Asthma Watch

DECEMBER 01, 2008

Kids' Asthma: Parents' Belief a Factor

Parental beliefs may impact asthma control for 1 in 3 children with the condition, according to telephone interviews and findings reported in the October 2008 issue of Pediatrics.

The study included 754 children aged 2 to 12 years old with persistent asthma, of whom 280 (27%) had "suboptimal control" of their asthma. Nearly half of the children with suboptimal control underutilized controller medication. The researchers found that children were more prone to have troublesome asthma symptoms if their parents had low expectations for how well their asthma could be controlled. The children also were more likely to have poorly controlled symptoms if no set schedule or routine for taking asthma medication were established.

Clinicians recommend asthma control medication daily for children with persistent asthma.

Misconceptions among some parents are that asthma is an intermittent rather than chronic condition, that 2 days of symptoms per week is adequate control, and that medication use is only needed when their child exhibited symptoms or not at all.

Gene Variations, Secondhand Smoke Related to Asthma

Specific genetic variations previously identified as putting individuals at greater risk for asthma appear to only increase the risk of early-onset asthma, which is a disease seen in children aged 4 and younger. The risk is further intensified by exposure to secondhand smoke, again early in life, found a study reported in the October 16, 2008, issue of the New England Journal of Medicine.

In this study, the researchers tested 36 single-nucleotide polymorphisms (SNPs) in the chromosome 17q21 region among 1511 patients from 372 families. The results indicated that 11 SNPs were "significantly associated" with asthma, and 3 of those were "strongly associated" with the condition. In addition, 4 SNPs were strongly associated with early-onset asthma, but had no correlation with lateonset disease.

A stronger association also was detected between 6 variants and asthma in patients exposed to secondhand smoke at a young age. The combination showed an almost 3-fold risk in children under age 4.

Asthma Practice Guidelines Not Followed

The results of a survey found that many inner-city primary care physicians do not follow national practice guidelines published more than a decade ago. The survey included 202 primary care providers from 4 major general medicine practices in and around New York City.

In the survey, the physicians reported their adherence to 5 National Heart, Lung, and Blood Institute guideline components: steroid inhaler use, lung function monitoring, action plan use, allergy testing, and flu vaccination. The findings revealed that self-reported familiarity with specific components was only 56% for steroid inhaler use and 57% for influenza vaccination.

The results were worse for recommendations about lung function monitoring (44%), asthma action plan use (32%), and allergy testing referrals (19%), the researchers recently reported in the Annals of Allergy, Asthma, and Immunology.

The survey also revealed that lack of confidence in the ability to implement a guideline and a lower level of training were strongly linked with nonadherence to steroid use among patients with persistent asthma and with not having an action plan or recommending the flu vaccine.

F A S T   F A C T: In early childhood, asthma is more common in boys than girls.

Diet May Ward Off Kids' Asthma

New research suggests that children who eat a Mediterranean-type diet may not develop asthma and allergic rhinitis (hay fever). A Mediterranean diet is high in vegetables, fruits and nuts, legumes, and fish, and low in dairy products, meat, junk food, and fat.

The study included 1476 children aged 6 to 7 years old. The research analyzed the association between both children's diet and their mother's diet during pregnancy, and the development of asthma and hay fever. Among children, the findings showed greater adherence in the previous year to a Mediterranean diet was associated with less asthma, wheezing, and hay fever. The researchers found no correlation between a Mediterranean diet during pregnancy and lower risk of asthma or hay fever in children, however.