How the presence of rhinoconjunctivitis and the severity of asthma modify the relationship between obesity and asthma in children 6-7 years old.

BACKGROUND: The association between asthma and obesity in children, and the effect modification of allergy on this association have not been fully established. Aims The objective of the study was to know the effect modification of the severity of asthma and of the coexistence of rhinoconjunctivitis (RC) in the relationship between obesity and asthma. METHODS: A cross-sectional study of 17 145 schoolchildren 6-7 years old from eight Spanish cities who had completed information on height and weight of the ISAAC phase III questionnaire, which also included questions about asthma and RC symptoms and on various risk factors. Body mass index (BMI) was used to define obesity according to international standards. Two different logistic regressions, using current occasional asthma (COA) and current severe asthma (CSA) as dependent variables, were made stratifying for gender and for the coexistence of RC and controlling for age, older and younger siblings, exercise, mother's education, truck traffic, cat/dog during the first year of life and smoking father or mother. RESULTS: Obesity was a risk factor of CSA without RC, both for boys (1.92, CI 95% 1.13-3.25) and for girls (2.99, CI 95% 1.68-5.32). Every BMI unit increment increased by 6.7% the risk of CSA without RC in boys and by 12.4% in girls. Obesity was not a risk factor for CSA with RC. The association between COA and obesity was weaker and the coexistence of RC did not modify it greatly. CONCLUSIONS: Obese schoolchildren are more at risk of suffering from non-allergic asthma than the non-obese subjects.

[Prevalence of asthma and rhinitis symptoms in A Coruña (Spain)]. / Prevalencia de síntomas de asma y rinitis en la población de A Coruña.

INTRODUCTION: The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. OBJECTIVE: To asses the prevalence of asthma and rhinitis symptoms in childhood. MATERIAL AND METHODS: We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. RESULTS: A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of "wheezing at some time" was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. CONCLUSIONS: The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied.

[Time trends and geographical variations in the prevalence of symptoms of allergic rhinitis in 6-7-year-old children from eight areas of Spain according to the ISAAC]. / Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6-7 años de ocho áreas españolas, según el ISAAC.

BACKGROUND: Phase III of the International Study of Asthma and other Allergies in Childhood (ISAAC) was carried out in schoolchildren aged 6-7 years from eight areas of Spain to estimate time trends and geographic variations in the prevalence of symptoms of allergic rhinitis (AR). MATERIAL AND METHOD: A standard and validated questionnaire was used following ISAAC methodology and was completed by the schoolchildren's parents. The prevalence of symptoms of AR in Phase I (1993-1994) and Phase III (2001-2002) was compared. Eight centers participated: Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona and Valencia. Poisson regression was used in the analysis. RESULTS: A total of 25,113 schoolchildren were studied with a median participation of 81.7 %. In all centers, AR symptoms tended to increase, with a prevalence ratio of rhinoconjunctivitis in the previous year of 1.61 (95 % confidence interval: 1.48-1.76) when both phases, adjusted by gender, center, and seasonal variation, were compared. The prevalence of AR symptoms was higher in boys than in girls. Wide variations in the prevalence of AR were observed across centers with a higher prevalence in Asturias, Madrid, Cartagena and Bilbao. Lower prevalences were reported in Barcelona, Castellón and Pamplona. CONCLUSIONS: There seems to have been a general increase in AR symptoms. Substantial variations between centers suggested that there may be local differences in risk factors. Intense research will be required for satisfactory preventive actions.

[Impact of an asthma educational intervention programme on teachers]. / Impacto de una intervención educativa sobre asma en los profesores.

OBJECTIVE: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

Parents' smoking habit and prevalence of atopic eczema in 6-7 and 13-14 year-old schoolchildren in Spain. ISAAC phase III.

