Prevalence and Severity of Asthma, Rhinitis and Eczema in Pre-School Children in the United Arab Emirates

Very few studies have been carried out on asthma and allergies in pre-schoolchildren. This is the first study of pre-school children with asthma and allergies in the United Arab Emirates. We studied 4,000 pre-schoolchildren from the United Arab Emirates: Dubai, Sharjah, Abu Dhabi, and Al-Ain. The ages of the study group were between 1-5 years, and were 2,000 boys and 2,000 girls; they were randomly selected from kindergartens and nurseries. We used the standardised International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The mean (SD) age, height, weight and BMI were 3.3 (1.4) years, 92.0 (1.3) cm, 17.3 (5.2) kg, and 23.4 (9.3). The prevalence rates of “wheeze ever”, “current wheeze”, “speech limitation”, “asthma” , “dry night cough”, and “exercise-induced asthma” were 40.4%, 43.8%, 37.6%, 26.5%, 36.1, and 37.6%, respectively. Boys had a significantly higher prevalence of wheeze ever and current wheeze than girls. Girls had a significantly higher prevalence of speech limitation than boys. The prevalence rates of “rhinitis ever”, “current rhinitis”, “itchy watery eyes” and “hay fever” were 42%, 40.5%, 39.1% and 46.9%, respectively. Boys had significantly higher prevalence rates of “rhinitis ever”, “current rhinitis”, and “itchy watery eyes” than girls. The prevalence rates of “rash ever”, “current rash” and “eczema ever” were 38.9%, 33.7% and 58.0%, respectively. Boys had significantly higher prevalence rates of rash ever, current rash, and eczema ever than girls. Children who were exposed to parental smoking have significantly higher prevalence rates of asthma, wheezing, and cough than those whom were not exposed. Children who breastfed more than 10 months had a significantly lower prevalence rates of “wheeze ever”, “current wheeze”, “speech limitation”, and “asthma”, than those whom breastfed less than 10 months. The prevalence rates of asthma, rhinitis and eczema were very high. Breastfeeding was found to be protective for asthma. The study can be used as a baseline intervention project to reduce incidents of asthma and allergies in these children and to establish atopic march in order to implement strategies to improve the respiratory health and allergies in these children. Keywords: asthma, wheeze, night cough, rhinitis, eczema, pre-school children, paediatric asthma

Are primary care and continuity of care associated with asthma-related acute outcomes amongst children? A retrospective population-based study

Background Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. Methods Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). Results Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. Conclusion Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.

The Effects of Short-term Pm 2.5 Exposure on Pulmonary Function Among Children With Asthma——A Panel Study in Shanghai, China

BackgroundFine particulate matter with aerodynamic diameter ≤ 2.5 mm (PM2.5) has been reported to be an important risk factor for asthma. Our study was designed to evaluate the relationship between air PM2.5 and lung function among children with asthma in Shanghai, China. MethodsFrom 2016 to 2019, a total of 70 Chinese children aged 4 to 14 in Pudong, Shanghai were recruited for this panel study. Upon entry to the group, questionnaire was used to collect basic information, and the lung function covering forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were carried out for each child more than two times during follow-up. Meanwhile, the simultaneous daily air atmospheric pollutants and meteorological data were collected. The linear mixed effect (LME) model was used to assess the relationship between air pollutants and lung function adjusting other covariates like sex, age, season and so on. ResultsA significantly negative association was found between PM2.5 level and lung function in children with asthma. In the single-pollutant model, the largest effect of PM2.5 on lung function were found on lag 0-2, FVC and FEV1 decreased by 0.91% [95% confidence interval (CI): -1.75, -0.07] and 1.05% (95% CI: -2.09, 0.00) for every 10 mg/m3 increase of PM2.5. In the multi-pollution model (adjusted PM2.5+SO2+O3), the maximum effect of PM2.5 on FVC and FEV1 also appeared on lag 0-2, FVC and FEV1 decreased by 1.57% (95% CI: -2.69, -0.44) and 1.67% (95% CI: -3.05, -0.26) for every 10 mg/m3 increase of PM2.5, respectively. In the subgroup analysis, boys, children and hot season more were sensitive. ConclusionThe short-term exposure of ambient PM2.5 is a risk factor for the lung function of children with asthma, particularly in boys, preschoolers (<6 years old) and in the hot season.

