Bronchial asthma and wheeze in a desert country

A cross-sectional, population-based study was conducted among school children (3300), aged 7–12 years, in the Kingdom of Saudi Arabia, during the period January, 1988–February, 1990. The aim of the study was to investigate the association between asthma, allergic rhinitis, wheeze and eczema among Saudi school children. The relationship between pet-ownership and respiratory allergy was also studied. Detailed information was collected about wheeze and asthma in 3041 children and history of asthma and allergic rhinitis in their parents. The population sample had a high prevalence rate of diagnosed asthma (6.8%), history of wheeze (10.5%), allergic rhinitis (17.9%), and eczema (10.8%). Allergic rhinitis was the most frequently seen respiratory illness when compared to other respiratory symptoms. The prevalence rate of asthma, allergic rhinitis and eczema among parents reflected the same pattern as that seen in the children. Prevalence rate for asthma in children with pets is twice that of children without pets (OR:2.4; 95%, Cl:1.8–3.1). The odds of having chronic cough (OR:3.9; 95%, Cl:2.8–5.2), chronic wheeze (OR:4.2; 95%, 3.3–5.4), allergic rhinitis (OR:8.0; 95% Cl:6.3–10.3) and eczema (OR:2.8:95 Cl:2.1–3.7) was higher in children with pets than in children without pets. The present study revealed that petownership was associated with increased respiratory symptoms.     

Factors associated with severe asthma

OBJECTIVE:To study the role of various factors associated with development and severity of bronchial asthma in children between 5-15 years of age. SETTING: Tertiary Care Medical College Hospital. METHODS: A case control study was carried out during May 96 to April 98. Sixty children each suffering from mild (chronic) and severe asthma (chronic) and 60 controls were enrolled to study the association of various risk factors with development of asthma and for severe disease. RESULTS: On univariate analysis factors associated with significant risk for development of asthma included family history of asthma (p = 0.003), lack of exclusive breastfeeding (p = 0.05), past history of bronchiolitis (p = 0.02), associated allergic rhinitis (p = 0.04) and atopic dermatitis (p = 0.01). For development of severe asthma, associated factors were early onset of symptoms (p = 0.01), family history of asthma in grandparents (p = 0.04) and more than 10 cigarettes per day smoked by any family member. No significant effect of air pollution, overcrowding, pets and passive smoking were found on either development of asthma or it's severity. On multivariate analysis only age of onset below 48 months was associated with severe asthma (OR 2.13, 95% CI 1.00-4.54). Exclusive breastfeeding for more than 4 months was the most protective factor for development of asthma (OR 0.25, 95% CI 0.08-0.70). A strong association between development of asthma and past history of bronchiolitis or tuberculosis (OR 5.26, 95% CI 1.7-16.20) and presence of associated atopic dermatitis or rhinitis (OR 7.5, 95% CI 1.64-34.48) was observed. CONCLUSION: History of associated allergic diseases and past history of bronchiolitis were significantly associated with development of asthma. Exclusive breastfeeding for first 4 months of life was protective. The most significant factor associated with severe asthma was onset of illness before 48 months of age. There was no significant effect of air pollution, over crowding, pets at home or passive smoking on severity of asthma     

Asthma in rural Bangladeshi children

Objective Although bronchial asthma causes a great deal of morbidity among children in Bangladesh, few epidemiological studies addressed this problem. The study aims to determine the prevalence of wheezing and its association with environmental and host factors. Methods A total of 1587 children aged 60–71 mth living in 50 villages in rural Bangladesh at Matlab was studied. Trained field workers interviewed caretakers of these children to diagnose wheezing using an adopted questionnaire of the International Studies of Asthma and Allergies in Childhood (ISAAC). History of pneumonia among wheezing and non-wheezing children during their childhood was obtained from the surveillance records. Results The prevalence of wheezing in the last 12 mth prior to survey was 16.1% (95% Cl: 14.3%, 18.0%), significantly higher among children who had attacks of pneumonia during their infancy compared to children who did not (23.0% vs 14.6%, p<0.0001). Risk factors associated with wheezing were pneumonia at ages 0–12m (OR= 1.50, 95% Cl 1.08, 2.10) and 13–24m (OR= 2.12, 1.46, 3.08), maternal asthma (OR=3.01, 95% Cl 2.02, 4.47), paternal asthma (OR= 3.12, 95% Cl 1.85, 5.26), maternal eczema (OR=1.81, 95% Cl 1.14, 2.87) and family income ≤ 100 US$ (OR for US$ 51–99= 1.63, 95% Cl 1.05, 2.53; OR for US$ ≤ 50= 2.12, 95% Cl 1.31, 3.44). Conclusion Our results suggest that wheezing is a significant cause of morbidity among children in rural Bangladesh. Greater efforts are needed to prevent pneumonia among children during their infancy to reduce the chances of subsequent development of wheezing.     

