Risk Factors For Wheezing Research Articles

Prenatal phthalate exposure and early childhood wheeze in the SELMA study.

Prenatal maternal phthalate exposure has been associated with wheeze and asthma in children, but results are inconclusive. Previous studies typically assessed exposure in late pregnancy, included only a small number of old phthalates, and assessed outcomes in children aged 5 years or older. We explored associations between 1st trimester prenatal maternal exposure to a wider range of phthalates and wheeze in early childhood. First trimester concentrations of 14 metabolites from 8 phthalates and one alternative plasticizer were quantified in first-morning void urine from 1148 mothers in the Swedish SELMA study. Associations between log-transformed metabolite concentrations and parental reported ever wheeze among 24-month-old children were investigated with logistic regression models adjusted for parental asthma/rhinitis, sex of child, maternal education, smoking, and creatinine. Metabolites of replacement phthalates di-iso-decyl phthalate (DiDP) and di-2-propylheptyl phthalate (DPHP) were associated with increased risk for wheeze (aOR 1.47, 95% CI 1.08-2.01 and aOR 1.49, 95% CI 1.04-2.15, respectively). The associations with DiDP and DPHP were stronger among children whose parents did not have asthma or rhinitis. In this group, wheeze was also associated with metabolites of butyl-benzyl phthalate (BBzP) and di-iso-nonyl phthalate (DiNP). Maternal phthalate exposure during early pregnancy may be a risk factor for wheeze in early childhood, especially among children whose parents do not have asthma or rhinitis symptoms.

The effect of the indoor environment on wheeze- and sleep-related symptoms in young Indian children

Background:Environmental exposures have a significant effect on respiratory and sleep symptoms in young children. Although the effect of air pollution on the respiratory symptoms in young children is well-established, less is known about the effect of household environmental characteristics and practices on wheeze and sleep concerns.Aims:The aim of this pilot study is to explore the association between household environmental characteristics and practices with the symptoms of wheezing and sleep concerns in the past year in a convenience sample of young Indian children.Materials and Methods:A detailed questionnaire about the child's home environment and respiratory and sleep symptoms was administered to the caregivers of 190 outpatients aged between 6 months and 5 years old at a teaching hospital.Results:Indoor environmental characteristics and cleaning techniques were analyzed for the association with wheeze and sleep disorders. Half (50%) of the cohort had the symptoms of wheezing and 21% had occasional or frequent sleep concerns. Sleeping with a stuffed toy was significantly associated with both wheezing and sleep concerns (P = 0.05).Conclusions:Sleeping with a stuffed toy was a risk factor for wheeze and a risk factor for sleep disorders independent of wheeze.

Prevalence and risk factors for wheeze, decreased forced expiratory volume in 1 s and bronchoconstriction in young children living in Havana, Cuba: a population-based cohort study

ObjectivesAsthma has not been extensively studied in low-income and middle-income countries, where risk factors and access to treatment may differ from more affluent countries. We aimed to identify the prevalence...

Respiratory health among office workers in Malaysia and endotoxin and (1,3)-β-glucan in office dust.

OBJECTIVE: To examine the associations between endotoxin and (1,3)-β-glucan concentrations in office dust and respiratory symptoms and airway inflammation among 695 office workers in Malaysia.METHODS: Health data were collected using a questionnaire, sensitisation testing and measurement of fractional exhaled nitric oxide (FeNO). Indoor temperature, relative air humidity (RH) and carbon dioxide (CO₂) were measured in the offices and settled dust was vacuumed and analysed for endotoxin and (1,3)-β-glucan concentrations. Associations were analysed by two level multiple logistic regression.RESULTS: Overall, 9.6% of the workers had doctor-diagnosed asthma, 15.5% had wheeze, 18.4% had daytime attacks of breathlessness and 25.8% had elevated FeNO (≥25 ppb). The median levels in office dust were 11.3 EU/mg endotoxin and 62.9 ng/g (1,3)-β-glucan. After adjusting for personal and home environment factors, endotoxin concentration in dust was associated with wheeze (P = 0.02) and rhinoconjunctivitis (P = 0.007). The amount of surface dust (P = 0.04) and (1,3)-β-glucan concentration dust (P = 0.03) were associated with elevated FeNO.CONCLUSION: Endotoxin in office dust could be a risk factor for wheeze and rhinoconjunctivitis among office workers in mechanically ventilated offices in a tropical country. The amount of dust and (1,3)-β-glucan (a marker of indoor mould exposure) were associated with Th2 driven airway inflammation.

