Reasons for inadequate asthma control in children: an important contribution from the "French 6 Cities Study"

The Prevalence of Self-reported Respiratory Symptoms, Asthma and use of Asthma Medication Among Young Adolescents from Southeast Kosovo

INTRODUCTION

Asthma is a chronic inflammatory airway disease characterized by episodes of airway narrowing leading to manifestations of symptoms such as wheeze, shortness of breath, chest tightness and cough, that may resolve spontaneously or following treatment.

AIM

The aim of this paper was to present the collected data related to the prevalence of self-reported respiratory symptoms, asthma, and use of asthma medication among school children aged 13-14 years from the city of Gjilan, a municipality located in southeast Kosovo.

METHODS

This was a cross-sectional study realized during the year 2018 as a part of the Project of Global Asthma Network (GAN) Phase I. The study elaborated randomly selected sample of 1200 school children from the city of Gjilan, in the southeast of Kosovo. The mean age was 13.4±0.51 with median IQR=13 (13-14). About 618 (51.5%) were male and 582 (48.5%) were female with the relation between the genders of 1:1.1. The percentage difference between the genders was not statistically significant (Difference test: Difference 3% [(-0.99-6.99) CI 95%]; Chi-square=2.159; df=1 p=0.1417). The prevalence of wheezing/ whistling in the chest EVER and the last 12 months was 12.7% vs. 6.4% respectively with no significant association between gender and symptoms (p>0.05) (Table 1). About 1132 (94.3%) had no attacks of wheezing in the last 12 MONTHS, 59 (4.9%) had 1-3 attacks, 7 (0.6%) had 4-12 attacks and 2 (0.2%) had>12 attacks. The analysis did not indicate a significant association between gender and the frequency of wheezing attacks (none / 1-3 / ≥ 4) for Pearson Chi-square: 2.5501; df=2; p=0.2801.

CONCLUSION

This study has found moderately low asthma prevalence among adolescents in the southeast region of Kosovo, with no significant association between genders. Although, should be considered as an urgent need the proper examination, because asthma seems to be under-diagnosed and also untreated. It's possible that doctors in our country hesitate to diagnose asthma or the parents themselves and the children deny it.

A comparison of tiotropium, long-acting β2-agonists and leukotriene receptor antagonists on lung function and exacerbations in paediatric patients with asthma

Diagnosing and treating asthma in paediatric patients remains challenging, with many children and adolescents remaining uncontrolled despite treatment. Selecting the most appropriate pharmacological treatment to add onto inhaled corticosteroids (ICS) in children and adolescents with asthma who remain symptomatic despite ICS can be difficult. This literature review compares the efficacy and safety of long-acting β₂-agonists (LABAs), leukotriene receptor antagonists (LTRAs) and long-acting muscarinic antagonists (LAMAs) as add-on treatment to ICS in children and adolescents aged 4-17 years.A literature search identified a total of 29 studies that met the inclusion criteria, including 21 randomised controlled trials (RCTs) of LABAs versus placebo, two RCTs of LAMAs (tiotropium) versus placebo, and four RCTs of LTRA (montelukast), all as add-on to ICS. In these studies, tiotropium and LABAs provided greater improvements in lung function than LTRAs, when compared with placebo as add-on to ICS. Although exacerbation data were difficult to interpret, tiotropium reduced the risk of exacerbations requiring oral corticosteroids when added to ICS, with or without additional controllers. LABAs and LTRAs had a comparable risk of asthma exacerbations with placebo when added to ICS. When adverse events (AEs) or serious AEs were analysed, LABAs, montelukast and tiotropium had a comparable safety profile with placebo.In conclusion, this literature review provides an up-to-date overview of the efficacy and safety of LABAs, LTRAs and LAMAs as add-on to ICS in children and adolescents with asthma. Overall, tiotropium and LABAs have similar efficacy, and provide greater improvements in lung function than montelukast as add-on to ICS. All three controller options have comparable safety profiles.

Determinants of asthma control among children in Saudi Arabia

OBJECTIVE

Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children.

METHODS

A cross-sectional study was conducted among children with asthma aged 4-11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables.

RESULTS

Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10-0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04-0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81-0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02-5.21) and 3.33 (95% CI = 1.33-8.35), respectively.

CONCLUSIONS

In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.