Direct and indirect costs of asthma in school-age children.

Wheeler L.

Surveillance and Evaluation Research Branch, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA 30341, USA. lgw0 cdc.gov

INTRODUCTION: Asthma is one of the most common chronic diseases of childhood and is the most common cause of school absenteeism due to chronic conditions. The objective of this study is to estimate direct and indirect costs of asthma in school-age children. METHODS: Using data from the 1996 Medical Expenditure Panel Survey, we estimated direct medical costs and school absence days among school-age children who had treatment for asthma during 1996. We estimated indirect costs as costs of lost productivity arising from parents' loss of time from work and lifetime earnings lost due to premature death of children from asthma. All costs were calculated in 2003 dollars. RESULTS: In 1996, an estimated 2.52 million children aged five to 17 years received treatment for asthma. Direct medical expenditure was 1009.8 million dollars (401 dollars per child with asthma), including payments for prescribed medicine, hospital inpatient stay, hospital outpatient care, emergency room visits, and office-based visits. Children with treated asthma had a total of 14.5 million school absence days; asthma accounts for 6.3 million school absence days (2.48 days per child with asthma). Parents' loss of productivity from asthma-related school absence days was 719.1 million dollars (285 dollars per child with asthma). A total of 211 school-age children died of asthma during 1996, accounting for 264.7 dollars million lifetime earnings lost (105 dollars per child with asthma). Total economic impact of asthma in school-age children was 1993.6 million dollars (791 dollars per child with asthma). CONCLUSION: The economic impact of asthma on school-age children, families, and society is immense, and more public health efforts to better control asthma in children are needed.

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Addressing the childhood asthma crisis in Harlem: the Harlem Children's Zone Asthma Initiative.

Hutchinson V.

Department of Pediatrics, Harlem Hospital Center/Columbia University, 506 Lenox Avenue, MLK 17-105, New York, NY 10037. swn2 columbia.edu.

OBJECTIVES: We determined the prevalence of asthma and estimated baseline asthma symptoms and asthma management strategies among children aged 0-12 years in Central Harlem. METHODS: The Harlem Children's Zone Asthma Initiative is a longitudinal, community-based intervention designed for poor children with asthma. Children aged 0-12 years who live or go to school in the Harlem Children's Zone Project or who participate in any Harlem Children's Zone, Inc, program were screened for asthma. Children with asthma or asthma-like symptoms were invited to participate in an intensive intervention. RESULTS: Of the 1982 children currently screened, 28.5% have been told by a doctor or nurse that they have asthma, and 30.3% have asthma or asthma-like symptoms. To date, 229 children are enrolled in the Harlem Children's Zone Asthma Initiative; at baseline, 24.0% had missed school in the last 14 days because of asthma. CONCLUSION: The high prevalence of asthma among children in the Harlem Children's Zone Project is consistent with reports from other poor urban communities. Intensive efforts are under way to reduce children's asthma symptoms and improve their asthma management strategies.

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[Evaluation of antigen specific IgE responses in Japanese asthmatics and non-asthmatics]

[Article in Japanese]

Nishimura M.

First Department of Medicine, School of Medicine, Hokkaido University. daicon med.hokudai.ac.jp

BACKGROUND: An increase in the prevalence of asthma does not seem to be comparable to the dramatic increase of atopy for the last two decades in Japan. Atopy is considered an important risk factor for asthma. It is, however, suggested that asthma itself may be responsible for the increased overall IgE responsiveness. We examined the significance of IgE responsiveness in asthma. METHODS: We studied 265 healthy controls and 275 patients with asthma. Total serum IgE levels and levels of antigen-specific IgE antibody to mite (D. farinae), cat, dog, timothy, and Candida spp. were determined. We defined atopy by positive RAST (>0.35UA/ml) or MAST scores (>1.0 lumicount) to at least one inhaled allergen. Frequencies of atopic subjects and frequencies of subjects sensitized to each allergen in atopic subjects were compared between the asthmatics and controls. All comparisons were made in younger (<41 yrs) and older (> = 41 yrs) groups, separately. RESULTS: In younger non-asthmatics, 76.5% (104/136) were atopic. The frequency of atopy was significantly higher in asthmatic subjects compared to non-asthmatics in both younger and older groups. In atopic subjects, older asthmatics were sensitized to animals more frequently than older controls. Although the frequency of subjects sensitized to mite did not differ between asthmatics and controls both in younger and older atopic subjects, asthmatics sensitized to mite had higher titers of specific IgE antibody to mite compared to those of controls sensitized to mite. Even non-atopic asthmatics had higher levels of total IgE compared to non-atopic controls. CONCLUSION: Our data may indicate that sensitization to animals and severer sensitizations to mite are risk factors for asthma. However, given the high prevalence of atopy in younger healthy controls, and increased levels of total serum IgE even in non-atopic asthmatics, our findings may reflect the increased overall IgE responsiveness that is inherent in asthma.

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Psychological adjustment and asthma in children and adolescents: the UK Nationwide Mental Health Survey.

Goodman R.

