22) was found despite an increase in allergic sensitization (20.6–29.9%, P  < 0.01). In boys, however, the prevalence of current wheeze (12.9–16.4%, P  < 0.01), physician-diagnosed asthma (7.1–9.3%, P  = 0.03) and asthma medication use increased. In girls the prevalence of current symptoms and conditions tended to decrease. The prevalence of all studied risk factors for wheeze and asthma increased in boys relative to girls from 1996 to 2006, thus increasing the boy-to-girl prevalence ratio in risk factors.
Conclusions:  The previously reported increase in current wheezing indices has plateaued in Sweden. Due to increased diagnostic activity, physician diagnoses continue to increase. Time trends in wheezing symptoms differed between boys and girls, and current wheeze increased in boys. This was seemingly explained by the observed increases in the prevalence of risk factors for asthma in boys compared with girls. In contrast to the current symptoms of wheeze, rhinitis or eczema, the prevalence of allergic sensitization increased considerably.     

Validation of ECRHS Questionnaire in Japanese to use for nation-wide prevalence study of adult asthma]

PURPOSE: To enable international comparison of prevalence in asthma, we translated and evaluated ECRHS Questionnaire, which is introduced in GINA. Considering COPD prevalence in elder people, we added two questions to the ECRHS Questionnaire. METHOD: The Japanese edition of ECRHS Questionnaire was responded by 366 patients who were diagnosed asthma without COPD, 61 patients who were diagnosed COPD without asthma, and 137 healthy persons who were not diagnosed asthma or COPD. We analyzed the answers of the each group and evaluated the validity of the questionnaire to use for the nation-wide prevalence study of adult asthma in future. RESULTS: The question of 'Wheezing at any time in the last 12 months' had the highest Youden's index and validity to pick up asthma patients. The questions of 'Waking up with a feeling of tightness in chest at any time in the last 12 months' and 'Waking up by an attack of shortness of breath at any time in the last 12 month' had the highest specificity to pick up asthma patients. Most of the questions which were related asthma were able to be answered by asthma patients properly, but some questions were improperly answered by patients and healthy persons in elderly. The results in this study showed the less recognition of their diseases in elderly patients than younger patients and the limitation of the study with written questionnaire for elderly people. Not a few COPD patients complained wheezing or whistling in the chests as same as asthma patients in this study. CONCLUSION: We concluded that we had almost enough reliability in the Japanese edition of the ECRHS questionnaire for screening survey of asthma prevalence in Japan.     

The prevalence of allergic conditions and immediate skin test reactions among Finnish adolescents

The purpose of the study was to determine the skin reactivity of 14–16-year-old adolescents to common allergens and its connections with the occurrence of bronchial wheezing, asthma, allergic rhinitis and atopic eczema. The series consisted of 218 persons living in south-eastern Finland. All the persons who took part in the study filled out a questionnaire concerning symptoms of any allergy. They were prick skin-tested with eight common allergens and examined clinically by the author. Positive skin test reactions were observed in sixty-six cases (31%), forty-one of which (62%) had past or present allergic symptoms. Symptoms indicating past or current allergy were observed in seventy persons (32%). 59% of the young people who had or had had allergic disorders were found to have a positive skin test; the figure for the asymptomatic group was 17%. Allergic rhinitis was most clearly connected with the positive skin test. 83% of those with rhinitis had a positive skin test, whereas the figure for bronchial wheezing and asthma was 70% and for eczema 44%. The prevalence of allergic symptoms and skin test positivity was about the same between the sexes, but the boys had experienced bronchial wheezing twice as often as the girls. This study shows that the prevalence of allergic symptoms, when the mild manifestations are also taken into account, is higher in Finland than is assumed. The occurrence of skin test positivity in the age groups examined is about the same as that observed in previous studies on this subject.     

Prevalence and severity of symptoms of asthma, rhinitis, and eczema in 13- to 14-year-old children in Taipei, Taiwan.

BACKGROUND: The prevalence of asthma and allergic diseases in children has increased worldwide. OBJECTIVE: To perform the phase 3 survey of the International Study of Asthma and Allergies in Children (ISAAC) to report the time trend of the prevalence and severity of asthma and allergic diseases in children in Taipei. METHODS: Two junior high schools in each of the 12 school districts in Taipei were randomly chosen to enter the study. All students aged 13 to 14 years in the chosen schools were invited to participate in written and video questionnaires in Chinese (identical to those of the ISAAC phase 1 survey). The study was performed between December 1, 2001, and January 31, 2002. All data analysis followed the protocol of the ISAAC and then was submitted to the ISAAC International Data Center. RESULTS: Of 6653 eligible children from 23 high schools (1 school refused participation), 6381 (95.9%) participated. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in the past 12 months in 13- to 14-year-old children increased by 37%, 51%, and 193%, respectively, on written questionnaires during a 7-year period. The severity of asthma symptoms, including more than 4 wheezing attacks in the past 12 months, wheezing that disturbs sleep more than once per week, and wheezing that limited speech in the past 12 months, did not show any significant changes on written questionnaires during the 7 years. CONCLUSION: The increasing prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in 13- to 14-year-old children in Taipei in a 7-year period is a significant burden on public health systems in Taiwan.     

