Risks of poor asthma outcome in 14,405 children and young people in London

This is a 12-month retrospective data analysis (2018/19) of asthma risk factors in 350 North West London general practices. Fourteen thousand four hundred and five of the 482,029 (40% female) children and young people (CYP) had diagnosed asthma. Exacerbations are as follows: (i) 749 (5%) CYP had 797 hospital admissions; 32 (<1%) had 2–6; (ii) 910 (6%) had 1168 recorded asthma attacks; 170 (1%) had 2–12; (iii) 1485 (10%) had 2123 oral corticosteroid courses; 408 (3%) had 2–11. Excess short-acting bronchodilators were prescribed in over half of the CYP. Of the 10,077 (70%) CYP prescribed inhaled corticosteroid preventers, 7279 (72%) were issued with <4 ICS inhaler prescriptions during the year; these CYP accounted for 11% of the admission spells. In all, 30% of CYP had poor symptom control. At least 10% of the CYP having had recent attacks are at risk and dashboards such as those available in North West London could easily facilitate recognition of risk and optimisation of care.

Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study

BackgroundAustralia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population.AimTo identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1–4 years of age).MethodsBirth, hospital and emergency data for all Aboriginal children born 2003–2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life.ResultsThere were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks’ gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%–7%. We did not observe a higher risk of asthma in those children who were from remote areas.ConclusionImproving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.

Risk factors for bronchial asthma among children in Medina city, Saudi Arabia: an ecological approach

Background: Asthma is a common disease in Saudi Arabia that affects many individuals. Children are profoundly affected, and the impact of the disease is noticeable in the frequent visits to the emergency departments, missed school days, recurrent hospitalizations, and high death rates. Our study is aimed at identifying the determinant of bronchial asthma risk factors based on the ecological model.Methods: A case-control study was conducted. Samples were randomly selected from two major hospitals in Medina Region, Saudi Arabia, including children aged between 1-14 years. A chi-square test was used to see any differences across categories between cases and control. Significant factors associated with asthma in bivariate analysis were submitted to conditional multivariate logistic regression analysis.Results: Factors significantly associated with asthma were being obese (OR=5.10; 95% CI 2.09-12.42), having a history of allergic rhinitis (OR=7.10; 95% CI 3.24-15.52), born preterm (OR=6.06; 95% CI 2.05-17.87), living in a carpeted home (OR=3.06; 95% CI 1.41-6.64), using a gas stove (OR=9.09; 95% CI 3.93-21.03), playing with plush toys (OR=4.58; 95% CI 2.04-10.30), living in a home distanced less than 500 meters from the main traffic road (OR=3.68; 95% CI 1.27-10.70), less than 500 meters from a plant farm (OR=3.78; 95% CI 1.68-10.70), and less than 500 meters from an electric station (OR=5.57; 95% CI 1.73-17.93).Conclusions: This study confirms the associations between individual, outdoor-indoor environmental factors, and bronchial asthma among children in Medina. This study is a step forward into the future of interventional programs to control bronchial asthma among children.

Risk factors for rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda

Background: The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase in Africa and globally. The causes of this increase are not well established. Objectives: To investigate the risk factors for ARDs among schoolchildren in Uganda. Methods: We conducted a secondary data analysis of a large asthma case-control study involving 1,700 schoolchildren, 5-17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP. We used inverse probability weighting to account for the differences in the sampling fractions in all our analyses. Results: The lifetime prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5%, and 13.5%, respectively. There was overlap of ARDs, with 66.3% of 1,193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. The important risk factors for rhinitis ever were city residence at birth [adjusted odds ratio (95% confidence interval) 1.97 (1.26-3.10) compared to rural]; fathers [2.08 (1.57-2.75)] and mothers history of allergic disease [2.29 (1.81-2.91)]; frequent de-worming in the last 12 months [1.80 (1.32-2.45), >2 versus none]; current high frequency of trucks passing on the street near home [1.90 (1.19-3.03), almost all the time versus rarely] and positive SPT [1.56 (1.24-1.96)] but not asIgE [1.33 (0.81-2.18)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. Conclusion: We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis, and eczema - similar to asthma risk factors - among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda. Thus, epidemiological research should investigate causes of all ARDs as one disease entity.