BACKGROUND AND AIMS: Atopic eczema (AE) is the most frequent inflammatory skin disease in childhood in the western world. Several studies have reported a significant increase of prevalence in recent decades and the environmental factors implicated in its aetiology, including environmental tobacco smoke. This study aims to investigate the possible association of AE prevalence in Spanish schoolchildren aged 6-7 and 13-14 years in relation to their parents' smoking habits. METHODS: We conducted a cross-sectional population-based study with 6-7 year-old (n = 27805) and 13-14 year-old (n = 31235) schoolchildren from 10 Spanish centres. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and the Spanish Academy of Dermatology criteria, used in Spain to diagnose AE. RESULTS: An association was found in school-children aged 6-7 (adjusted for gender, presence of asthma, presence of rhinitis, siblings and mother's level of education) between AE being clinically diagnosed with the mother's smoking habit (RPRa 1.40, 1.10-1.78) and there being more than 2 smokers at home (RPRa 1.34, 1.01-1.78). Regarding the presence of itchy rash, an association was observed with fathers who smoke (RPRa 1.40, 1.13-1.72). Among the 13-14 year-olds, no association was observed in relation to either clinically diagnosed AE or the appearance of itchy rash with parents' smoking habit. CONCLUSIONS: Our results indicate the risk for children of being exposed to environmental tobacco smoke in terms of AE, especially when they are younger.

BCG immunization at birth and atopic diseases in a homogeneous population of Spanish schoolchildren.

BACKGROUND: The role of immunization with bacillus Calmette-Guérin (BCG) in the prevalence of asthma, hay fever and atopic dermatitis is not definitely established and seems to be influenced by ethnic background. The aim of this study was to analyze the relationship between this immunization and the prevalence of those diseases in a homogeneous population of Spanish schoolchildren. METHODS: The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in four different centers of the Spanish North Atlantic coast. Bilbao, San Sebastián and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruña discontinued this practice in 1989. Except for this center, immunization coverage was above 90%. A random sample of schools of Asturias or all schools in the city district (rest of centers) with children 6 and 7 years old was surveyed. RESULTS: The participation rate was above 70%. After excluding those children born outside Spain, the numbers were 6,762 immunized and 2,828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, older and younger siblings and having a cat or a dog during the first year of the child's life, the adjusted ORs of the BCG-immunized children suffering from asthma, hay fever and atopic dermatitis were respectively 0.87 (95% CI 0.76-1.00), 0.87 (0.75-1.01) and 0.89 (0.76-1.05). CONCLUSIONS: BCG immunization offers a weak but significant protection against asthma and hay fever in Spanish schoolchildren.

Impacto de una intervención educativa sobre asma en los profesores / Impact of an asthma educational intervention programme on teachers

Objetivo: Determinar el impacto de una intervención educativa en el nivel de conocimientos de los profesores sobre el asma y su manejo. Material y método: Estudio cuasiexperimental, de tipo antes y después, con grupo control, de una intervención educativa (IE) dirigida a mejorar el grado de conocimientos sobre el asma infantil y su manejo en profesores de centros escolares de San Sebastián (Gipuzkoa). Se utilizó como elemento de medida el cuestionario de conocimientos Newcastle Asthma Knowledge Questionnaire (NAKQ) y como intervención educativa, una adaptación del programa Asma, Deporte y Salud. Se utilizó el test de los rangos con signo de Wilcoxon para comparar la puntuación total en el cuestionario antes y después de la intervención, el test de McNemar para comparar el porcentaje de respuestas correctas a cada ítem y el test U de Mann-Whitney para la comparación en la puntuación basal y a los 3 meses entre el grupo de intervención y el grupo control. Se estudiaron el tamaño del efecto y la respuesta media estandarizada. Resultados: Participaron 138 docentes de 6 centros elegidos aleatoriamente (grupo estudio) y 43 en el grupo control. En el grupo estudiado la puntuación media del cuestionario de conocimientos de asma NAKQ antes de la realización de la intervención educativa fue de 16,1±3,4 puntos, con una mediana de 16 (rango 7-23). Tras la intervención educativa, la puntuación ascendió a 22,3±4,1 con una mediana de 23 (rango 6-29), siendo la diferencia media en la puntuación global de conocimientos de 7,0±4,2 puntos, con una mediana de 8 (rango -2; 17), tamaño del efecto de 2,0(>0,8) siendo la respuesta media estandarizada de 1,7. A los 3 meses de la intervención, la puntuación media del cuestionario fue de 21,4±3,0 puntos, con una mediana de 22 (rango 12-29), significativamente superior al momento previo a la intervención (p<0,001) y algo menor que el inmediatamente posterior a la misma, suponiendo un tamaño del efecto de 1,6 y una respuesta media estandarizada de 1,2. En el grupo control no se modificó el nivel de conocimientos, permaneciendo más bajo que el grupo intervenido (p<0,001). Conclusiones: Una intervención educativa dirigida a los profesores aumenta significativamente el nivel de conocimientos sobre el asma. Además, el incremento disminuye algo pero se mantiene elevado durante al menos 3 meses. Algunos aspectos del conocimiento, aunque mejoran con la intervención educativa, no son óptimos (AU)

