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

Perceptions and Practices in Parents of Saudi Children with Asthma: A Cross-Sectional Survey

OBJECTIVE

To acquire more precise data on perceptions and practices adopted by Saudi parents of asthmatic children regarding asthma and its management.

METHODS

A cross-sectional study was conducted through 2015 on 292 parents of children (aged 3-15 years) with asthma visiting the outpatient clinics and the emergency departments (ED) of two tertiary care medical centers in Riyadh city, using a self-administered questionnaire.

RESULTS

Out of 292 parents who participated in this study, 60.2% reported that their children had previously difficulty in sleeping at night due to an asthma attack. The majority (70.4%) of parents was worried about adverse effects of inhaled corticosteroids, and 58.8% of participants were worried about other inhaler adverse effects, whereas 29.0% believed that their child would develop a dependency on asthma medications. Around 82% reported visiting the pediatric emergency department for asthma treatment and 61.2% of participants reported going to the routine physician follow-up visits. Family income was significantly associated with parental concerns about the adverse effects of inhaled medications and corticosteroids as well as drug dependency (p = 0.044, p = 0.033, and p = 0.001, respectively). One hundred and seventy (57%) of the children used inhaled β-agonists while only 39 (13.3%) were using inhaled corticosteroids.

CONCLUSIONS

Participated parents had misperceptions regarding the use of asthma medications and thus adopted ineffectual practices in its management. Therefore, to enhance asthma care and compliance in children, it is essential to develop different comprehensive parental education programs.

Parental Perceptions and Practices toward Childhood Asthma

Introduction. Parental perceptions and practices are important for improving the asthma outcomes in children; indeed, evidence shows that parents of asthmatic children harbor considerable misperceptions of the disease. Objective. To investigate the perceptions and practices of parents toward asthma and its management in Saudi children. Methods. Using a self-administered questionnaire, a two-stage cross-sectional survey of parents of children aged between 3 and 15 years, was conducted from schools located in Riyadh province in central Saudi Arabia. Results. During the study interval, 2000 parents were asked to participate in the study; 1450 parents responded, of whom 600 (41.4%) reported that their children had asthma, dyspnea, or chest allergy (recurrent wheezing or coughing), while 478 (32.9%) of the parents reported that their children were diagnosed earlier with asthma by a physician. Therefore, the final statistical analyses were performed with 600 participants. Furthermore, 321 (53.5%) respondents believed that asthma is solely a hereditary disease. Interestingly, 361 (60.3%) were concerned about side effects of inhaled corticosteroids and 192 (32%) about the development of dependency on asthma medications. Almost 76% of parents had previously visited a pediatric emergency department during an asthma attack. Conclusions. Parents had misperceptions regarding asthma and exhibited ineffective practices in its management. Therefore, improving asthma care and compliance requires added parental education.

Global strategies for reducing the burden from asthma

Asthma is one of the most important chronic diseases in childhood. For several decades, a steady increase in prevalence has been observed worldwide. In the structural collaboration between the Centre for Population Health Services in Edinburgh and the Research Institute CAPHRI of Maastricht we investigated the possibilities for primary prevention of asthma in childhood. We found that a multifaceted approach might be effective in delaying or preventing asthma, whereas a mono-intervention does not seem to have such a protective effect. The most likely explanation is that the development of a multifactorial disease, such as asthma, is extremely difficult, if not impossible, to prevent by eliminating only one risk factor. Underdiagnosis of asthma is still a big problem in primary care. Most patients do not present bronchial symptoms to the general practitioner, even though they have decreased lung function, so they remain unknown and undiagnosed. However, patients who do present with respiratory problems and who have reduced lung function are not always recognised as such. We found that the perception of dyspnoea seems to determine, at least in part, the presentation to the general practitioner with symptoms. These observations show that both the prevention of the development of asthma in early childhood, as well as case finding of asthma in adulthood, do not seem to be very effective in primary care. More research is needed to clarify what steps can be taken to reduce the global burden from asthma.

Parental perceptions and beliefs about childhood asthma: a cross-sectional study

Aim

To assess parental perceptions and beliefs about asthma in children.

Methods

We invited 6000 children aged 3 to 15 years from different schools in Lebanon to participate in the study from September 2007 to May 2008. In the first phase, in order to determine the prevalence of asthma in children, parents of all participating children filled out a small questionnaire. In the second phase, only parents of children with asthma filled out a detailed questionnaire about their perceptions of asthma.

