Nocturnal attacks, emergency room visits and ICU admission of pediatric asthma: frequency and associated factors

Asthma is the most frequent cause of chronic illness in childhood and emergency department visits. This study aims to determine the frequency of emergency room [ER] visits, intensive care unit [ICU] admission, and nocturnal attacks among asthmatic children and to identify associated factors. Records of asthmatic children in the pediatric chest clinic, Ain Shams University during 1995-2004 were reviewed. Asthmatic children with documents of ER visits, ICU admission, or nocturnal attacks were compared with asthmatic children without previously mentioned events. Out of 691 asthmatic patients, 302 [43.7%] had nocturnal attacks, 258 [37.3%] had emergency room visits, 39 [5.6%] were admitted to ICU, and 249 [36%] had no reports of previous events. ER visits and nocturnal attacks were more in children above 4 years. ER visits and ICU admission were higher among those with positive family history of asthma [p< 0.01], those exposed to environmental tobacco smoke [ETS] [p< 0.01], and those who had previous respiratory infections [p< 0.05]. Attacks of nocturnal asthma were associated with the previous factors in addition to animal contact [p<0. 01] and living in bad housing conditions [p<0.05]. Logistic regression showed that family history [OR= 2.87, CI= 1.9-4.1] and bad housing conditions [OR= 2.65, CI= 1.3-5.3] were the significant factors for ER visits, while respiratory infections [OR= 5.24, CI= 2.1-12.0] and family history [OR= 3.48 CI, 1.3-9.2] were the significant factors for ICU admission. For nocturnal attacks, all factors were significant. Control of respiratory infections, limitation of ETS exposure and good housing conditions are needed to limit severe asthmatic attacks

Epidemiological pattern and management of pediatric asthma review of Ain Shams pediatric hospital chest clinic data Cairo, Egypt 1995-2004

Pediatric asthma is the leading cause of chronic illness in childhood and has an impact on child's quality of life. To describe the epidemiological and clinical data of asthmatic children followed up in the Pediatric Chest Clinic Am Shams University during a 10 year period. Files of asthmatic children attending the Clinic in the period from1995 to 2004 were selected. Relevant data were extracted and analyzed. Out of 1006 recorded cases, a total of 691 [68.7%] were asthmatic. The proportion of asthmatics among all chest patients attending the clinic was lowest in 2002 being 51.6% and highest in 1995, being 78.3%. Male to female ratio was] .6:1, mean age was 5.27yrs [SD +/- 3.65], mean age of onset of disease was 1.84 yrs [SD +/- 2.78]. Persistent asthma was significantly more prevalent in males p<0.01. Severe asthma; using the American Thoracic Society Classification, was found in 151 [41.1%] of cases. From 2002, using GINA Guidelines Classification, severe persistent asthma accounted for 13.5%. Episodic attacks were reported by 270 [39%] of patients, nocturnal attacks by 302 of patients [43.7%] and exercise induced asthma in 97 [14%] of patients. Exacerbations occurred in 300 [43.4%] patients after respiratory infections, in 275 [39.8%] on exposure to smoke, in 139 [20%] with special food, in 91 [13.2%] following allergen exposure and 51 [7.4%] on exposure to inhaler sprays. Half of the patients were treated by combination of drugs [49.2%], corticosteroid inhalers in 32.1%, and beta agonists [short acting] in 31.4%. Asthma constitutes a main problem in the Pediatric Chest Clinic. Respiratory infection and environmental factors are major exacerbating factors. Better documentation of patient's data and complete record in the files is needed

Glutathione S-transferase Ml genotype [GSTM1] plus prenatal exposure to smoke as risk factors for pediatric asthma

Pediatric asthma is considered a complex multifactorial disease, with an obvious genetic predisposition and the possible involvement of noxious environmental factors. Glutathione S-transferase genes are known as risk factors predisposing to some environmentally induced diseases. This study has examined the hypothesis that glutathione S-transferase [GSTM1] genotype may play a role in asthma and wheezing occurrence among those exposed to tobacco smoke. Genomic DNA samples isolated from 35 asthmatic children and 35 healthy children were amplified using the flanking GSTM1 primer set premixed with the internal set. Asthmatic children showed a significant high prevalence of the GSTM1-null genotype [odds ratio [OR] 2.2, 95% confidence interval [Cl] 1.4-3.4]. Among GSTM1-null children, in utero smoke exposure was associated with increased prevalence of asthma [OR 3.7, 95% Cl 1.9-7.3]. The intermediate electrophilic metabolites, arising in the first phase of detoxification of tobacco smoke, are not utilized by GST enzyme in asthmatic children. These intermediate metabolites may therefore attack cells and provoke oxidative stress, which contribute to the pathogenesis of asthma. Our findings indicate that there are important long-term effects of in utero smoke exposure in a genetically susceptible group of children [genetic environmental interaction]