Toxocara sero-prevalence and its relationship with allergic asthma in asthmatic patients in north-eastern Iran

Toxocariasis is an important neglected tropical disease that has been suggested as a possible etiologic agent of asthma. The objective of the present study was to investigate possible significant association between Toxocara seroprevalence and asthma in a clinic-based case-control study. Blood samples were collected from human subjects aged 5–70 years, 50 of whom had signs of asthma and 50 of whom had no signs of asthma. Risk factors for asthma and Toxocara spp. infection were assessed by a questionnaire given to each patient. Blood samples were analysed to measure levels of anti-Toxocara spp. immunoglobulin G (IgG). Patients with bronchial asthma were observed to have higher Toxocara spp. seropositivity than that of the non-asthmatic controls (6 vs 2%, P = 0.47). The mean anti-Toxocara spp. antibody titre was not significantly higher in patients with bronchial asthma than in individuals without asthma (P = 0.395, 95% CI = 0.579–1.45). There was no significant difference in the mean age, sex, social class, exposure to smoking and presence of domestic dog or cat at home between the two groups (P ≥ 0.05). The presence of anti-Toxocara spp. IgG was statistically associated with higher blood eosinophils, but it was not associated with asthma (P ≥ 0.05). The observed relationship between exposure to Toxocara spp. infection and bronchial asthma in Iranian patients warrants further evaluation. An understanding of any potential influence on the pathogenesis of human asthma provides a potential avenue for prevention.

Hubungan Faktor Risiko terhadap Kejadian Asma pada Anak di RSUP Dr. M. Djamil Padang

AbstrakPrevalensi asma terus meningkat (5—30% dalam satu dekade terakhir) dan lebih dari 50% penderita saat ini adalah anak-anak. Fenomena ini tidak terlepas dari kompleksitas patogenesis asma yang melibatkan faktor genetik dan lingkungan yang dimulai sejak masa fetal. Tujuan penelitian ini adalah menentukan hubungan antara faktor genetik, demografi, lingkungan, dan perinatal terhadap kejadian asma anak di RSUP Dr. M.. Djamil Padang. Desain penelitian ini adalah case-control study terhadap pasien rawat inap di bangsal anak. Pemilihan sampel menggunakan teknik simple randomized sampling dengan jumlah 78 pasien (39 kasus dan 39 kontrol). Data didapatkan melalui rekam medis subyek penelitian. Analisis data yang digunakan yaitu univariat dan bivariat dengan chi-square. Hasil uji chi-square menunjukkan usia < 5 tahun (p= 0,364), jenis kelamin laki-laki (p=0,255), berat badan lahir rendah (p=0,358), obesitas (p=0,382) tidak memiliki hubungan bermakna dengan asma anak. Hanya riwayat atopi (p <0,05) yang memiliki hubungan berarti. Riwayat paparan asap rokok dan bulu binatang tidak lengkap; sedangkan usia gestasional hanya satu kelompok saja sehingga tidak dianalisis. Disimpulkan bahwa tidak terdapat hubungan bermakna antara usia <5 tahun, jenis kelamin laki-laki, prematuritas dan obesitas dengan kejadian asma anak. Hubungan bermakna hanya terdapat pada riwayat atopi dengan kejadian asma anak.Kata kunci: asma anak, faktor risiko, riwayat atopi AbstractPrevalence of asthma is still elevating (5—30% at last decade) and more than 50% of asthmatic is children. This phenomenon is predicted correlating with the complexity of pathogenesis of asthma (included genetic, environtment and perinatal factors) that began from fetal-age. The objectives of this study was to deternine the correlation of genetic, demographic, environtment, perinatal factors to asthma in children in RSUP Dr. M. Djamil Padang. Research design was case-control study. The pediatric patients in RSUP Dr. M. Djamil Padang were the population. The 78 samples were taken by simple randomized sampling technique (39 cases and 39 controls). The chi-square test showed no correlation among age <5 years old (p=0,364), male for sex (p=0,255), low birth-weight (p=0,358), obesity (p=0,382) to children asthma. The history of atopy (p <0,05) was the only correlation to asthma in RSUP M. Djamil Padang. The data of environtment tobacco smoke and pet’s hair were not completed and prematurity history just the only grouped in class of gestasional age, so the data were not analyzed. In conclusion, there are no correlation among age <5 years old, male for sex, low birth-weight, and obesity with children asthma. Atopic history is the only data that has correlation with children ashtma in RSUP M. Djamil Padang. Keywords: children asthma, risk factors, atopic history