Predictors of asthma control in children from different ethnic origins living in Amsterdam

Abstract

To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient.

Association of the Asthma Control Questionnaire with Exercise-Induced Bronchoconstriction

“…Boys and girls were equally likely to have EIB, but boys reported well-controlled asthma on the ACQ significantly more than girls and had an OR of between 0.46 and 0.48 to have well-controlled asthma. This was also observed in the study by van Dellen et al who analyzed the ACQ in a multiethnic group in Amsterdam and found that the male gender carried an OR of 0.5 for well-controlled asthma (12).…”

“…Before exercise, flow-volume loops were duplicated. After exercise, flow-volume loop measurements were repeated in duplex at 1,3,6,9,12,15,20,25, and 30 minutes. The best values for FEV 1 were used to analyze the expiratory loop, and Zapletal reference values were used to calculate the predicted values (16).…”

“…clinical practice, and surveys in children (10)(11)(12). In the recent update of the global initiative for asthma guidelines (GINA), the ACQ is recommended as a tool to measure asthma control (1).…”

Health-Related Quality of Life in Children with Asthma from Different Ethnic Origins

“…As we previously published, uncontrolled asthma was related with ethnicity. Immigrant children appeared to have poorer levels of asthma control compared to ethnic Dutch children (22).…”

The impact of ethnicity on asthma care

“…This issue may also be compounded by a lack of cultural competence on behalf of providers in cross-cultural consultations, [38][39][40] and an inability to comply with language preferences, 41 which may also contribute to poorer outcomes. 39,42 Beyond cultural competence and language, more complicated issues arise when attempting to translate medical concepts into languages in which there are no equivalent terms; 43 for example, there may be no word or direct translation for "wheeze" in many South Asian languages. 44 This is then both a linguistic and health literacy 40 concern.…”