Prevalence of childhood asthma and allergic diseases in Ankara, Turkey

Kalyoncu AF, Selçuk ZT, Karakoca Y, Emri AS, Çöplü L, Şahin AA, Bariş YI. Prevalence of childhood asthma and allergic diseases in Ankara, Turkey.
The first epidemiologic survey of the prevalence of childhood asthma and other allergic disease in Ankara, Turkey, was done in May 1992. A questionnaire on factors influencing the atopic status and allergic symptoms was distributed to parents of 1226 children aged 6-12 years. In this questionnaire, parents were asked to give information about physician-diagnosed asthma and atopic dermatitis (AD), and self-reported wheezing and rhinoconjunctivitis (perennial or seasonal). The overall response rate was 85 % and included 502 boys (48.5%) and 534 girls (51.5%). The lifetime prevalences of asthma, wheezing, rhinoconjunctivitis, and AD were 17.4%, 23.3%, 28%, and 6.1%, respectively, and the reported prevalences for the last 12 months were 8.3%, 11.9%, 15.4%, and 4%, respectively. Asthma and other allergic disease had been recognized in 23.2% of the children during the last year; in half of these, more than one disease was present. Eight percent of the families kept pet animals; 95.4% of children had been breast-fed, of whom 61% for more than 6 months; and at least one person smoked at home in the case of 73.9% of children. Some health insurance was available to 72.8% of the families. Cumulative prevalences of wheezing, rhinoconjunctivitis, and AD were significantly associated with the presence of pets, passive smoking at home, and absence of health insurance. The prevalence of asthma was not affected by any of these factors except atopic family history. In conclusion, asthma and other allergic diseases constitute a major health problem for schoolchildren in Ankara.     

Easy diagnosis of asthma: computer-assisted, symptom-based diagnosis

Diagnosis of asthma is often challenging in primary-care physicians due to lack of tools measuring airway obstruction and variability. Symptom-based diagnosis of asthma utilizing objective diagnostic parameters and appropriate software would be useful in clinical practice. A total of 302 adult patients with respiratory symptoms responded to a questionnaire regarding asthma symptoms and provoking factors. Questions were asked and recorded by physicians into a computer program. A definite diagnosis of asthma was made based on a positive response to methacholine bronchial provocation or bronchodilator response (BDR) testing. Multivariate logistic regression analysis was used to evaluate the significance of questionnaire responses in terms of discriminating asthmatics. Asthmatic patients showed higher total symptom scores than non-asthmatics (mean 5.93 vs. 4.93; p<0.01). Multivariate logistic regression analysis identified that response to questions concerning the following significantly discriminated asthmatics; wheezing with dyspnea, which is aggravated at night, and by exercise, cold air, and upper respiratory infection. Moreover, the presence of these symptoms was found to agree significantly with definite diagnosis of asthma (by kappa statistics). Receiver-operating characteristic curve analysis revealed that the diagnostic accuracy of symptom-based diagnosis was high with an area under the curve of 0.647 +/- 0.033. Using a computer-assisted symptom-based diagnosis program, it is possible to increase the accuracy of diagnosing asthma in general practice, when the facilities required to evaluate airway hyperresponsiveness or BDR are unavailable.     

Allergic rhinitis in preschool children from southern Brazil

There are few published studies on prevalence of allergic rhinitis in preschool children. The aims of this study were to verify the prevalence, clinical characteristics, and treatment of allergic rhinitis (AR) symptoms in the first year of life adding supplementary questions to the EISL instrument. A cross‐sectional study used Phase III EISL written questionnaire in addition to modified allergic rhinitis ISAAC questions. One thousand and three parents of infants answered the questionnaire: 484 (48.3%) had at least one sneezing, or a runny or blocked nose episodes without cold or flu in the first year of life. A quarter of infants had recurrent wheezing (≥3 episodes) and more frequent in the presence of AR symptoms. Physician diagnosis of AR and the use of intranasal steroids and both antihistamines and intranasal steroids were more common among those infants with AR symptoms. The prevalence of AR symptoms was high and starting early in life.     