Onset and remission of childhood wheeze and rhinitis across China — Associations with early life indoor and outdoor air pollution

ObjectiveFew longitudinal studies exist on childhood exposure to indoor and outdoor air pollution and respiratory illness in China. We studied associations between indoor and outdoor environment and prevalence, onset and remission of wheeze and rhinitis among children across China. MethodsChildren (3–6 y) were recruited from randomized day care centres in six cities. The main data analysis was restricted to children not moving since birth (N = 17,679). Data on wheeze, rhinitis and the home environment were assessed by a parental questionnaire. Prevalence in the first two years of life (baseline) and the last year (follow-up) was used to calculate onset and remission. Outdoor PM2.5, PM10, and NO2 at the day care centre were modelled from monitoring station data. Associations were calculated by multilevel logistic regression. ResultsPrenatal NO2 was associated with decreased remission of wheeze and increased prevalence and increased onset of rhinitis. Prenatal PM2.5 was associated with increased prevalence of wheeze. Postnatal NO2 and postnatal PM10 were associated with increased prevalence and lower remission of wheeze and rhinitis. Mould, window pane condensation, renovation and cockroaches at home were associated with increased prevalence and increased onset of wheeze and rhinitis. Gas cooking was associated with increased onset of rhinitis. Children of mothers with industrial work had more wheeze. ConclusionsOutdoor PM2.5, PM10 and NO2 can increase childhood wheeze and rhinitis. Dampness and mould can increase onset and decrease remission. Crowdedness, cockroaches at home and emissions from new building materials and gas cooking can be risk factors for wheeze and rhinitis.

Prevalence and risk factors for wheezing in infants in the region of Pamplona, Spain

BackgroundWheezing in the first year of life affects the baby's and family's quality of life. Risk factors such as male gender, nursery attending or a family history of asthma, and protective factors such as breastfeeding more than six months have been previously described. The aim of this study is to study the prevalence and risk factors for wheezing ever and recurrent wheezing in the first year of life in infants in the region of Pamplona, Spain. Material and methodsThis cross-sectional study was part of the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). Between 2006 and 2008, participating families answered a standardised validated questionnaire on respiratory symptoms, environmental factors or family issues. An analysis with the chi square test (statistical significance p<0.05) identified the risk factors for wheezing ever and recurrent wheezing, which were assessed using logistic regression. Results1065 questionnaires were answered. The prevalence of wheezing ever and recurrent wheezing were 31.2% and 12.3%, respectively. Male gender (p=<0.001), a history of pneumonia (p=<0.001) or nursery attendance (p=<0.001) were some of the risk factors found for wheezing ever. Infant eczema (p=<0.001), nursery attendance (p=<0.001) or prematurity (p=<0.001) were risk factors for recurrent wheezing. No associations with duration of breastfeeding (p=0.116 and p=0.851) or mould stains at home (p=0.153 and p=0.992) were found. ConclusionThe study of prevalence and risk factors for wheezing shows the importance of this public health problem, and allows the development of control and treatment strategies against preventable factors.

Risk factors for recurrent wheezing in infants: a case-control study.

