Childhood asthma in New Zealand

doi:10.1016/0007-0971(87)90181-1

British Journal of Diseases of the Chest

Volume 81, 1987, Pages 332-340

https://doi.org/10.1016/0007-0971(87)90181-1 Get rights and content

Abstract

To determine the prevalence and severity of childhood asthma in New Zealand we studied 815 children from a birth cohort by questionnaire, clinical examination and pulmonary physiological measurements at age 9 years. More than 19% of the sample had experienced wheezing in the previous year, and 11% had wheezed in the month before assessment. In all, 220 of 815 children (27.1%) had had wheezing episodes by age 9; in 34 (4.2%) episodes had been of sufficient frequency to warrant regular anti-asthma treatment. Only 32% of all wheezing children were reported by their parents to suffer from asthma, and, in groups matched for frequency of symptoms, treatment given for wheezing was influenced strongly by whether or not the label of ‘asthma’ had been given. The detailed history provided most information useful in diagnosing asthma; clinical examination, peak flow records, spirometry and bronchial provocation testing provided only limited additional information. A wide spectrum of frequency and severity of recurrent wheezing disorders was evident in New Zealand children. Throughout all degrees of severity, prevalence rates appeared higher than those reported in studies from the United Kingdom.

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Cited by (49)

Polygenic risk and the development and course of asthma: An analysis of data from a four-decade longitudinal study
2013, The Lancet Respiratory Medicine
Citation Excerpt :
Family history was summarised as the proportion of family members in the pedigree who had asthma, adjusted for genetic relatedness to the proband (ie, first-degree relatives were counted as 1 and second-degree relatives were counted as 0·5).22 Assessments of asthma phenotypes and definitions of biological variables including atopy, airway hyper-responsiveness, and incompletely reversible airflow obstruction have been described in previous publications from this cohort10,23–33 and are summarised in table 1. We analysed dichotomous outcomes (eg, asthma status) using Poisson regression models to derive relative risks (RRs).
Genome-wide association studies (GWAS) have discovered genetic variants that predispose individuals to asthma. To integrate these new discoveries with emerging models of asthma pathobiology, we aimed to test how genetic discoveries relate to developmental and biological characteristics of asthma.
In this prospective longitudinal study, we investigated a multilocus profile of genetic risk derived from published GWAS of asthma case status. We then tested associations between this genetic risk score and developmental and biological characteristics of asthma in participants enrolled in a population-based long-running birth cohort, the Dunedin Multidisciplinary Health and Development Study (n=1037). We used data on asthma onset, asthma persistence, atopy, airway hyper-responsiveness, incompletely reversible airflow obstruction, and asthma-related school and work absenteeism and hospital admissions obtained during nine prospective assessments spanning the ages of 9 to 38 years. Analyses included cohort members of European descent from whom genetic data had been obtained.
Of the 880 cohort members included in our analysis, those at higher genetic risk developed asthma earlier in life than did those with lower genetic risk (hazard ratio [HR] 1·12, 95% CI 1·01–1·26). Of cohort members with childhood-onset asthma, those with higher genetic risk were more likely to develop life-course-persistent asthma than were those with a lower genetic risk (relative risk [RR] 1·36, 95% CI 1·14–1·63). Participants with asthma at higher genetic risk more often had atopy (RR 1·07, 1·01–1·14), airway hyper-responsiveness (RR 1·16, 1·03–1·32), and incompletely reversible airflow obstruction (RR 1·28, 1·04–1·57) than did those with a lower genetic risk. They were also more likely to miss school or work (incident rate ratio 1·38, 1·02–1·86) and be admitted to hospital (HR 1·38, 1·07–1·79) because of asthma. Genotypic information about asthma risk was independent of and additive to information derived from cohort members' family histories of asthma.
