Pediatric asthma quality of life questionnaire: validation in children from Singapore.

"Quality of Life" is a multidimensional measure encompassing the physical, emotional and social functioning of the child. The asthma specific questionnaire contains 23 questions (items) in three areas (domains) of activity, symptoms and emotions. The objective of the present study was to validate the Paediatric Asthma Quality of Life Questionnaire "PAQLQ"(copyright 1991 McMaster University). If the questionnaire is valid, a change in the child's asthma will be accompanied by a change in the "Quality of Life" questionnaire score. The questionnaire was administered twice over four weeks and the child's asthma status was assessed concurrently. Two groups were thus identified; Group A = unchanged asthma, Group B = changed asthma. Forty-seven children, aged 7 to 14 years, completed the study. Reliability of the questionnaire shows an intraclass-correlation coefficient of only 0.71. Cross-sectional construct validity was demonstrated by a significant correlation between the whole questionnaire and the clinical asthma score (p<0.001) but not in the separate domains. Longitudinal construct validity was also demonstrated by the significant correlation between change in the total questionnaire score, but not separate domains, with change in the child's asthma score (p<0.05). Responsiveness was shown by a significant difference in the magnitude of the change in the questionnaire score between the two groups (p<0.001), but again not in the separate domains. It was concluded that the questionnaire was validated as a whole but not in as convincing a manner, as has been done by others, and we are therefore in a position to advise caution in its application in our population.

An evaluation of mattress encasings and high efficiency particulate filters on asthma control in the tropics.

The effect of two allergen avoidance modalities, Allergy Control Covers (ACC) and High Efficiency Particulate Filters (HEPA) on asthma control in children were evaluated. This was an open study involving 24 dust mite sensitive asthmatic children. Following a 4 week run-in period, the subjects were randomly allocated to use mattresses fitted with ACC (n = 6), HEPA filters in their bedrooms (n = 12) or act as controls (n = 6) for a study duration of 4 months. Measurements of the major Dermatophagoides spp. mite allergens, Der p 1 and Der f 1, levels in dust samples obtained from mattresses were made at baseline, 1, 2 and 4 months post implementation. Daily symptom scores including morning and evening peak flow readings, and monthly spirometry and exercise bronchoprovocation tests were carried out Our results showed that dust mite allergen levels in mattresses fell at 1 and 2 months post implementation in the ACC group (p<0.05). In contrast, no decrease in allergen levels was seen in the HEPA and control group. At the end of the 16 weeks, only the ACC group showed improvement in FEV1 and reduction in diurnal peak expiratory flow rate (p<0.05). Improvement in mean symptom scores was also observed for both the ACC and HEPA groups, but not the control groups (p<0.05). Although the numbers in this study were small, the results Indicate that the effectiveness on mite exposure barrier covers was short-lived, and the improvement in asthma control though documented was not obvious.

Prevalence of allergic sensitization to regional inhalants among allergic patients in Jakarta, Indonesia.

Sensitization towards a panel of eight regional inhalant allergens was evaluated among 107 patients with allergic rhinitis and/or asthma. A total of 32 children (age 5-13 years, mean 9 years; 18 male, 14 female), 75 adolescents and adults (aged 14-66 years, mean 32 years; 21 male, 54 female) and 20 normal control volunteers (aged 16-46, mean 30 years; 4 male, 16 female) were evaluated via skin prick test. A weal response of 3 x 3 mm or greater was taken to be positive. The sensitization rates among individuals to these allergens were: house dust mites, Dermatophagoides pteronyssinus (77.57%), Blomia tropicalis (71.96%), Austroglycyphagus malaysiensis (33.64%), pollen, palm oil Elaeis guineensis (22.43%), Acacia auriculiformis (12.15%), fern spore, resam Dicranopteris spp (11.21%), fungal spores: Curvularia fallax (8.41%) and Exserohilum rostratum (13.08%). There were significantly higher frequencies of sensitization to these allergens among allergic individuals compared to normal controls, and among atopic individuals with two allergy manifestations (rhinitis and asthma) compared to those with only one. No difference was noted between children and adults in the allergic group. In conclusion, the allergic patients were highly sensitized to dust mites and sensitization to regional pollen and spores was also documented. They should be considered as relevant and be included in skin test batteries in Indonesia.