ABSTRACTOBJECTIVE To evaluate the association between recurrent wheezing and atopy, the Asthma Predictive Index, exposure to risk factors, and total serum IgE levels as potential factors to predict recurrent wheezing.METHODS A case-control study with infants aged 6-24 months treated at a specialized outpatient clinic from November 2011 to March 2013. Evaluations included sensitivity to inhalant and food antigens, positive Asthma Predictive Index, and other risk factors for recurrent wheezing (smoking during pregnancy, presence of indoor smoke, viral infections, and total serum IgE levels).RESULTS We evaluated 113 children: 65 infants with recurrent wheezing (63.0% male) with a mean age of 14.8 (SD = 5.2) months and 48 healthy infants (44.0% male) with a mean age of 15.2 (SD = 5.1) months. In the multiple analysis model, antigen sensitivity (OR = 12.45; 95%CI 1.28–19.11), positive Asthma Predictive Index (OR = 5.57; 95%CI 2.23–7.96), and exposure to environmental smoke (OR = 2.63; 95%CI 1.09–6.30) remained as risk factors for wheezing. Eosinophilia ≥ 4.0% e total IgE ≥ 100 UI/mL were more prevalent in the wheezing group, but failed to remain in the model. Smoking during pregnancy was identified in a small number of mothers, and secondhand smoke at home was higher in the control group.CONCLUSIONS Presence of atopy, positive Asthma Predictive Index and exposure to environmental smoke are associated to recurrent wheezing. Identifying these factors enables the adoption of preventive measures, especially for children susceptible to persistent wheezing and future asthma onset.

Is Iron Deficiency Anaemia, a risk Factor For Wheeze Associated Respiratory Tract Infection in Children?

Introduction: Wheezing is the common in children with cumulative prevalence of almost 50% by the age of 6 yrs. Iron deficiency anaemia is an independent risk factor for lower respiratory tract infections (LRTI), however may also play an important role in wheeze associated respiratory tract infection. The present study aimed at finding a correlation between iron deficiency anaemia and wheeze associated respiratory tract infection. Materials and Methods: This case control study was conducted at a multidisciplinary tertiary care hospital from Jul 2012 to Jun 2013 among children six months to five years and having ≥2 episodes of wheeze associated respiratory tract infections. The clinical presentation and laboratory profile were recorded on a predesigned performa. Iron deficiency anaemia was diagnosed by haemoglobin &lt;11.0 gm%, serum ferritin&lt;12ng/ml and RDW&gt;15%. The statistical analysis was done using SPSS, Version 15.0. Results: A total of 100 children were enrolled in the study, of which 50 cases and 50 matched controls. Majority of subjects in both groups were males (n=31;62%),with male to female ratio of 1.6:1. Proportion of cases with iron deficiency anaemia were higher among cases(32%) as compared to controls(24%) but the difference between two groups was not significant statistically (p=0.373) despite having higher risk(OR=1.49;95% CI=0.62-3.59). Mean monocyte, oeosinophil and absolute oeosinophil count was found to be significantly higher in cases as compared to controls (p&lt;0.05). Conclusion: The present study do not suggest a possible linkage between iron deficiency anemia and wheeze associated respiratory infection, however its role as causative factor needs to be explored through long-term prospective and intervention studies on a large population.J Nepal Paediatr Soc 2014;34(3):195-199 DOI: http://dx.doi.org/10.3126/jnps.v34i3.11378

Epidemiological aspects of and risk factors for wheezing in the first year of life.

OBJECTIVE: To determine, in a sample of infants, the prevalence of and risk factors for occasional wheezing (OW) and recurrent wheezing-wheezy baby syndrome (WBS). METHODS: Parents of infants (12-15 months of age) completed the International Study of Wheezing in Infants questionnaire. RESULTS: We included 1,269 infants residing in the city of Blumenau, Brazil. Of those, 715 (56.34%) had a history of wheezing, which was more common among boys. The prevalences of OW and WBS were 27.03% (n = 343) and 29.31% (n = 372), respectively. On average, the first wheezing episode occurred at 5.55 ± 2.87 months of age. Among the 715 infants with a history of wheezing, the first episode occurred within the first six months of life in 479 (66.99%), and 372 (52.03%) had had three or more episodes. Factors associated with wheezing in general were pneumonia; oral corticosteroid use; a cold; attending daycare; having a parent with asthma or allergies; mother working outside the home; male gender; no breastfeeding; and mold. Factors associated with WBS were a cold; physician-diagnosed asthma; ER visits; corticosteroid use; pneumonia; bronchitis; dyspnea; attending daycare; bronchodilator use; having a parent with asthma; no breastfeeding; mother working outside the home; and a dog in the household. CONCLUSIONS: The prevalence of wheezing in the studied population was high (56.34%). The etiology was multifactorial, and the risk factors were intrinsic and extrinsic (respiratory tract infections, allergies, attending daycare, and early wheezing). The high prevalence and the intrinsic risk factors indicate the need and the opportunity for epidemiological and genetic studies in this population. In addition, mothers should be encouraged to prolong breastfeeding and to keep infants under six months of age out of daycare.