Comparison of risk factors for recurrent respiratory infections between urban and rural preschool children in Yiwu, China

Background

Many studies have shown an association between the risk of increased recurrent respiratory infections and socioeconomic and fostering factors, but often only a few risk factors have been studied. This study aimed to identify and compare such factors between urban and rural preschool children.

Methods

Case control studies were conducted in Yiwu urban and rural areas respectively in Zhejiang Province. A structured questionnaire was used to collect information on infl uencing factors such as socioeconomic factors, fostering factors, and housing conditions. The chisquare test was used to compare the distribution of some health related factors between urban and rural children. Risk factor analyses were also made in urban and rural children respectively. Univariate and multivariate analyses were made using the binary logistic regression.

Results

Multivariate analysis showed that maternal age (OR=0.94, 95%CI: 0.89?C0.99), asthma (OR=2.34, 95%CI: 1.22?C4.48), rickets (OR=5.03, 95%CI: 2.10?C12.05), snack (OR=1.62, 95%CI: 1.19?C2.20), traffi c mode (OR=1.38, 95%CI: 1.03?C1.86), living with patients with chronic respiratory system disease (OR=1.79, 95%CI: 1.02?C3.15), and indoor passive smoking (OR=1.46, 95%CI: 1.02?C2.10) were the influencing factors for recurrent respiratory infections in urban children. Rickets (OR=3.77, 95% CI: 1.13?C12.65) and passive smoking (OR=2.33, 95% CI: 1.17?C4.65) were the infl uencing factors for recurrent respiratory infections in rural children.

Conclusions

Public health measures against risk factors should be taken to prevent the occurrence of recurrent respiratory infections in urban and rural children respectively.     

Risk factors, clinical and laboratory aspects of asthma in children

OBJECTIVE: To evaluate the clinical and laboratory aspects and the risk factors associated with asthma in children treated at the Pediatric Outpatient Clinic of Hospital Universitário Júlio Müller. METHODS: A case-control study including 59 asthmatic children (cases) and 104 nonasthmatic children (controls). The following factors were considered for risk analysis: parent? level of education, domestic exposure to allergens, passive smoking, breast feeding, low income, and family history of allergy. Samples of blood were collected for hemogram and to determine the total serum IgE as well as the one specific to allergens. Immediate hypersensitivity skin tests were performed with puncture for the detection of the following allergens: house dust mite, animals, molds, and cockroaches with positive (histamine) and negative controls (physiologic solution). A logistic regression model was used to calculate the odds ratio (OR) and 95% confidence intervals (95%CI) adjusted for risk factors and for confounding factors. RESULTS: Among the risk factors studied, sex, parent? low level of education, low income, length of the breast feeding period, and passive smoking were not associated with the presence of asthma. The domestic exposure to allergens was similar in both groups except for the higher frequency of pets at the homes of control patients (chi-square=16.9; P<0.05). Paternal history of rhinitis was the only association with asthma (OR=3.33; 95%CI: 1.03-11.17; P<0.05). The asthmatic children presented higher frequency of positive reactions to skin tests than the controls, mainly to house dust mites: Dermatophagoides pteronyssinus (69.5%), Dermatophagoides farinae (59.3%) and Blomia tropicalis (59.3%); cockroaches: Periplaneta americana (59.3%), and cat: Felis domesticus (37.3%), with OR between 11.2-21.0; P<0.05. Eosinophilia and serum levels of total IgE were more elevated in the group of asthmatic children (P<0.05). The positivity of the specific IgE test for Dermatophagoides pteronyssinus and Blomia tropicalis was higher in the cases than in the controls (P<0.05). The multivariate analysis showed that sensitization to the allergens produced by cockroaches (OR=9.26; 95%CI: 2.59-33.4), animals (OR=3.93; 95%CI: 1.05-14.67) and house dust mites (OR=3.74; 95%CI: 1.18-11.8) were the most important risk factors for asthma. CONCLUSIONS: The sensitization to indoor allergens, mainly to house dust mites, cockroaches, and cats showed a strong association with asthma in this study.     

