Prevalence of and factors associated with underdiagnosis of pediatric asthma in Batumi, Georgia.

BACKGROUND AND OBJECTIVE: A recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it. METHODS: Subjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma). RESULTS: Clinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%-5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2±1.6 vs. 9.3±2.1; p=0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p=0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p=0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p=0.01). Multivariate analysis confirmed results of simple analyses. CONCLUSION: In Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi.

MATERNAL STRESS AND ENVIRONMENTAL RISK FACTORS OF CHILDHOOD ASTHMA.

Asthma is a common disease with increasing prevalence both in children and adults. WHO estimates that annually 15 million disability-adjusted life-years are lost and 250,000 asthma deaths are reported worldwide. Approximately 500,000 annual hospitalizations are due to asthma. To study the Relationship between environmental factors and childhood asthma has been studied. Maternal stress during pregnancy might affect fetal lung development and subsequently predispose to childhood asthma. The aim of the study was to assess the associations of maternal psychological stress during pregnancy and identify environmental correlates of the conditions with childhood asthma. Case-controlled retrospective study among 84 children, 6-8 yy. (among them 40 with verified asthma). We assessed maternal risk - factors and environmental correlates by the questionnaire. An increased risk of asthma was found in infants of pregnant women with severe stress. Results of statistical analyses showed reliable positive correlation with asthma: birth weight <2500 (r=.232; p=0.035); severe stress (r=.532; p=0.000); asthma history/mother (r=.426; p=0.000); allergy/mother (r=.402; p=0.000); chronic bronchitis /mother (r=.447; p=0.000); asthma/father (r=.425; p=0.000); allergy/father (r=.245; p=0.026); eczema/father - (r=0.081; - p=0.466); chronic bronchitis/father (r=.304; p=0.005); primary educatin/mother (r=.240; p=0.029); primary education/father (r=.246; p=0.025); Negative correlation: term newborn (r=-.514; p=0.000); breastfeeding (r=-.325; p=0.003); moderate stress (r=-.263; p=0.016); working parents (r=-.418; p=0.000); financial income of the family (r=-.275; p=0.012). Our results suggest intrauterine effects of maternal factors during pregnancy on the presence of childhood asthma. Maternal severe stress during pregnancy can trigger of wheezing and asthma of their child.