Prevalence and risk factors for wheezing in Salvador, Brazil: a population-based study.

Wheezing is one of the most frequent causes of visit to emergency rooms among children. However, data on wheezing burden are mostly provided at healthcare setting, and particularly only for infants. We sought to estimate the prevalence of wheezing in children under 4 years and to assess potential risk factors in the community. This was a cross-sectional analysis of a population-based cohort study. The sample comprised children aged <4 years living in Salvador, Brazil. Data were collected via home visits when the parents/guardians were interviewed. Data were recorded on standardized forms. Of 1534 children, mean age was 21 ± 14 months (minimum 3 days; maximum 47 months; 6% <2 months); 780 (51%) were males and 501 [33%; 95% confidence interval (95% CI): 30-35%] reported wheezing in the last 12 months. Among wheezers, 321 (64%) had occasional wheezing. Overall, 180 (12%; 95% CI: 10-14%) had recurrent wheezing and 157 (10%; 95% CI: 9-12%) had asthma. For children in the first, second, third and fourth year of life wheezing was reported in 23, 41, 34 and 37%, respectively. Mother atopic-related disease was independently associated with recurrent wheezing (AdjPR[95% CI]: 1.54 [1.12-2.11]) and asthma (AdjPR[95% CI]: 1.54 [1.10-2.16]). Smoker at home (AdjPR[95% CI]: 1.34 [1.07-1.67]) and low birth weight (AdjPR[95%CI]: 1.38 [1.05-1.81]) were independently associated with occasional wheezing. One-third of under 4 years reported wheezing; history of mother's atopic-related disease was an independent risk factor for recurrent wheezing and asthma; smoker at home and low birth weight were independent risk factors for occasional wheezing.

Rhinitis, asthma and respiratory infections among adults in relation to the home environment in multi-family buildings in Sweden.

Risk factors for rhinitis, asthma and respiratory infections in the home environment were studied by a questionnaire survey. Totally 5775 occupants (≥18 years old) from a stratified random sample of multi-family buildings in Sweden participated (46%). 51.0% had rhinitis in the last 3 months (current rhinitis); 11.5% doctor diagnosed asthma; 46.4% respiratory infections in the last 3 months and 11.9% antibiotic medication for respiratory infections in the last 12 months. Associations between home environment and health were analyzed by multiple logistic regression, controlling for gender, age and smoking and mutual adjustment. Buildings constructed during 1960–1975 were risk factors for day time breathlessness (OR = 1.53, 95%CI 1.03–2.29). And those constructed during 1976–1985 had more current rhinitis (OR = 1.43, 95%CI 1.12–1.84) and respiratory infections (OR = 1.46, 95%CI 1.21–1.78). Cities with higher population density had more current rhinitis (p = 0.008) and respiratory infections (p<0.001). Rented apartments had more current rhinitis (OR = 1.23, 95%CI 1.07–1.40), wheeze (OR = 1.20, 95%CI 1.02–1.41), day time breathlessness (OR = 1.31, 95%CI 1.04–1.66) and respiratory infections (OR = 1.13, 95%CI 1.01–1.26). Living in colder parts of the country was a risk factor for wheeze (p = 0.03) and night time breathlessness (p = 0.002). Building dampness was a risk factor for wheeze (OR = 1.42, 95%CI 1.08–1.86) and day time breathlessness (OR = 1.57, 95%CI 1.09–2.27). Building dampness was a risk factor for health among those below 66 years old. Odor at home was a risk factor for doctor diagnosed asthma (OR = 1.49, 95%CI 1.08–2.06) and current asthma (OR = 1.52, 95%CI 1.03–2.24). Environmental tobacco smoke (ETS) was a risk factor for current asthma (OR = 1.53, 95%CI 1.09–2.16). Window pane condensation was a risk factor for antibiotic medication for respiratory infections (OR = 1.41, 95%CI 1.10–1.82). In conclusion, rhinitis, asthma and respiratory infections were related to a number of factors in the home environment. Certain building years (1961–1985), building dampness, window pane condensation and odor in the dwelling may be risk factors.