Domestic allergen and endotoxin exposure and allergic sensitization in Cyprus

We investigated the relationship between domestic allergen and endotoxin exposure and allergic sensitization among children in Cyprus. We skin prick tested 128 children aged 15-16 yr (random samples of 85 children with self-reported asthma and 43 healthy controls) and measured their domestic exposure to endotoxin and allergens (mite, cat, and dog). We analyzed the data using multivariate logistic regression (adjusting for gender, area of residence and parental history) and presented the outcomes as odds ratios (OR) and 95% confidence intervals (CI). Among this selected population, 19% of children were sensitized to mite, 15% to cat and 7% to dog. Male gender (OR 2.74, 95% CI 1.18-6.38, p = 0.02), maternal history of allergic disease (OR 3.53, 95% CI 1.13-11.00, p = 0.03), increasing endotoxin (OR 1.58, 95% CI 1.00-2.49, p = 0.05) and residence in the district of Nicosia (OR 2.48, 95% CI 1.01-6.08, p = 0.05) were independent associates of allergic sensitization. Factors associated with mite sensitization were increasing Der p 1 and endotoxin exposure (OR 1.28, 95% CI 1.01-1.62, p = 0.04 and OR 1.76, 95% CI 1.01-3.08, p = 0.05, respectively) and living in an urban area (OR 6.80, 95% CI 1.37-33.67, p = 0.02). Sensitization to domestic pets was associated only with paternal allergic disease (cat: OR 5.68, 95% CI 1.57-23.56, p = 0.02; dog: OR 13.5, 95% CI 1.79-101.73, p = 0.01), but not with pet ownership or specific allergen or endotoxin exposure. In conclusion, mite allergen exposure was associated with sensitization to mite, but there was no association between cat and dog allergen exposure and specific sensitizations. Surprisingly, in this area, increasing endotoxin exposure was associated with an increased risk of sensitization.     

Wheeze in children: the impact of parental education on atopic and non‐atopic symptoms

de Meer G, Reijneveld SA, Brunekreef B. Wheeze in children: the impact of parental education on atopic and non‐atopic symptoms.
Pediatr Allergy Immunol 2010: 21: 823–830.
© 2009 John Wiley & Sons A/S There is conflicting evidence for the relationship between parental socioeconomic position and their children’s asthma. The aim of this study was to investigate relationships between parental education and respiratory symptoms in their children, distinguishing atopic and non‐atopic symptoms. A cross‐sectional survey among 3262 elementary school children (age 8–13) was performed; data on parental education were obtained for 3213 children. Parents completed a questionnaire on their child’s allergic and respiratory symptoms, and potential explanatory variables including family history, indoor environment, and the child’s medical history. Subsets of children were tested for atopy (n = 1983), lung function (n = 2325), and airway hyperresponsiveness (AHR) (n = 880). Logistic regression was used to assess relationships of health outcomes with parental education. A high parental education was associated with an increased risk of atopic sensitization to indoor allergens (OR 1.31, 95% CI 1.02; 1.69). Studied explanatory variables did not influence the relationship. In contrast, a high parental education protected children from wheeze (OR 0.77, 95% CI 0.61; 0.97). This only applied to non‐atopic wheeze (OR 0.65, 95% CI 0.43; 0.99) and not to atopic wheeze (OR 0.89, 95% CI 0.60; 1.31). The protection from non‐atopic wheeze in children of highly educated parents declined after adjustment for household smoking and breastfeeding (OR 0.96, 95% CI 0.58; 1.57). Similar results were observed for non‐atopic and atopic rhinitis. We conclude that children from highly educated parents are protected from non‐atopic respiratory symptoms, which is largely explained by a lower rate of household smoking and a higher rate of breastfeeding.     