Our findings confirm that GWAS discoveries for asthma are associated with a childhood-onset phenotype. Genetic risk assessments might be able to predict which childhood-onset asthma cases remit and which become life-course-persistent, who might develop impaired lung function, and the burden of asthma in terms of missed school and work and hospital admissions, although these predictions are not sufficiently sensitive or specific to support immediate clinical translation.
US National Institute on Aging and UK Medical Research Council.
Interactions between breast-feeding, specific parental atopy, and sex on development of asthma and atopy
2007, Journal of Allergy and Clinical Immunology
Citation Excerpt :
A positive test was defined as a weal ≥2 mm greater than that resulting from the negative control at 15 minutes. Detailed methods are in previous publications5,8-16,19,20 and this article's Online Repository at www.jacionline.org. In this cohort, although there were no significant sex differences in the prevalence of recurrent wheeze by age 13 years, boys were more likely to have been diagnosed with asthma than girls.16
The influence of breast-feeding on the risk of developing atopy and asthma remains controversial.
To examine asthma and atopy outcomes by sex, reported specific parental history of atopy, and breast-feeding.
In a birth cohort, we examined childhood asthma and atopy (positive skin prick tests) by sex and breast-feeding in relation to maternal and paternal atopy. Interactions were explored in logistic regression models.
For boys, breast-feeding (odds ratio [OR], 1.63; 95% CI, 0.93-2.87; P = .09) and maternal atopy (OR, 1.95; 95% CI, 0.93-4.08; P = .08) were each associated with atopy at age 13 years. Breast-feeding increased the risk for atopy among boys with paternal atopy (OR, 7.39; 95% CI, 2.21-24.66) compared with non–breast-fed boys with paternal atopy, but did not significantly further increase risk among subjects with maternal atopy. For girls, breast-feeding (OR, 0.74; 95% CI, 0.41-1.31) and maternal and paternal atopy were not independent risk factors for atopy at age 13 years. However, breast-feeding increased the risk for atopy in girls with maternal atopy (OR, 3.13; 95% CI, 1.20-8.14) compared with non–breast-fed girls with maternal atopy. There was no such effect among subjects with paternal atopy. Results for the outcome of asthma followed a similar pattern.
The influence of breast-feeding on development of atopy and asthma differs by sex and by maternal and paternal atopy, and is most significant among subjects at lower baseline risk.
Analyses of environmental risk factors for asthma and atopy should be stratified by specific parental atopy and sex.
The natural history of asthma
2006, Journal of Allergy and Clinical Immunology
Citation Excerpt :
The children were seen every 2 years between 3 and 15 years and then at 18, 21, and 26 years. At age 9 years, 27% of all children had a history of at least 1 episode of wheezing, and 4.2% were receiving antiasthma treatment.7 By the age of 26 years, half of the cohort had reported wheezing at 1 or more of these assessment visits.
Asthma begins most often in infants as wheezing with respiratory infections. If these episodes are mild and infrequent, asthma does not usually persist into the school years. However, if they are more frequent and severe, the asthma is likely to persist. After infancy, incidence falls and continues at about 100/100,000 for the rest of the lifespan. Allergic asthma develops most often in the second decade of life and frequently persists into adult years, but young patients with allergic asthma often enjoy a transient or even a permanent remission. More severe disease and continued allergen exposure cause persistence. Some patients with occupational asthma continue to have asthma long after exposure ceases. Asthma beginning after the fourth decade is usually intrinsic and may include the aspirin triad. Its severity tends to increase with time. Many middle-aged and elderly adults have a persistent decline in lung function that is retarded but not completely prevented by aerosol glucocorticoids. This loss of lung function is often the result of coexisting lung diseases, particularly bronchiectasis and COPD. Patients with asthma have the same overall rate and age of death as the general population, but are more likely to die of lung diseases, including cancer.
Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: A longitudinal study