The Relationship Between a Specific IgE Level and Asthma Outcomes: Results from the 2005-2006 National Health and Nutrition Examination Survey

Allergen exposure is associated with increased specific IgE (sIgE), and allergen exposure plus sensitization is predictive of asthma outcomes. However, it is not known if sIgE is predictive of asthma outcomes in the absence of exposure data. To investigate whether IgE to indoor allergens is predictive of and has a dose-response relationship with asthma emergency department (ED) visits and wheeze. In the 2005-2006 National Health and Nutrition Examination Survey, 351 children and 390 adults reported current asthma. Continuous sIgE to 9 indoor allergens were considered. Asthma morbidity in the past year was measured by wheezing. Health care utilization was defined as any asthma ED visits in the past year. Analyses were adjusted for race, age, education, poverty index ratio and (in adults) tobacco use. In children, ED visits were associated with cockroach (odds ratio [OR] 1.5 [95% CI, 1.1-2 .1), rat (OR 1.9 [95% CI, 1.2-2.8]), and Aspergillus (OR 1.6 [95% CI, 1.001-2.60]). Continuous Aspergillus (OR 1.5 [95% CI, 1.04-2.1), Alternaria (OR 1.4 [95% CI, 1.1-1.6]), and total IgE (OR 1.2 [95% CI, 1.1-1.4]) were associated with wheeze in children. Adult ED visits were associated with sIgE for dust mites (Dermatophagoides pteronyssinus OR 1.6 [95% CI, 1.3-2.1]; Dermatophagoides farinae OR 1.6 [95% CI, 1.3-1.9]), total IgE (OR 1.4 [95% CI, 1.04- 1.9]), and the sum of sIgEs (OR 1.6 [95% CI, 1.2-2.2]). Sensitization to particular indoor environmental allergens was found to be a risk factor for wheeze and asthma ED visits. These outcomes increased as the concentration of sIgE to these allergens increased.

Preliminary analysis of a birth cohort study (Go-Child) assessing wheeze and atopy in infancy

Aims Wheeze during infancy may be related to development of asthma in childhood. Most studies that have explored this question have been retrospective and have not assessed wheeze at 1 year of age. We have established a genotyped birth cohort (GO-CHILD) to investigate the influence of genetic and environmental factors on childhood atopy. The aim of this preliminary analysis of the cohort data is to identify the environmental risk factors for wheeze at age 1 year. Methods Participants were recruited antenatally. Following Ethics approval and informed consent, the expecting mothers completed a questionnaire on the antenatal risk factors of atopic diseases in the newborn. Family history of atopy was assessed. Details of environmental factors, like exposure to smoking during pregnancy, type of cooking fuel and socioeconomic background, were also collected. A postal questionnaire to assess atopic conditions, infections, feeding was administered at 1 year of age. The data from the antenatal and 1 year follow-up questionnaires were analysed by using SPSS version 16. The study aims to recruit 3000 UK mothers. This analysis only includes the Sussex data. Results 66 (19%) of 341 participants developed wheeze by 1 year. 29% infants required hospital admission due to exacerbation of wheeze. The risk of wheeze was significantly increased in infants with maternal (p value Conclusions This is the first large prospective study with detailed phenotyping of wheeze at the end of the first year of life. It shows that infants with eczema, family history of asthma and those attending nursery or playgroups are at increased risk of developing wheeze during the first year of life. An earlier presentation of wheeze is associated with more number of attacks of wheeze over the first year of life. Funded by SPARKS

Work-related respiratory symptoms and lung function among solderers in the electronics industry: a meta-analysis