Prevalence and risk factors of obesity among school-aged children in Xi'an, China

The purpose of this study was to examine the prevalence and the risk factors associated with obesity among school-aged children in Xi'an city. The body mass index of 6,740 children aged 7–18 years was compared with the Working Group on Obesity in China cut-off value to estimate the prevalence of obesity. A case–control study of obese and non-obese children was carried out to study risk factors for obesity. A standardized questionnaire was used to collect information on possible risk factors causing obesity. Univariate analysis was performed first to compare the distribution of risk factors between cases and controls. Conditional logistic regression analysis was used to assess independent risk factors of obesity. The results showed that the overall prevalence of obesity among school-aged children was 4.11% (4.63% for males and 3.57% for females). A total of 516 subjects (258 pairs of cases and controls) were included in the final analysis. High maternal education and a longer sleeping time were shown to be protective factors against obesity (odds ratio [OR] 0.148, 95% confidence interval [CI] 0.074–0.296 and OR 0.472, 95% CI 0.342–0.652, respectively). Whereas family history of diabetes (OR 5.498, 95% CI 2.606–11.600), parental overweight (OR 3.720, 95% CI 2.068–6.689), and watching television, playing video games, and using computers (OR 1.564, 95% CI 1.133–2.159) were associated with a higher obesity risk. Conclusion: the prevalence of childhood obesity in Xi'an has become a concern, and sleeping time, sedentary behavior, and family factors have pronounced effects on the prevalence of obesity.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6–7 and 13–14 yr old in Bogotá, Colombia

This cross‐sectional study of children aged 6–7 years and adolescents aged 13–14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)‐phase III. Asthma prevalence among the children was assessed using a parental self‐administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6–7 year age‐group were more likely to report current asthma symptoms than the 13–14 year age‐group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6–7 year age‐group included higher maternal education (OR = 1.7, [95% CI 1.2–2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0–2.3], p = 0.036), watching TV 1–2 hours/day (OR = 2.1, [95% CI 1.2–3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3–2.4], p < 0.001; OR = 2.2, [95% CI 1.7–2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4–2.5], p < 0.001). Among the 13–14 year age‐group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4–2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1–1.9], p = 0.010; OR = 0.8, [95% CI 0.6–1.0], p = 0.046; OR = 0.6, [95% CI 0.4–1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6-7 and 13-14 yr old in Bogotá, Colombia.

This cross-sectional study of children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)-phase III. Asthma prevalence among the children was assessed using a parental self-administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6-7 year age-group were more likely to report current asthma symptoms than the 13-14 year age-group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6-7 year age-group included higher maternal education (OR = 1.7, [95% CI 1.2-2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0-2.3], p = 0.036), watching TV 1-2 hours/day (OR = 2.1, [95% CI 1.2-3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3-2.4], p < 0.001; OR = 2.2, [95% CI 1.7-2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4-2.5], p < 0.001). Among the 13-14 year age-group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4-2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1-1.9], p = 0.010; OR = 0.8, [95% CI 0.6-1.0], p = 0.046; OR = 0.6, [95% CI 0.4-1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Coverage of the national vitamin A supplementation program in Ethiopia

Periodic vitamin A supplementation is a major intervention toreduce morbidity, mortality, and blindness among children indeveloping countries. The goal was to characterize the coverageof the Ethiopia national vitamin A program among preschool childrenand to identify risk factors for not receiving vitamin A. Inthe Ethiopia Demographic and Health Survey of 2005, among 4762preschool children, aged 12–59 months, 46.8% receiveda vitamin A capsule within the last 6 months. There were nosignificant differences in stunting, underweight, or wastingbetween children who did or did not receive a vitamin A capsule.In multivariate logistic regression analyses, maternal educationof 10 years [odds ratio (OR) 1.90, 95% confidence interval (CI)1.23–2.92], 7–9 years (OR 2.47, 95% CI 1.67–3.65),4–6 years (OR 1.56, 95% CI 1.18–2.07), and 1–3years (OR 1.11, 95% CI 0.90–1.37), and paternal educationof 10 years (OR 1.61, 95% CI 1.14–2.29), 7–9 years(OR 1.24, 95% CI 0.94–1.64), 4–6 years (OR 1.26,95% CI 1.03–1.56), and 1–3 years (OR 1.29, 95% CI1.05–1.50) were associated with the child receiving avitamin A capsule compared with no years of formal parentaleducation. Expanded coverage of the national vitamin A capsuleprogram may help protect children from nutritional blindnessand to help reach Millennium goals for reducing under-five childmortality in Ethiopia.     