Analysis of the Consumption of Drugs Prescribed for the Treatment of Asthma in Belgian Children

(1) Asthma is one of the most common chronic diseases in the world among children. The main purpose of this study was to analyze the consumption of asthma medications in order to investigate asthma in children (2–18 years) and the association with health care consumption; (2) a retrospective study using anonymized administrative data for 2013–2018 from the third largest Belgian health insurer was conducted; (3) in 2018, 12.9% of children received at least one asthma medication and 4.4% received at least two packages with a minimum of 30 days between purchases. Preschool children (2–6 years) were three times more likely to take asthma medication than older children (7–18 years). ICS, in combination or not with LABA, were the most dispensed drugs among children. Children with asthma medications were almost twice as likely to receive antibiotics, more likely to end up in the emergency room, and twice as likely to be hospitalized; (4) most children took ICS, according to the GINA guidelines. High rates of nebulization in young children were observed, despite the recommendation to use an inhaler with a spacing chamber as much as possible. Finally, children who took asthma medications were more likely to end up in the ER or be hospitalized.

Gastric motility and pulmonary function in children with functional abdominal pain disorders and asthma: A pathophysiological study

Background An association has been shown between functional abdominal pain disorders (FAPDs) and asthma. However, the exact reason for this association is obscured. The main objective of this study is to identify the possible underlying pathophysiological mechanisms for the association between FAPDs and asthma using gastric motility and lung function tests. Methods This was a cross-sectional comparative study that consisted of four study groups. Twenty-four children (age 7–12 years) each were recruited for four study groups; asthma only, FAPDs only, both asthma and FAPDs, and healthy controls. Asthma was diagnosed using the history and bronchodilator reversibility test. The diagnosis of FAPDs was made using Rome IV criteria. All subjects underwent ultrasound assessment of gastric motility and pulmonary function assessment by spirometry, using validated techniques. Results All gastric motility parameters, gastric emptying rate, amplitude of antral contraction, and antral motility index, were significantly impaired in children with FAPDs only, children with asthma only, and children with both asthma & FAPDs, compared to controls (p<0.05). Pulmonary function parameters indicating airway obstruction (FEV1/FVC ratio, peak expiratory flow rate, FEF25-75%) were not impaired in children with FAPDs only compared to controls (p>0.05), but significantly impaired in children with asthma and children with both disorders. Antral motility index correlated with the FEV1/FVC ratio (r = 0.60, p = 0.002) and FEF25%-75% (r = 0.49, p = 0.01) in children with both asthma and FAPDs. Conclusions Gastric motor functions were significantly impaired in children with asthma, children with FAPDs, and children with both disorders. Motility index, measuring overall gastric motor activity, showed a significant positive correlation with lung function parameters that measure airflow limitation. Therefore, these diseases might arise as a result of primary disturbance of smooth muscle activity in the airways and gastrointestinal wall, which could be a possible pathophysiological mechanism for this association between asthma and FAPDs.

Relationship between montelukast and behavioral problems in preschool children with asthma

Background: There is insufficient clarity regarding whether or not drugs used in asthma cause behavioral problems in children.Methods: A total of 155 individuals, categorized into an asthma group (n = 95) and a control group (n = 60), were enrolled in the current prospective controlled study. The asthma group consisted of patients receiving treatment (inhaled corticosteroids [ICS] or montelukast) for at least 1 month. Check Behavior Checklist (CBCL) for ages 1.5–5 scores for the asthma and controls were compared. The asthma group was divided into two subgroups based on prophylactic therapy received, ICS and montelukast, and these groups’ CBCL scores were also compared. Results: The asthma group consisted of 95 children (ICS subgroup 45, montelukast subgroup 50) and the healthy control group of 60 cases. The mean total CBCL score was higher in the asthma group than in the control group (42 vs 32, respectively, P = 0.001). Internalization and externalization scores were also higher in the asthma group compared to the control group (P = 0.004 and P = 0.005, respectively). No significant difference was determined in terms of CBCL scores between the ICS and montelukast groups (P = 0.3). Montelukast was discontinued in one asthmatic child due to hallucination.Conclusion: This study determined a higher rate of behavioral problems in preschool children with asthma compared to healthy children. In contrast to other studies in the literature, we determined no difference in terms of total CBCL, and internalization and externalization scores of children with asthma who received ICS and montelukast. Nevertheless, it should be kept in mind that montelukast may cause serious neuropsychiatric events such as hallucination.

Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991‐2018

Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8‐9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime (“ever had”) rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.