Wheezing in Chinese schoolchildren: disease severity distribution and management practices, a community‐based study in Hong Kong and Guangzhou

Abstract

SummaryBackground Asthma is a common chronic disease and information on its management practices at the community level is helpful in identifying problems and improving asthma care. Objective To assess the severity status and management of the asthma symptom of wheeze of children at the community level in Hong Kong (HK) and Guangzhou (GZ). Methods Cross-sectional study of children aged 10 years using the International Study of Asthma and Allergic disease in Childhood (ISAAC Phase II protocol). Asthma management and lung function were assessed in 178 (98 from HK and 80 from GZ) randomly selected children with wheeze over the past 12 months. Results Eighty-three percent, 11%, 6% and 0% of children suffered from intermittent, mild persistent, moderate persistent and severe persistent asthma, respectively, according to the frequency of their symptoms. Addition of spirometric parameter only changed the asthma severity classification in 2.8% of children. Medications were used by 30.6% and 71.3% of children for wheeze in HK and GZ, respectively. In HK, inhaled b 2 -agonist (73.3% among the drug users) was the commonest medication used followed by inhaled corticosteroid (ICS) (23.3%). In GZ, inhaled b 2 -agonist was used by 75.4% of children, but use of ICS (26.3%), oral b 2 -agonist (26.3%), oral theophylline (45.6%), oral ketotifen (36.8%) and oral steroid (35.1%) were also common. ICS was only used by 11.4% of children with persistent asthma. Ten percent and 18.7% of children in HK and GZ, respectively, had emergency department visits, while 16.3% and 11.6% of children in HK and GZ, respectively, had missed school secondary to asthma over the past 1 year. Conclusions Most children in the community had intermittent asthma and addition of lung function to symptoms did not significantly affect classification of asthma severity. Significant morbidity was seen even in this group of children with mostly intermittent and mild persistent asthma.

Distribution of severity of asthma in childhood

“…Estudos realizados com adultos e crianças em outros países, como China e França, mostram uma frequência de asma leve intermitente variando de 13 a 83%; de asma leve persistente variando de 11 a 27%; 6 a 36% de asmáticos com doença moderada; e 0 a 25% com doença grave 12,13 . Diferentemente do nosso, a maioria desses estudos considerou o critério de função pulmonar associado aos sintomas para classificar a gravidade da asma.…”

“…Nosso estudo mostrou uma frequência de asma leve persistente (40%) mais alta que a encontrada em estudos anteriores [12][13][14] . É provável que esse achado possa ser resultante de uma asma inadequadamente tratada, uma vez que os corticoides inalatórios ainda não são amplamente utilizados em populações de baixa renda no Brasil, tais como a que estudamos em Salvador 15 .…”

“…As perguntas foram elaboradas com base na frequência de sintomas 12 , sem utilizar parâmetros de função pulmonar. A primeira pergunta foi elaborada utilizando o número de episódios no último ano, à semelhança do questionário ISAAC, com a diferença que essa pergunta utilizou outros termos além do chiado (tosse, falta de ar, aperto no peito).…”

Distribuição da gravidade da asma na infância

“…12,13 Unlike the present study, however, most of these investigations considered pulmonary function criteria in combination with symptoms for classification of asthma severity. A large population-based study conducted in 29 countries in the Americas, Europe, and Asia estimated asthma severity on the basis of GINA clinical criteria and found that the frequency of severe asthma varied by region, ranging from 11 to 32%.…”

“…14 Our study showed mild persistent asthma rates (40%) higher than those reported in the past. [12][13][14] This finding is likely due to inadequate treatment, as inhaled corticosteroids have yet to gain wide use in low-income Brazilian populations, such as this sample of children from Salvador. 15 The present study showed a frequency of severe asthma in the affirmative to questions that used terms other than "wheezing" or "whistling" to refer to symptoms, however.…”