Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997-2007.

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC (Estudio epidemiológico de EPOC en España) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1-10.2%) in 1997 to 4.5% (95% CI 2.4-6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40-69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p<0.05) within this 10-yr frame. The finding of a substantial reduction in the prevalence of COPD in Spain is unexpected, as were the observed changes in the severity distribution, and highlights the difficulties in comparisons between repeated cross-sectional surveys of spirometry in the population.

Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

AIMS: This study aimed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in Spain and identify the level of undiagnosed disease and its impact on health-related quality of life (HRQL) and activities of daily living (ADL). METHODS: A population-based sample of 4274 adults aged 40-80 years was surveyed. They were invited to answer a questionnaire and undergo prebrochodilator and postbronchodilator spirometry. COPD was defined as a postbronchodilator FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. RESULTS: For 3802 participants with good-quality postbronchodilator spirometry, the overall prevalence of COPD was 10.2% (95% CI 9.2% to 11.1%) and was higher in men (15.1%) than in women (5.6%). The prevalence of COPD stage II or higher was 4.4% (95%CI; 3.8%-5.1%). The prevalence of COPD increased with age and with cigarette smoking and was higher in those with a low educational level. A previous diagnosis of COPD was reported by only 27% of those with COPD. Diagnosed patients had more severe disease, higher cumulative tobacco consumption and more severely impaired HRQL compared with undiagnosed subjects. However, even patients with undiagnosed COPD stage I+ already showed impairment in HRQL and in some aspects of ADL compared with participants without COPD. CONCLUSIONS: The prevalence of COPD in individuals between 40 and 80 years of age in Spain is 10.2% and increases with age, tobacco consumption and lower educational levels. The rate of diagnosised COPD is very high and undiagnosed individuals with COPD already have a significant impairment in HRQL and ADL.

[The EPI-SCAN survey to assess the prevalence of chronic obstructive pulmonary disease in Spanish 40-to-80-year-olds: protocol summary]. / Estudio EPI-SCAN: resumen del protocolo de un estudio para estimar la prevalencia de EPOC en personas de 40 a 80 años en España.

BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) causes considerable morbidity and mortality in Spain. The 1997 IBERPOC study, applying the old criteria of the European Respiratory Society, reported a COPD prevalence of 9.1% in the adult population of Spain. The Epidemiologic Study of COPD in Spain (EPI-SCAN) aims to determine the current prevalence of COPD in residents of Spain aged 40-80 years and to estimate changes over the past 10 years. Secondary objectives are, among others, to describe the current prevalence of smoking and changes in COPD prevalence relative to previous studies; to describe treatments received by patients, quality of life, and the BODE index (body mass index, obstruction of airflow, dyspnea, and exercise tolerance); and to measure inflammatory markers in blood and exhaled-breath condensate. PATIENTS AND METHODS: EPI-SCAN is a population-based, cross-sectional epidemiologic study targeting the general population of Spain aged between 40 and 80 years. Participating centers were located in Barcelona, Burgos, Cordoba, Huesca, Madrid, Oviedo, Seville, Valencia, Vic, and Vigo. All subjects filled in an extensive questionnaire to collect social, demographic, and clinical information. Slow and forced spirometry tests before and after a bronchodilator test were also undertaken. Additionally, selected subjects performed a 6-minute walk test and answered generic and specific quality-of-life questionnaires, as well as an activities-of-daily-living questionnaire. Exhaled-breath condensate and blood samples were also collected from these subjects for measurement of inflammatory and other biomarkers.

Estudio EPI-SCAN: resumen del protocolo de un estudio para estimar la prevalencia de EPOC en personas de 40 a 80 años en España / The EPI-SCAN Survey to Assess the Prevalence of Chronic Obstructive Pulmonary Disease in Spanish 40-to-80-Year-Olds: Protocol Summary