Research on the respiratory effect of exposure to solder fumes in electronics workers has been conducted since the 1970s, but has yielded inconsistent results. The aim of this meta-analysis was to clarify the potential association. Effect sizes with corresponding 95% confidence intervals (CIs) for odds of respiratory symptoms related to soldering and spirometric parameters of solderers were extracted from seven studies and pooled to generate summary estimates and standardized mean differences in lung function measures between exposed persons and controls. Soldering was positively associated with wheeze after controlling for smoking (meta-odds ratio: 2.60, 95% CI: 1.46, 4.63) and with statistically significant reductions in forced expiratory volume in 1s (FEV1) (-0.88%, 95% CI: -1.51, -0.26), forced vital capacity (FVC) (-0.64%, 95% CI: -1.18, -0.10), and FEV1/FVC (-0.35%, 95% CI: -0.65, -0.05). However, lung function parameters of solderers were within normal ranges [pooled mean FEV1: 97.85 (as percent of predicted), 95% CI: 94.70, 100.95, pooled mean FVC: 94.92 (as percent of predicted), 95% CI: 81.21, 108.64, and pooled mean FEV1/FVC: 86.5 (as percent), 95% CI: 78.01, 94.98]. Soldering may be a risk factor for wheeze, but may not be associated with a clinically significant impairment of lung function among electronics workers.

Endotoxin Exposure and Childhood Wheeze and Asthma: A Meta-Analysis of Observational Studies

Background. Exposure to endotoxin has been widely investigated as a potential factor for asthma and associated symptoms in children with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of endotoxin exposure with wheeze and asthma in children. Methods. A search for relevant studies and reviews was conducted in MEDLINE, Highwire, CINAHL, and The Cochrane Library databases. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for endotoxin exposure and wheeze or asthma were retrieved and pooled to generate summary effect estimates in STATA 11.1. Results. Nineteen studies were included in the meta-analysis. The summary estimates suggested that endotoxin was positively associated with wheeze in infants and toddlers (meta-OR: 1.48, 95% CI: 1.10–1.98), but negatively related to asthma in school-aged children (meta-OR: 0.82, 95% CI: 0.69–0.97 for endotoxin concentration and 0.68, 95% CI: 0.50–0.93 for endotoxin load). Conclusions. Based on the studies evaluated, endotoxin is a risk factor for wheeze in younger children, but a protective factor for asthma in older children. Thus, this study supports the “hygiene hypothesis.”

Factores de risco e prevalência de asma e rinite em crianças em idade escolar em Lisboa

Aims A cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. Material and Methods Between October and December 2008, parents of 900 students of the basic schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40%. Logistic regression was used in the analysis of results. Results The prevalence of asthma, allergic rhinitis and wheeze was 5.6%, 43.0% and 43.3%, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. Conclusion Contrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.

Risk factors and prevalence of asthma and rhinitis among primary school children in Lisbon

AimsA cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. Material and methodsBetween October and December 2008, parents of 900 students of the elementary schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40 %. Logistic regression was used in the analysis of results. ResultsThe prevalence of asthma, allergic rhinitis and wheeze was 5.6 %, 43.0 % and 43.3 %, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. ConclusionContrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.

Risk factors and prevalence of asthma in schoolchildren in Castellon (Spain): a cross-sectional study

BackgroundResearch on potential risk factors of asthma can enhance our understanding of geographic differences and inform decisions on preventive strategies. MethodsIn 2002, a cross-sectional population-based study was carried out in the area of Castellon (Spain), following the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III methodology. Asthma symptoms and related risk factor questionnaires were completed by parents of 6-7 year-old schoolchildren. Logistic regression was used in the analysis. ResultsParticipation rate was 88 % (4492 of 4872 schoolchildren). Prevalence of wheeze in the past year, asthma ever, and physician-diagnosed asthma were 8 %, 7 % and 6 %, respectively. Risk factors independently associated with all three asthma case definitions were history of bronchitis or pneumonia, allergic rhinitis, family members with atopic disease, and residing in an industrialised area. Risk factors for asthma ever and physician-diagnosed asthma were male sex, atopic eczema and presence of a dog at home; exclusive breast-feeding and the presence of another animal (not a dog or cat) were protective factors. Maternal age was inversely related to physician-diagnosed asthma. Residence in an area of heavy truck traffic and the father smoking at home were associated with asthma ever. Risk factors for wheeze in the past year were low social class, history of sinusitis and the father smoking at home. ConclusionsEnvironmental factors are related to the presence of asthma. Preventive measures should be directed to improving air pollution, promoting breast-feeding and reducing smoking in the home.