Qol questionnaire for pediatric patients with bronchial asthma and their parents or caregivers preparation and evaluation of the short form version 2008 (gifu)

Background: The QOL questionnaire version 2001 for pediatric patients with bronchial asthma and their parents or caregivers includes 15 questions for patients under the age of 4 years and 20 questions for patients over the age of 4 years. We have already reported that the QOL questionnaire version 2001 reflects reliability (including reproducibility), factorial validity, and changes in paroxysmal attacks of asthma. In this study, we revised the questionnaire for use in routine medical practice. Methods and Results: In this study, based on the data of a previous report, the number of questions was reduced further and it was revised to the questionnaire the short form by integrated data. The revised version 2008 (Gifu) consisted of emotional burden, asthma attack, instability of symptoms and proper acceptance of asthma as a common factor, moreover 4 or more years old added load of exercise factor which consisted of two questions in each factor. This QOL short form questionnaire version 2008 (Gifu) is a disease specific questionnaire in comparison with health control, bronchial asthma and non-asthmatic patients, such as atopic dermatitis and allergic rhinitis. Conclusion: Although Cronbach's alpha fell with reduction of the number of questions, we conclude that it was acceptable in the clinical practice.     

Asthma, rhinitis and eczema in Maltese 13–15 year-old schoolchildren — prevalence, severity and associated factors [ISAAC]

Background

Allergic conditions, especially asthma, seem to be increasingly common the world over. The International Study of Asthma and Allergies in Childhood [ISAAC] was the first worldwide study carried out with standardized questionnaires in order to create a reliable global map of childhood allergy.

Objectives

The Maltese Islands were one of the centres participating in this study and in this paper the data obtained from 4184 13–15 year olds from 22 state and three private schools [88.7% response rate], and also data obtained from some added ‘local’ questions addressed to the same children, are included. in order to evaluate the problem of allergic conditions in Maltese schoolchildren.

Results

27.9% of the participants were wheezers ‘ever’ while 16% were current wheezers. Of the latter children 15.1% were experiencing nocturnal wheezing at least once a week and 22% had a wheezing episode severe enough to limit speech. Nasal problems were present in 52.7% of these teenagers and 47.4% of all respondents persisted with these symptoms up to the year of answering the questionnaire. Hayfever had been diagnosed in 32.3% of all the children. 12.8% of respondents had a recurring itchy rash suggestive of eczema for at least 6 months of their lives and 10% had it currently. This was slightly lower than the global mean, unlike the case of wheezing, which in Malta was more common than the world average, and rhinitis, for which we had the second highest cumulative prevalence rate in the world. Multiple variables such as gender, smoking, family history of atopy, pets, soft furnishings and living in busy roads affected the prevalence and severity of the allergic conditions studied.

Conclusions

Allergic conditions are very common in Maltese schoolchildren and are causing a lot of hardship to these same youngsters. The results of this study should serve as a stimulus to try and decrease this suffering through better management of these conditions, measures to control possible detrimental factors and further research on asthma, allergic rhinitis and eczema.

     

Prevalence of wheeze, bronchial hyper-responsiveness and asthma in the elderly Chinese

BACKGROUND: Asthma is a common health problem affecting patients of all ages. Because of the ease of sampling, epidemiological studies have concentrated mainly on the paediatric and general population. OBJECTIVE: This study aimed to determine the prevalence of wheeze, bronchial hyper-responsiveness and asthma amongst our elderly population and deduce any clinical and laboratory risk factors that might identify elderly asthmatics at an earlier stage. METHODS: Two thousand and thirty-two elderly Chinese aged > or = 70 years, randomly selected from a registered list of all recipients of Old Age and Disability Allowances in Hong Kong, were administered a questionnaire on lung health. Two hundred and fifty subjects were invited to attend our laboratory for skin tests and pulmonary function tests and 179 agreed. Of these, 173 (96.6%) and 176 (98.3%) had eosinophil count and serum IgE levels measured, respectively. Two definitions of asthma were used: (1) bronchial hyper-responsiveness (BHR) plus current wheeze, and (2) history of wheezing without previous diagnostic labels of emphysema or chronic bronchitis. RESULTS: Fifteen patients (out of 179: 8.4%) reported wheezing over the past 1 year. Fifty-one patients (28.5%) demonstrated BHR on spirometry or histamine challenge tests. Seven patients had both symptoms of wheezing and evidence of BHR. The prevalence of asthma using this definition is therefore 3.9% (95% CI 1.6-7.9%). Nine patients had symptoms of wheezing without previous diagnostic labels of chronic bronchitis or emphysema and, using this definition, the prevalence is 5.0% (95% CI 2.3-9.3%). Using multiple logistic regression studies, sex, social class, age, smoking habits, serum IgE levels and eosinophil counts did not predict a diagnosis of asthma using either definition. We found no association between a positive skin test and any respiratory symptoms or illnesses including asthma. CONCLUSION: Wheeze, bronchial hyper-responsiveness and asthma are prevalent amongst our elderly population. However, there were no identifiable demographic and laboratory risk factors in this study that may help us predict a diagnosis of asthma.