Introducción y objetivos la enfermedad pulmonar obstructiva crónica (EPOC) es un trastorno que causa gran morbilidad y mortalidad en España. El estudio IBERPOC, realizado en 1997, identificó una prevalencia de EPOC en España, según el criterio antiguo de la European Respiratory Society, del 9,1% de la población adulta. El estudio EPI-SCAN (del inglés The Epidemiologic Study of COPD in Spain) pretende conocer la prevalencia de la EPOC en población de 40 a 80 años de edad residente en España en la actualidad suprimir. Otros objetivos secundarios que se plantean son describir la prevalencia de tabaquismo, la evolución de la prevalencia de EPOC respecto a estudios previos, el tratamiento recibido por los pacientes, la calidad de vida y el índice BODE (índice de masa corporal, obstrucción al flujo aéreo, disnea y capacidad de ejercicio), y determinar marcadores inflamatorios en sangre y en condensado exhalado.Pacientes y métodoEPI-SCAN es un estudio epidemiológico de base poblacional, transversal, de ámbito nacional, llevado a cabo en población general de 40 a 80 años residente en España. Las áreas participantes fueron: Barcelona, Burgos, Córdoba, Huesca, Madrid, Oviedo, Sevilla, Valencia, Vic y Vigo. Todos los participantes rellenaron un cuestionario sociodemográfico y clínico extenso, y realizaron una espirometría lenta y forzada antes y después de una prueba broncodilatadora. Además, algunos participantes seleccionados efectuaron las siguientes pruebas: prueba de la marcha de 6min, medición de la calidad de vida mediante cuestionarios específico y genérico, y de actividades de la vida diaria, recogida del condensado de aire exhalado y obtención de una muestra de sangre para medición de biomarcadores y diferentes parámetros inflamatorios(AU)

Background and Objectives Chronic obstructive pulmonary disease (COPD) causes considerable morbidity and mortality in Spain. The 1997 IBERPOC study, applying the old criteria of the European Respiratory Society, reported a COPD prevalence of 9.1% in the adult population of Spain. The Epidemiologic Study of COPD in Spain (EPI-SCAN) aims to determine the current prevalence of COPD in residents of Spain aged 40–80 years and to estimate changes over the past 10 years. Secondary objectives are, among others, to describe the current prevalence of smoking and changes in COPD prevalence relative to previous studies; to describe treatments received by patients, quality of life, and the BODE index (body mass index, obstruction of airflow, dyspnea, and exercise tolerance); and to measure inflammatory markers in blood and exhaled-breath condensate.Patients and MethodsEPI-SCAN is a population-based, cross-sectional epidemiologic study targeting the general population of Spain aged between 40 and 80 years. Participating centers were located in Barcelona, Burgos, Cordoba, Huesca, Madrid, Oviedo, Seville, Valencia, Vic, and Vigo. All subjects filled in an extensive questionnaire to collect social, demographic, and clinical information. Slow and forced spirometry tests before and after a bronchodilator test were also undertaken. Additionally, selected subjects performed a 6-minute walk test and answered generic and specific quality-of-life questionnaires, as well as an activities-of-daily-living questionnaire. Exhaled-breath condensate and blood samples were also collected from these subjects for measurement of inflammatory and other biomarkers(AU)

The socio-economic burden of asthma is substantial in Europe.

BACKGROUND: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS: In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. RESULTS: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). CONCLUSIONS: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.

Changes in the use of anti-asthmatic medication in an international cohort.

The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.

[Large-scale genotyping in research into autism spectrum disorders and attention deficit hyperactivity disorder]. / Genotipado a gran escala en la investigación del trastorno del espectro autista y el trastorno por deficit de atención con hiperactividad.

INTRODUCTION AND DEVELOPMENT: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative genomic methylation and hybridisation in order to identify chromosomal rearrangements in patients with autism and severe mental retardation. CONCLUSIONS: Genotyping large SNP-type collections that are potentially functional in genes that are candidates for these disorders, based on pharmacological, biochemical and neuropathological data together with that coming from animal models and linkage studies in a wide collection of samples from patients and controls, will enable us to identify the genetic components of these pathologies and to define their biological foundations.

Genotipado a gran escala en la investigación del trastorno del espectro autista y el trastorno por déficit de atención con hiperactividad / Large-scale genotyping in research into autism spectrum disorders and attention déficit hyperactivity disorder

Introducción y desarrollo. El trastorno del espectro autista (TEA) y el trastorno por déficit de atención con hiperactividad (TDAH) son dos trastornos neuropsiquiátricos de inicio en la infancia que presentan un elevado grado de agregación familiar. El TEA se caracteriza por alteraciones de la interacción social y problemas de la comunicación, mientras que los pacientes con TDAH presentan inatención persistente y/o comportamiento hiperactivoimpulsivo. A excepción de unos pocos casos de autismo en los que se han descrito anomalías citogenéticas o mutaciones en genes concretos, la etiología de estas enfermedades es desconocida. Se trata de enfermedades multifactoriales, con varios genes con un efecto menor y la contribución del ambiente. Los estudios de ligamiento genético han señalado unas 20 regiones cromosómicas sugestivas de contener genes que confieren susceptibilidad al autismo, al TDAH o a ambos trastornos. Los retos de investigación se centran en la caracterización clínica, el reclutamiento de pacientes con TEA y TDAH, estudios de cuantificación de dosis génica, metilación e hibridación genómica comparada para identificar reordenamientos cromosómicos en pacientes con autismo y retraso mental grave. Conclusión. El genotipado de amplias colecciones del tipo SNP potencialmente funcionales en genes candidatos para estos trastornos, en base a datos farmacológicos, bioquímicos, neuropatológicos, de modelos animales y de estudios de ligamiento, en una amplia colección de muestras de pacientes y controles permitirán identificar los componentes genéticos de estas patologías y definir sus bases biológicas (AU)