Asking the correct questions to assess asthma symptoms

A national survey of 896 parents of children with asthma was performed and responses to 2 types of inquiry were compared: global assessment versus specific assessment of symptoms. Almost all parents, 860 (96%), described their child's asthma as under "good control' when asked a global assessment question. However, 306 (34%)-when asked specific questions-actually described poor asthma control with frequent symptoms. Medicaid insurance (OR: 1.59; 95% CI: 1.03, 2.44) and parental smoking (OR: 1.60; 95% CI: 1.06, 2.43) increased the likelihood that parents' responses would be at risk for misinterpretation. Increased education (OR 0.41: 95% CI: 0.18, 0.91) and English as the primary language (OR 0.39; 95% CI 0.16, 0.96) were associated with decreased likelihood of misinterpretation. Vague, global assessment questions lead to incomplete clinical information and places the patient at risk for inadequate asthma therapy. A better approach is to use specific questions to determine the frequency of daytime or nighttime symptoms.     

Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children

Environmental tobacco smoke (ETS) is a significant risk factor for the presence and increased severity of asthma- and allergy-related symptoms in children. Smoking during pregnancy has detrimental effects on asthma-associated outcomes in childhood. Whether passive exposure of pregnant women to ETS may also lead to asthma in their offspring, is not known. The aim of this study was to investigate the association of passive exposure of pregnant women to ETS and asthma- and/or allergy-related symptoms in Preschool children. Cross-sectional data were collected with questionnaires from 2374 Preschool children, recruited from public and private nurseries and day-care centers. Parental smoking was significantly associated with wheezing symptoms in their children. Mother's active smoking during pregnancy significantly increased the risk for occurrence of asthma symptoms and/or medically diagnosed asthma in Preschool children in a dose-dependent manner. Passive exposure to ETS, mainly during the third trimester of pregnancy, was significantly associated with asthma- and allergy-related symptoms after adjusting for several confounders in a multivariate analysis (current wheeze: OR = 1.42, 95% CI = 1.06–1.91, pruritic rash ever: OR= 1.45, 95% CI = 1.01–2.08). Passive exposure of pregnant women to ETS during the third trimester is positively associated with asthma- and allergy-related symptoms in their Preschool age children. Public health policies should be oriented not only towards smoking cessation, but also reinforce elimination of ETS exposure of pregnant women.     

Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr

The aim of this study was to evaluate the interaction between the exclusive breast-feeding protective effect and the exposure to tobacco smoke at domicile in the first year of life, on the onset of respiratory allergy (asthma and rhinitis) in children until 5 yr of age. This is prospective cohort study, observational, institutional based. Three hundred children born in a public hospital of Salvador-Bahia (Brazil) were followed from birth to 5 yr of age. Data from 268 children at 60 months of life were analyzed. Occurrence of allergic symptoms were studied and correlated with gender, allergic relatives in first degree, exclusive breast-feeding duration, smoking mother, and presence of other smoker at home, considering the first year of life. Exclusive breast-feeding for at least 6 months showed a protection effect against the onset of respiratory allergy in children from birth to 5 yr (p < 0.05); odds ratio (OR): 0.33 (95% CI: 0.18–0.59). Breast-fed children for less then 6 months compared with those breast-fed for 6 months or more, presented a higher risk (OR: 2.34–95% CI: 1.4–3.74) for developing allergic respiratory symptoms just to 5 yr. The protective effect of exclusive prolonged breast-feeding on the onset of respiratory allergy in children from birth until 5 yr was lost when their mothers were smokers (OR: 2.50–95% CI 1.19–5.19). Therefore, the protective effect of breast-feeding in the first year of life on the onset of allergic symptoms until the age of 5 yr was confirmed. This study proposes a confounding effect of maternal smoking on this protection, exposed by a higher risk for present allergic symptoms until the age of 5 yr, in children exclusively breast-fed for 6 months or more, when their mothers smoked.     

Gene polymorphisms of IL-6<Superscript>−174</Superscript> G/C and IL-1Ra VNTR in asthmatic children

Objective  To check for the association of genetic polymorphisms of IL-6-⁻¹⁷⁴G/C and IL-1RaVNTR with the susceptibility and severity of asthma in Egyptian children. Methods  Subjects included 69 asthmatic children and 98 healthy unrelated controls from the Nile Delta of Egypt. Cases consisted of 20 males and 49 females with an age mean± SD is 7.5 ± 2.1 ranging between 2-13 years. DNA amplification using PCR with sequence-specific primers was done for detection of promotor single nucleotide polymorphism of IL-6 gene as well as intron 2 VNTR of IL-1Ra gene. Frequency of case-genotypes or alleles were compared to controls using Fisher exact test and Odds ratio. Results  Cases showed significant higher frequency of the genotypes: IL-6-174 GG (P<0.05, OR=3.2, 95% CI=1.09–10) that was evident mainly in the uncontrolled asthma subgroup indicative of the possibility of being a severity genotype. All cases as well as case-subgroups showed high significant frequency of IL-1Ra A1A1 (p<0.0001, OR=1.5, 95% CI=1.3–1.8). This may be considered a susceptibility genotype. Cases have also shown significant lower frequency of IL-6⁻¹⁷⁴ GC and IL-1Ra A1A2 genotypes (P<0.001 and P<0.0001 respectively). Conclusion  IL-6 and IL-1Ra polymorphisms can be considered genetic markers for bronchial asthma susceptibility and/or severity among Egyptian children. This may have a potential impact on family counseling and management.     

