| Abstract |
Asthma is a multifactorial disease of genetic, immunologic and environmental etiology. Many studies suggest that there has been a true increase in morbidity, despite recent advances in science which have improved our understanding of asthma and our abilities to manage it effectively. Its recent increasing prevalence is attributed to environmental changes, atopy and early childhood sensitization possibly interacting with genetic factors. We were interested in studying the nature of childhood asthma in Crete. We investigated if there is a relationship between atopy, respiratory infections and childhood asthma in Crete. We also evaluated the contribution of a well organized pediatric pulmonary outpatient clinic to the reduction of childhood asthma morbidity in our region. We included in the study a group of 196 randomly selected children aged one to fourteen years with the diagnosis of asthma who had been referred at the Pediatric Pulmonary Outpatient Clinic of the University Hospital of Heraklion, Crete. We first evaluated the presence of atopy by means of high IgE (higher than 150 IU/ml) and of specific sensitization (positive (2) radioallergosorbent test (Rast) for specific IgE antibodies, Pharmacia) to common aeroallergens i.e. dermatophagoides pteronyssinus and dermatophagoides farinae (d1 or d2), parietaria judaika, olive pollen, cat and dog epithelia, pine and fungi. The total IgE value was higher than normal in 56% of children with asthma when respiratory infections had been linked to the exacerbation of their asthma and in 65% of children with asthma and acute asthma exacerbations with other triggers. Specific sensitization to one or more common aeroallergens was found in 56% and 65% respectively. We also evaluated possible differences in atopic markers between asthmatic children in urban and rural areas in Crete. We found more urban (80%) than rural (63%) children having high IgE (p<0.01). More urban (56%) than rural (41%) children were sensitized to one or more common aeroallergens (p<0.01). More urban than rural children were sensitized against house dust mites, house dust and dog allergens while more rural than urban children were sensitized to parietaria judaica. The family history for asthma was similarly positive in urban (62%) and rural (66%) patients. The exposure to passive smoking was also similar between urban (60%) and rural (58%) patients Secondly we investigated if there is a relationship between respiratory infections, atopy and childhood asthma in Crete. Among the 196 with asthma, 139 (71%) had more than one reports of acute exacerbation of asthma disease during an acute respiratory tract infection. We found that children with acute exacerbations of asthma during acute respiratory infections, start having asthma symptoms earlier in their life. Prior to their initial visit to the specialized pediatric pulmonary outpatient clinic all children were receiving inhaled b2 agonists during acute asthma attacks. 74% (146/196) of the asthmatic children were receiving antibiotics with bronchodilators during acute asthma exacerbations, especially during the first year of their life. 34% (66/196) of the asthmatic children had received a short course of oral corticosteroid therapy while only 12% (24/196) had received long-term controller anti-inflammatory medications (cromoglycate or inhaled corticosteroids). We followed-up 118 of these asthmatic children, aged 1-14 years, at a special pediatric pulmonary outpatient clinic (PPOC). We evaluated the total number of hospital admissions due to asthma as well as asthma exacerbations during the 12 months before and 12 months after the regular followup care at the special pediatric pulmonary outpatient clinic. The total annual number of hospital admissions of the 118 children before and after the regular followup was 122 and 19 respectively (reduction of 84%). Similarly, the total number of asthma exacerbations was 771 before and 230 after the one-year follow-up (reduction of 71%). In this study, the observed decreasing trend in hospital admissions due to asthma and emergency room visits in addition to lung function improvement among children, can be attributed to regular follow up care of asthmatic patients in a well organized pediatric pulmonary outpatient clinic (PPOC), where both parents and patients are supervised and supported by health care professionals, well-educated to manage both chronic and acute symptoms of asthma. Prevention and asthma control are dependant on proper diagnosis of asthma, (which children have asthma), detection of asthma triggers and institution of proper medication to control symptoms and chronic lung inflammation. The above require accurate and specialized medical knowledge concerning asthma, proper patient education as well as a high patient-doctor continuity.
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Ειδική μελέτη του παιδικού βρογχικού άσθματος σε παιδιά στην Κρήτη