Introduction and development. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative genomic methylation and hybridisation in order to identify chromosomal rearrangements in patients with autism and severe mental retardation. Conclusions. Genotyping large SNP-type collections that are potentially functional in genes that are candidates for these disorders, based on pharmacological, biochemical and neuropathological data together with that coming from animal models and linkage studies in a wide collection of samples from patients and controls, will enable us to identify the genetic components of these pathologies and to define their biological foundations (AU)

The utility of specific immunoglobulin E measurements in primary care.

BACKGROUND: The identification of atopic patients may not be considered a necessary step in the diagnosis process in primary care. This study investigated the impact of the addition of a specific immunoglobulin E (IgE) antibody test on the current management by primary-care physicians of patients with respiratory and skin symptoms. METHODS: The study had a prospective before-after design. It was conducted in two geographic areas of Italy and Spain and consisted of two parts, Part I and Part II. In each part patients were recruited according to inclusion and exclusion criteria. After the clinical examination, the patients were classified into one of the following categories using a physician's classification: allergic, nonallergic or uncertain. A blood sample was taken from each included patient for specific IgE antibody determination using a Pharmacia CAP System, including either Phadiatop Infant (0-5 years of age) or Phadiatop and food mix (fx5e) (>5 years of age). If a positive result was found, an additional 6-26 specific IgE tests were performed. In Part I the result of the specific IgE antibody determinations was not available before the physician's classification was made. In contrast, in Part II, the result of the IgE test was available at the time when the physician's classification was made. Between Part I and Part II an educational intervention for physicians to improve their knowledge of blood testing for IgE-mediated allergy was carried out. RESULTS: A total of 721 patients were included in the study. The agreement between classifications based on clinical data and IgE antibody results changed from a kappa coefficient of 0.13 in Part I to 0.86 in Part II. With regard to the allergic status the proportion of uncertain cases was reduced from 26.3% in Part I to 4.1% in Part II. The proportion of patients that were advised to avoid allergens increased from 18% in Part I to 62% in Part II in the group of patients classified both by the clinician and the IgE test. CONCLUSIONS: The use of specific IgE antibody determinations improves the clinical management of patients with allergy related symptoms in primary care, allowing advice to be given on specific allergen avoidance. However, the applicability of this diagnostic tool in different areas and countries should be further assessed in cost-effectiveness studies.

[An assessment of the quality of life of patients with COPD and chronic hypoxemia by using the Spanish version of the Chronic Respiratory Disease Questionnaire]. / Valoración de la calidad de vida de los pacientes con EPOC e hipoxemia crónica mediante la versión española del Chronic Respiratory Disease Questionaire.

