Asthma control affects school absence, achievement and quality of school life: a multicenter study.

INTRODUCTION AND OBJECTIVES: Asthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children. MATERIALS AND METHODS: From January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child's disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life. RESULTS: 507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child's asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters. CONCLUSION: School interventions are important to improve asthma management.

Relationship between nasal mucociliary clearance and disease severity in children with allergic rhinitis: A comparative cross-sectional study.

OBJECTIVES: Mucociliary clearance (MCC) is impaired due to chronic inflammation in allergic rhinitis. Our aim was to evaluate MCC in children with allergic rhinitis, to determine its relationship with disease severity and evaluate MCC change after nasal irrigation. MATERIALS AND METHODS: Saccharin test was performed in 51 patients with allergic rhinitis and in 50 controls. Nasal irrigation was performed to the patients and saccharin test was repeated at the 10th minute. Total nasal symptom score (TNSS) and visual analogue scale (VAS) results were recorded. Patients were divided into mild/moderate-severe groups according to TNSS, VAS, and ARIA guidelines. Nasal MCC time (NMCCT) of the patients and the controls and NMCCT before and after nasal irrigation of the patients were compared. Correlations between NMCCT and TNSS/VAS were evaluated. NMCCTs of the mild and moderate-severe groups were compared. The cut-off values ​​were calculated to discriminate the patient group. RESULTS: The mean NMCCT of the patient group was higher than the controls. Mean NMCCTs were different between before and after irrigation. NMCCT was higher in uncontrolled/moderate-severe groups than in controlled/mild groups. NMCCT correlated positively with VAS and TNSS. The sensitivity and specificity of NMCCT>535s were found to be 86.27% and 94%, respectively. CONCLUSIONS: In children with allergic rhinitis, the prolongation of MCC may be identified with the easily applicable saccharin test, the deterioration in MCC increases as disease severity increases. Nasal irrigation is important in children with allergic rhinitis to improve MCC.

Laboratory and severity evaluation of pediatric atopic dermatitis and moisturizer response in different phenotypes.

INTRODUCTION AND OBJECTIVES: Atopic dermatitis (AD) is an eczematous skin disease. Our aim was to evaluate the clinical and laboratory findings of children with AD and identify the higher responsive group to moisturizers. MATERIALS AND METHODS: Total and specific IgE, eosinophil count, prick/patch test results of patients with AD were retrospectively analyzed. The presentation SCORAD was compared between the demographic and clinical subgroups. The SCORAD change (presentation to third month) between the intrinsic and extrinsic groups was compared. The effect of age, sex, disease duration, presentation SCORAD, being intrinsic/extrinsic, exclusive breastfeeding duration, familial atopy, total IgE, eosinophil count, concomitant illness presence, moisturizer use frequency and exacerbation frequency on SCORAD change was examined. RESULTS: The mean age was 3.65±3.77 years. Food allergy was found in 5.90% and inhalant allergy was found in 12.67% of patients. 158 (44.5%) were mild, 154 (43.4%) were moderate and 43 (12.1%) were severe AD. 141 (39.7%) were intrinsic AD. The SCORAD at 3rd visit and SCORAD change was different between the intrinsic and extrinsic groups. SCORAD change was positively associated with presentation SCORAD, eosinophil count, moisturizer use frequency and being extrinsic AD. CONCLUSIONS: The clinical and laboratory findings of AD patients in our community were revealed. Higher SCORAD and eosinophils at presentation, frequent daily moisturizer use and being extrinsic increased the moisturizer response. Although the barrier defect was shown to be lesser in intrinsic AD by considering transepidermal water loss, this study is the first to evaluate intrinsic and extrinsic AD patients according to response to moisturizers.

Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers.

BACKGROUND: The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. METHODS: Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. RESULTS: 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003). CONCLUSION: IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey.

OBJECTIVES: The aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey. METHODS: The study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing. RESULTS: The prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR=2.5, 95% CI: 1.3-4.7, p=0.004), dampness at home (OR=2.4, 95% CI: 1.2-4.8, p=0.008), a history of intestinal parasites (OR=4.3, 95% CI: 1.7-10.9, p=0.002), previous history of pneumonia (OR=6.9, 95% CI: 1.9-25.9, p=0.004), initiation of complementary foods before the age of three months (OR=6.1, 95%CI: 1.4-26.9, p=0.02) and presence of food allergy (OR=3.1, 95% CI: 1.1-9.2, p=0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR=5.2, 95% CI: 0.9-28.7, p=0.05) and high serum IgE levels (OR=2.9, 95% CI: 0.9-9.0, p=0.05) at borderline significance. CONCLUSION: Our study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.

The relation of innate and adaptive immunity with viral-induced acute asthma attacks: Focusing on IP-10 and cathelicidin.

BACKGROUND: Despite growing evidence suggesting potential association between innate and adaptive immunity in viral-induced acute asthma, there is paucity of data in this area. OBJECTIVE: This study aimed to investigate the association of innate and adaptive immunity with acute asthma attacks by analysing the role of IFN-γ-inducible protein 10 (IP-10), TLR2, cathelicidin, vitamin D and cytokines. MATERIAL AND METHODS: This prospective study included 33 patients with viral-induced acute asthma and 30 children with controlled asthma. Nasopharyngeal swab samples were collected for virus identification and asthma attack scores assessed in acute asthma group. Blood sampling for IP-10, TLR2, cathelicidin, vitamin D levels, and spirometric indices were employed. RESULTS: Serum IP-10 and cathelicidin levels of acute asthma group were significantly higher and vitamin D levels were lower than controlled asthma group (IP-10; p=0.006, cathelicidin; p=0.002, vitamin D; p<0.001). Serum IP-10 levels showed a significant negative correlation with age (p=0.009), TLR2 (p=0.05) and spirometric indices (p=0.002) in all asthmatics and a significant positive correlation with parameters of asthma attack severity (p=0.03) in acute asthma group. Higher cathelicidin values showed significant positive relation to IP-10 (beta coefficient: 33, p=0.02). Serum IP-10 levels higher than 38.9pg/ml (sensitivity: 85%, specificity: 47%, p=0.002) were predictive of virus-induced asthma. Serum IP-10 and vitamin D levels were found to be significantly related to viral-asthma attacks (IP-10; aOR: 8.93, p=0.03 and vitamin D; aOR: 0.82, p=0.001). CONCLUSIONS: Innate immunity biomarkers such as serum IP-10 and cathelicidin can be used to predict viral-induced acute asthma. These biomarkers may provide potential new treatment targets for acute asthma.