Results

Phase I included parents of 4051 children, 574 (14%) of whom had asthma and were recruited to phase II. Out of these, 389 parents entered the final data analysis. Around 54% of parents believed that asthma was hereditary and 7% believed it was contagious. When asked about triggering factors, 51% stated virus infection, 75% dust, and 17% food. Sixty percent of children with asthma lived with someone who smoked. Sixty-seven percent of parents believed that herbs had a role in asthma treatment and only 49% received asthma education. There was a significant difference in education level (P = 0.01) between the parents who denied the label of asthma (79%) and those who accepted it (21%). Sixty-seven percent of parents preferred oral over inhaler treatment, 48% believed inhalers were addictive, 56% worried about inhalers’ side effects, and 76% worried about using inhaled corticosteroids. Significantly more parents from rural (53%) than from urban areas (38%) believed that inhalers were addictive (P = 0.004).

Conclusion

Parents of children with asthma had considerable misperceptions about the use of inhalers and the safety of inhaled corticosteroids. To improve asthma care in children, it is necessary to provide adequate education to parents.

The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school

Allergy affects at least one-quarter of European schoolchildren, it reduces quality of life and may impair school performance; there is a risk of severe reactions and, in rare cases, death. Allergy is a multi-system disorder, and children often have several co-existing diseases, i.e. allergic rhinitis, asthma, eczema and food allergy. Severe food allergy reactions may occur for the first time at school, and overall 20% of food allergy reactions occur in schools. Up to two-thirds of schools have at least one child at risk of anaphylaxis but many are poorly prepared. A cooperative partnership between doctors, community and school nurses, school staff, parents and the child is necessary to ensure allergic children are protected. Schools and doctors should adopt a comprehensive approach to allergy training, ensuring that all staff can prevent, recognize and initiate treatment of allergic reactions.

Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7-12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3-4; age 7-9 years) and older children (school years 5-7; age 9-12 years). Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% (P < 0.001) in the younger group and from 27.6% to 25.1% (P = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.

Impact of asthma and air pollution on school attendance of primary school children: are they at increased risk of school absenteeism?

AIM

The aim of this study was to determine the impact of asthma and air pollution on school attendance of primary school children 6 to 12 years of age in Qatar.

STUDY DESIGN

This was a cross-sectional population-based study.

SUBJECTS

The total 31,400 Qatari school children at the primary school (16,130 boys and 15,270 girls) 6 to 12 of age were studied to investigate school absenteeism caused by asthma and wheezing during the academic year October 2003 to July 2004.

METHODS

We have used the School Health Registry for obtaining the student information and school absenteeism due to asthma and wheezing. Again we had double confirmation on the data obtained on asthmatic children by using the modified version of the International Study of Asthma and Allergies in Childhood [ISAAC] questionnaire.

RESULTS

A total of 3,270 (10.4%) pupils were diagnosed as having asthma and wheezing. Overall 2,516 (8.02%) pupils were absent from the school for at least one day during the year. There was a statistically significant difference between asthmatic and wheezing students in number of days absent from the school (p < 0.0001). Most absenteeism occurred during spring for both boys (45%) and girls (47%), followed by autumn for boys (33%) and girls (36%). The measured pollutants reached a peak during the spring season and then in autumn of the studied academic year.

CONCLUSION

Children with known asthma miss more days of school than those who do not have asthma. This study finding shows that air pollution has an impact on asthma, which results in significant school absenteeism.

Interactive effect of family history and environmental factors on respiratory tract-related morbidity in infancy

BACKGROUND

Family and environmental factors affect the development of respiratory morbidity. How these factors interact is unclear.

OBJECTIVE

We sought to clarify the interactive effect of family history of asthma and environmental factors on the occurrence of respiratory morbidity.

METHODS

Two hundred twenty-one infants with a positive family history of asthma (PFH) and 308 with a negative family history of asthma (NFH) were prenatally selected and followed until the age of 2 years. Exposure to environmental factors and the occurrence of respiratory morbidity were recorded. By using multiple logistic regression analysis, increased risk was expressed in odds ratios (ORs) adjusted for relevant covariables.