Academic Division of Clinical Psychology, University of Manchester, Second Floor, Education and Research Centre, Wythenshawe Hospital, Manchester M23 9LT, UK. Rachel.Calam man.ac.uk

OBJECTIVE: Data from a nationwide child mental health survey were analyzed to examine relationships between asthma and psychological adjustment. METHODS: Survey design with random selection based on national computer records of 10,438 children aged 5 to 15 from 12,529 eligible families (83%). Strengths and Difficulties Questionnaire (SDQ) was completed by parents, teachers, and 11- to 17-year-olds, providing scores for total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, social behavior, and total impact. The Development and Well-Being Assessment (DAWBA) generated ICD-10 diagnoses. Parents reported physical disorders and disabilities, other child mental health risk factors, and rated child's general level of health. RESULTS: Children with organic conditions other than asthma were excluded, leaving 9,834 children, 49.9% male. Preliminary comparisons indicated higher parent and teacher rated scores for children with asthma. New variables combined asthma and general health to produce four groups. Logistic regressions were conducted with children without asthma and in good health as the reference group. Children with asthma in good health showed greater parent-rated emotional problems, but otherwise, few elevated odds ratios. Children without asthma in poor health were at significantly greater risk of disorder, as were children with asthma in poor health. Findings on ratings of hyperactivity are discussed. CONCLUSION: Findings that children with asthma have elevated psychological difficulties may result from poor health rather than asthma itself.

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Rubbing ointments and asthma morbidity in adolescents.

Ozuah PO.

Albert Einstein College of Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.

OBJECTIVE: To determine the relationship between the use of rubbing ointments and asthma morbidity in adolescents. DESIGN: Cross-sectional study. SETTINGS/LOCATION: Inner-city high school in the Bronx, New York. SUBJECTS: 165 adolescents with asthma. OUTCOME MEASURES: Asthma morbidity, defined as emergency department (ED) use for asthma in the past year and over the lifetime. RESULTS: While 127 (77%) of subjects used albuterol as the first treatment for their last asthma attack, 18 (11%) used rubbing ointments. The rubs and albuterol groups were similar in asthma severity, mean age, gender, and ethnicity. However, subjects in the the rubs group were less likely than subjects in the albuterol group to have made an ED visit over the past 12 months or over their lifetime. Regression analysis revealed that, after controlling for asthma severity, use of rubs independently predicted less lifetime ED use. CONCLUSIONS: After controlling for asthma severity, use of rubs by adolescents with asthma was associated with lower asthma morbidity as measured by ED use.

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Superoxide release and cellular gluthatione peroxidase activity in leukocytes from children with persistent asthma.

Condino-Neto A.

Departamento de Pediatria e Centro de Investigacao em Pediatria, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.

Asthma is an inflammatory condition characterized by the involvement of several mediators, including reactive oxygen species. The aim of the present study was to investigate the superoxide release and cellular glutathione peroxidase (cGPx) activity in peripheral blood granulocytes and monocytes from children and adolescents with atopic asthma. Forty-four patients were selected and classified as having intermittent or persistent asthma (mild, moderate or severe). The spontaneous or phorbol myristate acetate (PMA, 30 nM)-induced superoxide release by granulocytes and monocytes was determined at 0, 5, 15, and 25 min. cGPx activity was assayed spectrophotometrically. The spontaneous superoxide release by granulocytes from patients with mild (N = 15), moderate (N = 12) or severe (N = 6) asthma was higher at 25 min compared to healthy individuals (N = 28, P < 0.05, Duncan test). The PMA-induced superoxide release by granulocytes from patients with moderate (N = 12) or severe (N = 6) asthma was higher at 15 and 25 min compared to healthy individuals (N = 28, P < 0.05 in both times of incubation, Duncan test). The spontaneous or PMA-induced superoxide release by monocytes from asthmatic patients was similar to healthy individuals (P > 0.05 in all times of incubation, Duncan test). cGPx activity of granulocytes and monocytes from patients with persistent asthma (N = 20) was also similar to healthy individuals (N = 10, P > 0.05, Kruskal-Wallis test). We conclude that, under specific circumstances, granulocytes from children with persistent asthma present a higher respiratory burst activity compared to healthy individuals. These findings indicate a risk of oxidative stress, phagocyte auto-oxidation, and the subsequent release of intracellular toxic oxidants and enzymes, leading to additional inflammation and lung damage in asthmatic children.

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Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study.

Korppi M.

Department of Pediatrics, Kuopio University Hospital, and Kuopio University, Kuopio, Finland.

OBJECTIVE: To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls. DESIGN: An 18- to-20-year prospective cohort study. SETTING: Pediatric department at a university hospital, providing primary hospital care for a defined population.Patients Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years. MAIN OUTCOME MEASURES: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included). RESULTS: By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions. CONCLUSION: The increased risk for asthma persists until adulthood after bronchiolitis in infancy.

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Prevalence and incidence of asthma related to waist circumference and BMI in a Swedish community sample.

Zetterstrom O.

Allergy Centre, University Hospital, SE-581 85, Linkoping, Sweden. ulla.nystrom.kronander lio.se

Both asthma and obesity have become more common in affluent societies during the recent decades and several studies have shown a correlation between the presence of asthma and obesity. In order to further study this association we have investigated a population from a community in southern Sweden, where almost all inhabitants had their body indices measured as part of a study on diabetes at a primary care centre. An asthma unit working with a structured care programme for asthma was available. This organisation enabled us to study whether body mass index and waist circumference was associated with having or developing asthma. There was a significant association between both overweight, increased waist circumference and asthma, P < 0.01. The risk for developing asthma was associated with increased body weight and abdominal circumference, P < 0.05. The increase in asthma morbidity in the overweight subjects was found almost exclusively in the non-atopic asthma patients. This study confirms earlier findings of an increased prevalence of asthma in obese and overweight patients. Increased obesity and especially abdominal obesity is thus a risk factor for asthma, which probably contributes to the high prevalence of asthma in affluent societies.

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