36 - Prevalence and risk factors of asthma in damascus school children aged 10-14 - 31/03/08

Introduction: Asthma is major public concern in the world. This is more serious in countries with limited resources and lower public awareness.

Aim: to identify children school with asthma and other allergic diseases. All risk factors and precipitants were studied.

Patients and methods: based on BTS definition of asthma, we identified asthmatic children aged 10-14 years in 11 private and public schools of different geographic and socioeconomic distribution.

As in other similar studies, we modified ECHRS and ISAAC protocols.

Formal approval from school authority in Damascus and Damascus Medical School were obtained.

Asthma symptom questionnaires were distributed to 2100 families. Children who returned the questionnaires (n=1365, 65%) were asked to enroll in the study. children were classified as having probable asthma, possible asthma, or no asthma.

Children who were considered to have no evidence of asthma on the 5-item questionnaire underwent no additional testing.

Probable asthma was considered if the answers were Yes to 4 and 5a (the child was diagnosed or taking medications of asthma in the last 12 months). Possible asthma was Yes to ≥1 question. No asthma if the answer was No to all questions.

All children who had probable or possible asthma underwent PFT evaluation and if needed stress PFT. Children with a FEV1/FVC ratio of ≪80% are considered to have probable asthma. Children with normal spirometry performed a submaximal exercise challenge test as a test of BHR. This test is made simply by running in the school hall for 6 minutes. Spirometry is performed 3 minutes after cessation of the exercise. Children are considered to have probable asthma if they show a >15% decrease in FEV1 or a 25% decrease in FEF25-75 rate from baseline.

Many factors influencing the prevalence of Asthma were studied. These included: sex, age, location, type and condition of housing ventilation and sunlight), passive smoking, other allergic diseases, family history and maternal smoking.

Results: Based on the questionnaire alone, 1020 (74% of) children did not have asthma, 88 (6.7%) had almost confirmed asthma and 257 (18.8%) and probable asthma.

After performing simple and stress PFT, we found that overall asthma prevalence was 6.7% (ranging from 3% in some areas to as high as 27% in other areas). Areas of high prevalence are known to more crowded and have higher pollution status.

Factors that influenced the prevalence of asthma were: poor residence aeration (16 vs. 6%), poor residence sunlight (18 vs. 6%), male sex (8.2% vs. 5.7%), smoking during pregnancy (11% vs. 4.7%), croup or bronchiolitis in early childhood (48% vs. 23%), taking medication during pregnancy (12 vs. 7%), and GI symptoms (17% vs. 4%).

Passive smoking tended to be associated with more asthma (53% vs. 47%).

The type of residence and desaturation during childbirth. did not have significant impact.

The following symptoms were more prevalent in asthmatics in the last 12 months as compared to the rest of the children: Wheezing (5 vs. 45%). Morning symptoms (7.7 vs. 33.3%), nocturnal symptoms (5.1 vs. 37.1%), physical activity-related symptoms: (4.4 vs. 39.3%), allergic rhinitis (11 vs. 27%), allergic conjunctivitis (7.7 vs. 11.9%)

Asthma diagnosis was extremely underestimated (3.2%) before the study by the community physicians as compared to rate of diagnosis in our study (6.8%).

Pharmacologic treatment for asthma(inhalers or bronchodilators) in the last 12 months was 48.5% in asthmatics and 4.9% for the nonasthmatics. Compliance with treatment was 40% for inhalers. Negative factors influencing the use of inhalers were: perception that inhalers are for severe disease only (17%), lack of knowledge about the technique (5%), fear of addiction (37%), and lack of the physicians insistence (2.5%).

Conclusion: Asthma is major public concern in Damascus. There are many modifiable risk factors that need to be looked into in order to control the disease.