Objective: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. Material and method: Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. Results: A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<0.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<0.001). Conclusions: An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal (AU)

Parents’ smoking habit and prevalence of atopic eczema in 6-7 and 13-14 year-old schoolchildren in Spain. ISAAC Phase III

Background and aims: Atopic eczema (AE) is the most frequent inflammatory skin disease in childhood in the western world. Several studies have reported a significant increase of prevalence in recent decades and the environmental factors implicatedin its a etiology, including environmental tobacco smoke.This study aims to investigate the possible association of AE prevalence in Spanish school children aged 6-7 and 13-14 years in relation to their parents’smoking habits. Methods: We conducted a cross-sectional population-based study with 6-7 year-old (n = 27805) and 13-14 year-old (n = 31235) school children from10 Spanish centres. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and the Spanish Academy of Dermatology criteria, used in Spain to diagnose AE. Results: An association was found in school children aged 6-7 (adjusted for gender, presence of asthma, presence of rhinitis, siblings and mother’s level of education) between AE being clinically diagnosed with the mother’s smoking habit (RPRa 1.40,1.10-1.78) and there being more than 2 smokers at home (RPRa 1.34, 1.01-1.78). Regarding the presence of itchy rash, an association was observed with fathers who smoke (RPRa 1.40, 1.13-1.72). Among the 13-14 year-olds, no association was observed in relation to either clinically diagnosed AE or the appearance of itchy rash with parents’ smoking habit. Conclusions: Our results indicate the risk for children of being exposed to environmental tobacco smoke in terms of AE, especially when they are younger

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Prevalencia de síntomas de asma y rinitis en la población de A Coruña / Prevalence of asthma and rhinitis symptoms in a Coruña (Spain)

Introducción El asma y la rinitis son dos enfermedades con elevada prevalencia en la infancia, con tendencia a incrementarse en los últimos años. En ambas es frecuente el infradiagnóstico. Objetivo Verificar la prevalencia de síntomas de asma y rinitis en la población infantil. Material y métodos Hemos realizado, mediante cuestionario escrito, un estudio transversal siguiendo la metodología del International Study of Asthma and Allergies in Childhood (ISAAC), de prevalencia de sintomatología de asma y rinitis en el área de A Coruña. Resultados Han sido incluidos 3.017 niños y niñas de 6 y 7 años (tasa de respuesta del 73,9 %), y 2.981 de 13 y 14 años (tasa de respuesta del 93,6 %). Refirieron haber presentado sibilancias alguna vez el 25,3 % de los niños y niñas de 13 y 14 años y el 37,2 % de los de 6 y 7 años. Han presentado asma en alguna ocasión el 18,5 % de los adolescentes y el 13,7 % del grupo de menor edad. La prevalencia de rinitis alguna vez fue del 30,4 % a los 6 y 7 años y del 47,3 % a los 13 y 14 años. La mayor prevalencia de rinitis se produjo en el otoño. Conclusiones El asma y la rinitis son especialmente frecuentes en nuestra población