Early‐life rotavirus and norovirus infections in relation to development of atopic manifestation in infants

The increase in incidence of atopic diseases (ADs) in the developed world over the past decades has been associated with reduced exposure of childhood infections. To investigate the relation between early intestinal viral infections in relation to the development of atopic symptoms (eczema, wheeze and atopic sensitization) in the first and second year(s) of life. In the KOALA Birth Cohort Study, we assessed IgG seropositivity for rota- and norovirus (GGI.1 and GGII.4) at 1 year of age. This was related to allergic sensitization [specific immunoglobulin E (IgE)] at 1 and 2 years, and parent reported eczema and wheeze in the first 2 years, using logistic regression analysis adjusted for confounders. Rotavirus seropositivity (39%) was associated with an unexpected higher risk of recurrent wheeze in the first and second year of life [adjusted odds ratio (OR) 3.1 and 95% confidence intervals (CI) 1.1-9.1] and persistent and new recurrent wheeze (adjusted OR 2.7 and 95% CI 1.1-6.2). No further associations were found between intestinal viral seropositivity and atopic manifestations. Our data did not show a clear protection by enteric viral infections in young children on development of IgE response to allergens, but rotavirus infection in the first year was a risk factor for wheeze. However, this needs to be followed up to older ages in order to establish the true importance of intestinal viral infections and especially cumulative effects in AD aetiology. Exposure to rotavirus may offer a new and interesting focus on infant wheeze and later asthma development.

Neonatal Antibiotic Treatment Is a Risk Factor for Early Wheezing

Alm B, Erdes L, Möllborg P, et al. Pediatrics. 2008;121(4):697–702 PURPOSE OF THE STUDY. To analyze the risk factors for wheezing at 12 months of age with special reference to antibiotic treatment. STUDY POPULATION. Participants were infants in western Sweden, which includes urban, rural, and coastal areas, who are participating in an ongoing study. Of the total birth cohort of 16 682 infants born in 2003, 50% (8176) were randomly selected. METHODS. Families of infants were sent an invitation to participate in the study. Respondents completed questionnaires regarding the infant and the family when the child was 6 and 12 months of age. Response rates were 68.5% at 6 months and 68.9% at 12 months. Factors significant in an initial univariate analysis were analyzed in a multivariate model. RESULTS. At 12 months of age, 20.2% of infants had ≥1 episode of wheezing, and 5.3% had ≥3 episodes of wheezing during the first year of life. Overall, 4.1% received inhaled corticosteroids (ICSs). In the multivariate analysis, independent significant risk factors for “wheezing ever” and for wheezing disorder treated with ICSs were neonatal antibiotic treatment, male gender, gestational age (GA) of &amp;lt;37 weeks, having a mother with asthma, having a sibling with asthma or eczema, and breastfeeding for &amp;lt;5 months. Treatment with antibiotics was more common among extremely preterm infants. Neonatal antibiotic treatment increased the risk of later wheezing in both term and preterm infants. The odds ratio (OR) for infants with a GA of ≥33 weeks was 2.9 (95% confidence interval: 1.8–4.7) and for infants with a GA of ≥37 weeks was 2.9 (95% confidence interval: 1.7–4.9). CONCLUSIONS. The authors found that treatment with antibiotics in the neonatal period is the most potent independent risk factor for wheezing treated with ICSs during the first year of life. REVIEWER COMMENTS. Previous studies have suggested that antibiotics in the first year of life are a risk factor for developing asthma. It is difficult, however, to exclude the confounder that infants who wheeze may receive more antibiotics during the first year of life. The advantage of this large study is that administration of antibiotics in the neonatal period was evaluated as an independent risk factor. An obvious limitation, however, is that the study was conducted with a questionnaire that required parental recall. Additional limitations that were partly addressed included lack of determination of the type or duration of antibiotics given, the underlying diagnoses, and confirmation of asthma diagnoses. Nonetheless, this study supports the hygiene hypothesis and presents an opportunity to consider asthma/allergy prevention strategies.