Airway eosinophilia is associated with wheeze but is uncommon in children with persistent cough and frequent chest colds.

The role of eosinophilic airway inflammation in the variant asthma syndromes of cough and chest colds is not well defined. We tested the hypothesis that children with persistent cough and chest colds have increased sputum eosinophils, similar to those with wheeze. The parents of 390 primary school children completed a symptoms questionnaire. Children with wheeze (n = 28), cough (n = 12), recurrent chest colds (n = 17), and no symptoms (control subjects, n = 26), underwent allergy skin prick tests, spirometry, hypertonic saline inhalation challenge, and sputum induction, and then completed a peak expiratory flow (PEF) and symptoms diary over a 2-mo period. Children with wheeze had significantly reduced PEF (p = 0.001) and higher sputum eosinophils when compared with the cough, chest cold, and control groups (3.1% versus 0.5%, 0%, 0%; p = 0.03). The prevalence of eosinophilic bronchitis (sputum eosinophils > 2.5%) was 45% in the wheeze group, which was significantly higher than the control group (9.35%, p = 0.04). Eosinophilic bronchitis was present in two children with cough (20%) and two with chest colds (15%, p > 0.05 versus control). In these groups, eosinophilic bronchitis was not associated with airway hyperresponsiveness (AHR) to hypertonic saline (p > 0.05). Children with cough and chest colds reported greater exposure to environmental tobacco smoke. In conclusion, this community-based survey of children with chronic respiratory symptoms has shown that wheeze is a good discriminator for the presence of eosinophilic bronchitis, and that persistent cough and recurrent chest colds without wheeze should not be considered a variant of asthma. Eosinophilic bronchitis did occur in a significant minority of these "variant asthma" syndromes.

Outdoor air pollution and children's respiratory symptoms in the steel cities of New South Wales.

OBJECTIVE: To investigate the relationship between outdoor air pollution and the respiratory health of children aged 8 to 10 years. DESIGN: A cross-sectional survey (between October 1993 and December 1993) of children's health and home environment. Summary measures of particulate pollution (levels of particles with an aerodynamic diameter less than 10 microns [PM10] each 6th day) and SO2 (daily mean and maximum hourly values) were estimated for each area (using air quality monitoring station data from July 1993 to June 1994). SETTING AND SURVEY PARTICIPANTS: Parents of 3023 primary school children (Years 3, 4 and 5) from industrial and non-industrial areas with air quality monitoring stations in the Hunter and Illawarra regions of New South Wales. MAIN OUTCOME MEASURES: Reported occurrence of four or more chest colds, four or more attacks of wheezing, and night-time cough without a cold for more than two weeks, all within the previous 12 months. RESULTS: 77% response rate, ranging by area from 66% to 88%. The average annual outdoor air pollution for the nine areas was 18.6-43.7 micrograms/m3 for PM10 and 0.16-0.90 parts per hundred million for SO2. The proportion of children reported to have the main outcome symptoms were: chest colds, 3.0%-9.7%; night cough, 12.3%-30.5%; and wheeze, 3.4%-11.3%. There was no significant association with SO2, but a significant increase in the odds of symptoms per 10 micrograms/m3 increase in PM10 on chest colds (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.12-1.82) and night-time cough (OR, 1.34; 95% CI, 1.19-1.53), but not wheeze. Passive smoking was significantly associated with chest colds but not with the other symptoms. Maternal allergy was associated with all three respiratory symptoms, most strongly with wheeze. CONCLUSION: These results provide evidence of health effects at lower than expected levels of outdoor air pollution in the Australian setting. They also suggest differences in contributions of environmental and hereditary factors to cough and chest colds compared with wheeze.

Self-management, autonomy, and quality of life in asthma. Population Medicine Group 91C.

STUDY OBJECTIVE: Asthma management guidelines emphasize increased autonomy for asthmatics through patient education and patient-initiated action plans. The aim of this study was to examine autonomy, as reflected in the preferences of asthmatic subjects for decision making and their preferences for information seeking. The results were related to quality of life in asthma. SUBJECTS: One hundred twenty-three adults with asthma. DESIGN: Questionnaire-based cross-sectional analytic survey. SETTING: Eighty-five subjects were recruited from community pharmacies at the point of sale of albuterol inhalers for asthma and compared with 38 subjects recently hospitalized for acute severe asthma. MEASUREMENTS: Asthma-related quality of life, autonomy preferences questionnaire. RESULTS: The subjects in both groups had a mild-to-moderate quality of life impairment in all domains that was greater in the posthospitalization group (p < 0.05). Both groups expressed strong preferences for information concerning their condition (92se 0.8, 91se 1.1, out of a possible 100). Subjects did not prefer to make decisions alone about the management of asthma exacerbations (51.0se 1.2, 52.5 se2.0, out of a possible 100). As the severity of the asthma exacerbation increased, the desire to make decisions decreased (p < 0.05). Older subjects expressed less desire for decision making than younger subjects. Self-management autonomy was not correlated with quality of life in asthma. CONCLUSIONS: We conclude that while asthmatics have strong desires to be informed about their illness, they do not wish to be the prime decision makers during an exacerbation. These findings have implications for the success of self-management programs and action plans.