INTRODUCTION: The Chronic Respiratory Disease Questionnaire (CRDQ) is a specific evaluation instrument that has been recently translated to Spanish and validated in patients with COPD without chronic respiratory insufficiency. OBJECTIVE: To study the relation of CRDQ scores to several lung function parameters in COPD patients with chronic hypoxemia (PaO2 < 65). MATERIAL AND METHODS: Forty-four middle aged [68 (7)] men with COPD (FEV1 post-PBD < 50%; PaO2 < 65 mmHg) were enrolled with established medical histories, including blood gas and spirometric data. We collected the patients' responses to the CRDQ and measured blood gas levels, spirometric and plethysmographic variables and DLCO. Performance on a six-minute walking test was recorded, with dyspnea assessed on a visual analogue scale (VAS) initially and at the end of the walk. Nighttime pulse oximetry was also monitored. Pearson's and Spearman's correlation coefficients were used to study the relation between CRDQ scores and the aforementioned parameters. Gas and spirometric data were compared to CRDQ scores between groups of patients treated with continuous domiciliary oxygen therapy (CDOT) and the untreated group, using Student t-test and a Mann-Whitney U-test. RESULTS: Results are expressed as means and standard deviations within parentheses. FVC was 2,609 (618) ml, 72 (15)%; FEV1 867 (297) ml, 34 (11)%; FEV1/FVC 33 (8)%; PaO2 55(8) mmHg; and PaCO2 49(6) mmHg. The overall CRDQ score was related to FEV1 (0.38; p < 0.01); FEV1/FVC (0.43, p < 0.005); walking test distance (0.49, p < 0.01); final VAS (-0.64, p < 0.0001) and DLCO (0.59, p < 0.01). No relation was observed between CRDQ score and blood gases, nighttime pulse oximetry or plethysmograph data. "Dyspnea", "fatigue", "emotional function" and "disease control" dimensions of the CRDQ were related to the same variables as was the overall score, with the exception of FEV1/FVC for the "fatigue" dimension and FEV1 and DLCO for the "disease control" dimension. The CRDQ scores were similar in the CDOT and non-CDOT groups in spite of differences in their spirometric and gasometric variables. CONCLUSIONS: 1) Score on the CRDQ is related to FEV1, the FEV1/FVC ratio, walking test distance, dyspnea and DLCO but not to blood gases, FVC, lung volume or nighttime pulse oximetry. 2) The VAS dyspnea score recorded at the end of the walking test is the variable that is most strongly related to CRDQ score. 3) We found that use of CDOT did not undermine the COPD patient's quality of life.

Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children.

BACKGROUND: There has been controversy over the relation between poverty and asthma in the community. The aim of this analysis was to disentangle geographical and socioeconomic variation in asthma symptoms. METHODS: The analysis is based on parental reports of symptoms from data collected in 1990 and 1991. Children aged 5-11 years from three populations (English representative sample, Scottish representative sample, and an English inner city sample) were included. Of 17 677 eligible children, between 14 490 (82.0%) and 15 562 (88.0%) children were available for analysis according to symptom group. RESULTS: Wheezy symptoms were less prevalent in the Scottish sample than in the English samples and asthma attacks were most prevalent in the English representative sample. Asthma attacks were less prevalent in inner city areas than in the English representative sample (OR 0.79, 95% CI 0.66 to 0.95), but persistent wheeze and other respiratory symptoms were more prevalent (OR 1.95, 95% CI 1.65 to 2.32 and OR 1.67, 95% CI 1.52 to 1.84, respectively). The prevalence of persistent wheeze was higher in children whose father's social class was low and in those living in areas with a high Townsend score (an index of poverty) than in other children (p<0.001). Of the 14 areas with the highest Townsend score, 13 had an OR above 1 and six had an OR significantly higher than the reference area. CONCLUSIONS: Persistent wheeze is more prevalent in poor areas than in less deprived areas. This may indicate that poverty is associated with severe asthma or that a high percentage of persistent asthma symptoms in inner city areas are unrecognised and untreated.

Serum cholesterol and haematology at age eight to ten years.

The aim of the study was to estimate 95% reference ranges for blood constituents in 9-year-old children. Venepuncture was successful in 753 white children age 8-9 years in 21 areas in England and 5 in Scotland. Agreement with published reference ranges for haematological measurements from undocumented samples was good. The reference ranges were 3.22 to 5.79 mmol/l for serum total cholesterol, 0.9 to 2.1 mmol/l for high density lipoprotein cholesterol, and 13 to 61 micrograms/l for ferritin. The upper limit for total cholesterol is well above the recommended level for adults, with 9.3% of children having a value of 5.2 mmol/l or more. The results provide a scientific basis for ranges previously published for haematological measurements. Documented data should be combined from national studies to provide further reference ranges for routine use.

Family size, atopic disorders in parents, asthma in children, and ethnicity.

BACKGROUND: Several studies have reported an association between family size and atopic conditions, but few have found an association between asthma and family size. OBJECTIVE: This study was designed to assess the effect of familial aggregation and sibling number on asthma in children. METHODS: Children from 5 to 11 years of age in England and Scotland participated in a study in 1990 or 1991 in which responses to questions on asthma and wheezing in children and atopic conditions in parents were ascertained. Data on 11,924 complete family sets of child, mother, and father in three samples (the "representative" samples of England and Scotland and the English "inner city" sample) were analyzed. RESULTS: The following factors were highly associated with child's asthma or wheezing: mother's or father's asthma or wheezing (with the same odds ratio [OR], 2.4; 95% confidence interval [CI], 2.0 to 2.9), other atopic condition in mothers and fathers (OR, 1.5; 95% CI, 1.3 to 1.8 and OR, 1.4; 95% CI, 1.2 to 1.7, respectively), and three or more siblings compared with no siblings (OR, 0.5; 95% CI, 0.4 to 0.6). CONCLUSION: The negative relation between family size and wheezing or asthma indicates a protective effect of number of children sharing an environment at a young age. The level of association of asthma or wheezing in the parents and the child and the association between the child's asthma or wheezing and other atopic conditions in parents suggest that a general susceptibility and a lung-specific susceptibility are important in the etiology of asthma.

Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study.

OBJECTIVE: To examine the extent to which the prescription of drugs for asthma adhered to recommended guidelines in 1990-1 and to assess the influence of ethnic group on prescription. DESIGN: Cross sectional. SETTING: Primary schools in England and Scotland in 1990-1. SUBJECTS: Children aged mainly 5-11 years. The representative samples included 10628 children. The inner city sample included 7049 children, 4866 (69%) from ethnic minority groups. For the prevalence estimation 14490 children were included in the analysis (82% of the eligible children). For the treatment analysis a subgroup of 5494 children with respiratory symptoms was selected. MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms and drugs commonly prescribed for asthma, method of administration, inappropriate treatment, and odds ratios to assess the effect of ethnic group on rate of prescription and method of administration. RESULTS: Children with respiratory symptoms in the inner city sample were less likely to be diagnosed as having asthma. Of children with reported asthma attacks, those in inner city areas had a higher risk of not having been prescribed any drug for asthma (odds ratio 1.87 (95% confidence interval 1.26 to 2.77). Overall, 773 (75%) of these children had received a beta 2 agonist, 259 (25%) had received steroids, 148 (14%) had received sodium cromoglycate, and 194 (19%) had received no drug treatment in the previous year. When prescribed, beta 2 agonists were inhaled in 534 (69%) of cases, and this percentage was even lower in ethnic minority groups. Children of Afro-Caribbean and Indian subcontinent origin who had asthma were less likely to receive beta 2 agonists, and those from the Indian subcontinent were less likely to receive anti-inflammatory drugs. Antibiotics were less prescribed and antitussives more prescribed in children from ethnic minority groups than in white children. CONCLUSION: In 1990-1 the risk of underdiagnosis and undertreatment of asthma was higher in children from ethnic minority groups. The implementation of indicators and targets to monitor inequalities in the treatment of asthma in ethnic groups could improve equity and effectiveness in the NHS.

Factors associated with weight for height and skinfold thickness in British children.

STUDY OBJECTIVE: To examine the associations of social and biological factors with measures of obesity in children. DESIGN: The study had a cross sectional design. SETTING: The analyses were based on data from two national study of health and growth cross sectional surveys. The "representative sample" comprised 1990 data from 22 English areas and 1990-91 data from 14 Scottish areas; the "inner city sample" comprised 1991 data from 20 English areas. PARTICIPANTS: The subjects were primary school children aged mainly 5-11 years living in England and Scotland. The "representative" sample included 10,628 children--6463 living in England and 4165 living in Scotland. The "inner city" sample included 7049 children--2183 white, 1124 Afro-Caribbean, 2696 Indian subcontinent, and 1046 from other groups. Due to missing values on continuous variables, 8374 children were included in the analyses. MEASUREMENTS AND MAIN RESULTS: The relation between social environment and childhood overweight was studied using several indicators of obesity. Triceps, subscapular, the sum of triceps and subscapular skinfolds, and weight for height were used as dependent variables. The analyses were carried out in two stages. Firstly, multiple linear regression analyses were used to assess the factors associated with dependent variables treated as continuous. Secondly, multiple linear logistic regression analyses were used to examine the association between independent factors and overweight and fatness defined as binary variables. Birth weight, mother's body mass index (BMI), and father's BMI were consistently associated (p < 0.001) in all models and were the variables that contributed most to the explained variation in the dependent variables. In the multiple regression analyses there was a consistent interaction between the effects of ethnic origin and family size on each outcome variable. In the logistic regression analyses the interaction was not significant, and highly significant associations between both overweight and fatness with the number of children were shown. Ethnic group was not significantly associated with overweight but it was with fatness. The strengths of the remaining significant associations were slight and inconsistent in relation to the dependent variables or the type of analysis. CONCLUSION: Very few variables were associated with measures of overweight and fatness. The only useful factor that was highly associated with all measures of fatness was the parents' BMI. Strategies to prevent childhood obesity should be aimed at the total population and special emphasis should be placed on families in which one or both parents are overweight.