RESULTS

Infants with a PFH had more respiratory morbidity than infants with an NFH. Adjusted ORs ranged from 1.7 (95% CI, 1.0-2.8) for expiratory wheezing to 4.9 (95% CI, 1.7-13.6) for croup. Parental smoking increased the OR of a PFH for wheezing ever (OR, 5.8 [95% CI, 2.5-13.8]) and attacks of wheezing (OR, 6.8 [95% CI, 2.7-16.9]), as did Der p 1 (OR, 10.2 [95% CI, 2.8-36.3] and OR, 7.1 [95% CI, 7.1-21.0], respectively). Exposure to both parental smoking and Der p 1 further increased this OR (OR, 30.8 [95%, CI, 6.9-137.2] and OR, 26.2 [95% CI, 5.9-115.6], respectively). Breast-feeding decreased the ORs of PFH for tonsillitis and acute otitis media: the increased ORs for these diagnoses in formula-fed infants with PFHs versus those with NFHs (OR, 9.2 [95% CI, 2.1-39.7] and OR, 2.9 [95% CI, 1.1-7.2], respectively) was attenuated in breast-fed infants (OR, 1.8 [95% CI, 0.8-3.8] and OR, 0.7 [95% CI, 0.4-1.3]).

CONCLUSION

Parental smoking and Der p 1 increase the effect of a PFH on respiratory morbidity. Breast-feeding reduces this effect.

CLINICAL IMPLICATIONS

Extra attention should be given to stimulate mothers to breast-feed their children in case they cannot stop smoking or taking sanitation measures.

The child with asthma at school: results from a national asthma survey among schoolchildren in Israel

PURPOSE

To evaluate school absence and restriction in school activities of children with asthma, and to estimate the involvement of the school staff in asthma disabilities.

METHODS

A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14-year-old schoolchildren across Israel. Questions regarding social and demographic factors, school absence owing to asthma symptoms, and school staff involvement were added.

RESULTS

There were 10,057 complete questionnaires available for analysis; 710 children reported having asthma. Children with asthma were absent on the average 7.3 +/- 9.8 days in the past school year compared with 3.9 +/- 6.3 days in children without (p = .0001). Absenteeism owing to respiratory symptoms was significantly more common in children with asthma and associated with a more severe asthmatic condition. Four percent of the children with asthma were absent from school more than 30 days. Of the children reporting asthma, 25.9% were not allowed to participate in one or more school activities for medical reasons, compared with 4.2% of children without asthma. Of the children with asthma, 44.3% reported that the school nurse knew about their asthma, and only 13.8% reported that the nurse discussed their asthmatic condition with them; 38.2% of children with asthma reported that no one at school knew about their illness.

CONCLUSIONS

Children with asthma are absent annually on average 3.4 days more than children without asthma. School absence is associated with the severity of asthma. A significant percentage of asthmatic children participate less in school activities. School staff awareness of the children illness is not satisfactory.

The primary prevention of asthma in children study: design of a multifaceted prevention program

The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.

Deprivation, smoking, and quality of life in asthma

AIMS

To explore associations of deprivation and smoking, with prevalence of asthma, wheeze, and quality of life.

METHODS

Survey, using International Study of Asthma and Allergies in Childhood (ISAAC) methodology, of children aged 13-14 years attending Scottish schools previously surveyed in 1995.

RESULTS

4665/5247 (89%) pupils completed questionnaires. 3656/4665 (78.4%) had missed school for any reason in the last 12 months, 587 (12.6%) because of asthma or wheeze. Compared to children with 1-3 wheeze attacks per year, those with >12 attacks in the last year were more likely to have missed school, twice as likely to have missed physical education in the last month, to report interference with home activities, or to have visited accident and emergency departments, and three times more likely to have been hospitalised. Deprivation was not independently associated with self-reported asthma or wheeze, but was associated with school absence, either for any reason or specifically for asthma or wheeze, but not with use of services such as accident and emergency visits, doctor visits, or hospital admissions. Active smoking was associated with wheezy symptoms, and active and passive smoking with use of medical services. These associations were independent of wheeze severity, treatment taken, and other associated atopic conditions. Smoking also had an impact on school absence and home and school activities.

CONCLUSIONS

Deprivation does not affect the prevalence of asthma or wheeze. Exposure to cigarette smoke was associated with the increased use of services. Deprivation and smoking have independent adverse effects on the quality of life in subjects with asthma or wheeze.