Format

Send to

Choose Destination
Int J Hyg Environ Health. 2018 Mar;221(2):293-299. doi: 10.1016/j.ijheh.2017.12.001. Epub 2017 Dec 24.

Asthmatic/wheezing phenotypes in preschool children: Influential factors, health care and urban-rural differences.

Author information

1
Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Pfarrstr. 3, 80538 München, Germany. Electronic address: Susanne.Kutzora@lgl.bayern.de.
2
Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Pfarrstr. 3, 80538 München, Germany.
3
Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Pfarrstr. 3, 80538 München, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the University of Munich, Ziemssenstr. 1, 80336 München, Germany.
4
Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleißheim, Germany.
5
Dr. von Haunersches Children's Hospital and Polyclinic, Ludwig-Maximilians-University, München, Germany.
6
Department of Occupational and Environmental Health/Epidemiology, Bavarian Health and Food Safety Authority, Pfarrstr. 3, 80538 München, Germany; Ludwig-Maximilians-Universität München, Geschwister-Scholl-Platz, 80539 München, Germany.

Abstract

BACKGROUND:

Different wheezing and asthmatic phenotypes turned out to indicate differences in etiology, risk factors and health care. We examined influential factors and urban-rural differences for different phenotypes.

METHODS:

Parents of 4732 children filled out a questionnaire concerning children's health and environmental factors administered within the Health Monitoring Units (GME) in a cross-sectional study in Bavaria, Germany (2014/2015). To classify respiratory symptoms, five phenotype groups were built: episodic, unremitting and frequent wheeze, ISAAC (International Study of Asthma and Allergies in Children) - asthma and physician-diagnosed asthma (neither of the groups are mutually exclusive). For each phenotype, health care variables were presented and stratified for residence. Urban-rural differences were tested by Pearson's chi-squared tests. Multivariable logistic regression was performed to analyze associations between influential factors and belonging to a phenotype group, and to compare groups with regard to health care variables as outcome.

RESULTS:

Risk factors for wheezing phenotypes were male gender (OR = 2.02, 95%-CI = [1.65-2.48]), having older siblings (OR = 1.24, 95%-CI = [1.02-1.51]), and preterm delivery (OR = 1.61, 95%-CI = [1.13-2.29]) (ORs for unremitting wheeze). 57% of children with ISAAC asthma and 74% with physician-diagnosed asthma had performed allergy tests. Medication intake among all groups was more frequent in rural areas, and physician's asthma diagnoses were more frequent in urban areas.

CONCLUSIONS:

In accordance with previous research this study confirms that male gender, older siblings and preterm delivery are associated with several wheezing phenotypes. Overall, low numbers of allergy tests among children with physician's diagnoses highlight a discrepancy between common practice and current knowledge and guidelines. Residential differences in health care might encourage further research and interventions strategies.

KEYWORDS:

Allergy test; Asthma; Children; Health care; Urban-rural differences; Wheezing phenotypes

PMID:
29330038
DOI:
10.1016/j.ijheh.2017.12.001
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center