Risk factors associated with wheezing in infants

Objectiveto identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil.Methodsthis was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI).Resultsthe written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46).Conclusionsthe study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.     

Prevalence and risk factors of asthma and allergic diseases among schoolchildren in Bolu, Turkey

AIM: In this study we aimed to detect the prevalence and risk factors of asthma and allergic diseases in children aged between 7 and 14 years old at rural and urban areas of Bolu, Turkey. METHODS: Questionnaire of International Study of Asthma and Allergies in Childhood (ISAAC) phase one and questionnaire including questions about family, demographic, socio-economic characteristics of children were applied to 931 schoolchildren who were selected by randomized sampling. RESULTS: In children, the prevalence of diseases and symptoms were as follows: wheeze ever: 15.5%, asthma: 5.6%, nasal symptoms ever: 41.4%, allergic rhinitis: 23.2%, itchy rash ever: 5.9% and eczema: 5.0%. In multivariate regression analysis, presence of allergic disease in the family was risk factor for wheezing (OR=1.74, 95% CI=1.19-2.76), asthma (OR=2.19, CI=1.06-4.52), allergic rhinitis (OR=2.68, CI=1.80-3.98) and eczema (OR=2.33, CI=1.17-4.65); living in shanties was risk factor for allergic rhinitis (OR=5.26, CI=2.1-13.16); a monthly income below $300 was risk factor for asthma (OR=2.54, CI=1.06-6.08). CONCLUSION: It was detected that the prevalence of allergic rhinitis and its symptoms was more common in schoolchildren living in Bolu. Presence of allergic disease in fathers or mothers and low socio-economic level increase the risk of asthma and other allergic diseases in children.     

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference <6 mm per week (OR 4.0, 95% CI: 1.1–14.8), parenteral nutrition ≥6 weeks (OR 2.5, 95% CI: 1.1–6.0), and mechanical ventilation >14 days (OR 2.3, 95% CI: 1.0–5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0–44.9), neonatal seizures (OR 5.2, 95% CI: 1.2–22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1–17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.     

Association of asthma with extra-respiratory symptoms in schoolchildren: Two cross-sectional studies 6 years apart

Epidemiological information on symptoms affecting extra-respiratory organs and apparatuses in asthmatic children is scarce. The aim of this study therefore was to evaluate, at a population level, if and what extra-respiratory symptoms are associated with asthma. Two questionnaire-based, cross-sectional surveys were carried out on 1,262 students (651 males; mean age 9.57 years, age-range 6–14 years) in 1992 and on 1,210 students (639 males; mean age 9.02 years, age-range 6–14 years) in 1998, from two elementary and two junior high schools in Rome, Italy. Questionnaires included queries about asthma and its risk factors and extra-respiratory symptoms (headache, restlessness, sleep disturbances, urticaria, itching, and abdominal pain). Of responders, 11.9% (279/2,342) had a history of asthma. After adjustment for gender, family history of atopic disease, low birth weight, early respiratory problems, and damp house, asthma was significantly associated with recurrent abdominal pain (odds ratio [OR] 1.90; 95% confidence interval [CI]: 1.04, 3.16), itching (OR 3.15; 95% CI: 1.75, 5.68), and urticaria (OR 2.52; 95% CI: 1.02, 6.20). Asthma was reported by 10.2% (201/1,962) of children unaffected by this triad, by 20.1% (56/279; OR 2.20) with one of the symptoms, and by 31.6% (12/38; OR 4.04) with two or more symptoms. An emerging characteristic of pediatric asthma in our setting appears to be its association with certain extra-respiratory symptoms (abdominal pain, itching, and urticaria). A global, internistic approach to asthmatic children is increasingly required both in the clinical setting and in future epidemiological studies.