Introduction The prevalence of asthma and rhinitis is high in childhood and has been increasing in the last few years. In both diseases underdiagnosis is frequent. Objective To asses the prevalence of asthma and rhinitis symptoms in childhood. Material and methods We performed a cross-sectional study using a written questionnaire, following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC), on the prevalence of symptoms of asthma and rhinitis in La Coruña. Results A total of 3017 boys and girls aged 6-7 years old (response rate 73.9 %) and 2981 boys and girls aged 13-14 years old (response rate 93.6 %) were included. The prevalence of 'wheezing at some time' was 25.3 % in adolescents aged 13-14 years old and was 37.2 % in children aged 6-7 years. The prevalence of "asthma at some time" was 18.5 % in adolescents and 13.7 % in children. The prevalence of "rhinitis at some time" was 30.4 % in the group aged 6-7 years and 47.3 % in the group of adolescents. The prevalence of rhinitis was highest in autumn. Conclusions The prevalence of asthma and rhinitis is high in our population and is higher than that observed in most Spanish populations studied

Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6-7 años de ocho áreas españolas, según el ISAAC / Time trends and geographical variations in the prevalence of symptoms of allergic rhinitis in 6-7-year-old children from eight areas of Spain according to the ISAAC

Antecedentes: Se presenta la fase III del estudio ISAAC (International Study of Asthma and other Allergies in Childhood) en escolares de 6-7 años de ocho áreas españolas para estimarla tendencia temporal y variaciones geográficas de los síntomas de rinitis alérgica. Material y método: Se comparan las prevalencias de síntomas de rinitis alérgica entre la fase I y fase III, efectuadas entre los años1993-1994 y 2001-2002, mediante un cuestionario estandarizado y validado según metodología ISAAC, cumplimentado por los padres de los escolares. Participaron ocho centros de Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona y Valencia. Se empleó la regresión de Poisson en el análisis. Resultados: La población estudiada fue de 25.113 escolares con una mediana de participación del 81,7 %. En todos los centros se observó una tendencia creciente en síntomas de rinitis alérgica, destacando la razón de prevalencia de rinoconjuntivitis en los últimos 12 meses de 1,61 (intervalos de confianza del 95 %: 1,48-1,76) al comparar ambas fases, y después de ajustar por sexo, centro y variación estacional. La prevalencia de síntomas de rinitis alérgica fue mayor en los niños que en las niñas. Se apreciaron amplias variaciones entre centros con elevadas prevalencias en Asturias, Madrid, Cartagena y Bilbao. Las menores prevalencias se produjeron en Barcelona, Castellón y Pamplona. Conclusiones: El incremento de los síntomas de rinitis alérgica parece ser general y existen amplias variaciones entre centros que sugieren la diferente magnitud de factores de riesgo aescala local y cuya investigación más exhaustiva potenciaría actuaciones preventivas más adecuadas

Background: Phase III of the International Study of Asthma and other Allergies in Childhood (ISAAC) was carried out in school children aged 6-7 years from eight areas of Spain to estimate time trends and geographic variations in the prevalence of symptoms of allergic rhinitis (AR).Material and method A standard and validated questionnaire was used following ISAAC methodology and was completed by the school children’s parents. The prevalence of symptoms of AR in Phase I (1993-1994) and Phase III (2001-2002) was compared. Eight centers participated: Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona and Valencia. Poisson regression was used in the analysis. Results: A total of 25,113 schoolchildren were studied with a median participation of 81.7 %. In all centers, AR symptoms tended to increase, with a prevalence ratio of rhinoconjunctivitisi n the previous year of 1.61 (95 % confidence interval:1.48-1.76) when both phases, adjusted by gender, center, and seasonal variation, were compared. The prevalence of AR symptoms was higher in boys than in girls. Wide variations in the prevalence of AR were observed across centers with a higher prevalence in Asturias, Madrid, Cartagena and Bilbao. Lower prevalences were reported in Barcelona, Castellón and Pamplona. Conclusions: There seems to have been a general increase in AR symptoms. Substantial variations between centers suggested that there may be local differences in risk factors. Intense research will be required for satisfactory preventive actions