2002, Lancet
Citation Excerpt :
At the assessment at age 7 years, trained interviewers asked whether the child had ever had asthma, wheezing, hayfever, bronchitis, or allergies.16 From age 9 years, a more comprehensive questionnaire was used by an interviewer, who recorded occurrence and frequency of symptoms of wheezing, diagnoses of asthma and hayfever, drugs, clinical characteristics, admissions, and environmental exposures.17,18 At ages 18, 21, and 26 years, participants also completed questions derived from questionnaires from the American Thoracic Society19 and the International Union Against Tuberculosis and Lung Diseases.20
Breastfeeding is widely advocated to reduce risk of atopy and asthma, but the evidence for such an effect is conflicting. We aimed to assess long-term outcomes of asthma and atopy related to breastfeeding in a New Zealand birth cohort.
Our cohort consisted of 1037 of 1139 children born in Dunedin, New Zealand, between April, 1972, and March, 1973, and residing in Otago province at age 3 years. Children were assessed every 2–5 years from ages 9 to 26 years with respiratory questionnaires, pulmonary function, bronchial challenge, and allergy skin tests. History of breastfeeding had been independently recorded in early childhood.
504 (49%) of 1037 eligible children were breastfed (4 weeks or longer) and 533 (51%) were not. More children who were breastfed were atopic at all ages from 13 to 21 years to cats (p=0·0001), house dust mites (p=0·0010), and grass pollen (p<0·0001) than those who were not. More children who were breastfed reported current asthma at each assessment between age 9 (p=0·0008) and 26 years (p=0·0008) than those who were not. Breastfeeding effects were not affected by parental history of hayfever or asthma. Multifactor analysis controlling for socioeconomic status, parental smoking, birth order, and use of sheepskin bedding in infancy, showed odds ratios of 1·94 (95% CI 1·42–2·65, p<0·0001) for any allergen positive at age 13 years, 2·40 (1·36–4·26, p=0·0003) for current asthma at 9 years, and 1·83 (1·35–2·47, p<0·0001) for current asthma at 9–26 years by repeated-measures analysis.
Breastfeeding does not protect children against atopy and asthma and may even increase the risk.
The prevalence of asthma and wheezing illnesses amongst 10-year-old schoolchildren
2002, Respiratory Medicine
Asthma and wheezing illnesses carry a significant burden of disease during childhood. Prevalence studies have the capacity to provide invaluable insights into the nature of these common conditions. As part of the Isle of Wight Whole Population Birth Cohort Study (n=1456) we have examined wheezing and asthma development amongst 10-year- old children. At this age 1373 children completed ISAAC written questionnaires whilst 1043 children performed further testing including skin-prick testing, serum inhalant IgE antibody screening, spirometry and bronchial challenge. At 10-years, prevalence of current wheeze was 18·9%, current asthma (symptomatic bronchial hyper-responsiveness—BHR) 14·4% and currently diagnosed asthma (current wheeze and asthma ever—CDA) 13·0%. Both wheezing and asthma at 10 years were associated with average symptom onset at 3 years of age indicating an early life origin for such conditions. Current wheeze (P=0·011) and CDA (P=0·008) showed significant male predominance. Considerable disease morbidity was identified for these states that tended to be greatest amongst children defined asthmatic rather than simply current wheezers. Wheezing and asthma were significantly associated with both atopy (P<0·001) and allergic co-morbidity. Children with these states, particularly current asthma, also demonstrated impaired lung function (FEV₁,P <0·001 and FEV₁/FVC, P=0·010) and increased BHR (inverse slope,P <0·001). In conclusion, Asthma and wheezing showed substantial prevalence at 10 years of age. Strong associations to male gender, atopy, impaired lung function and BHR were seen for both wheeze and asthma. In regard to prevalence and morbidity characteristics, a questionnaire-based definition of currently diagnosed asthma gave similar results to the use of symptomatic BHR in defining current asthma.
Risk factors for development of bronchial asthma in children in Delhi
1999, Annals of Allergy, Asthma and Immunology
Information on the magnitude of the problem of childhood asthma in India and the factors influencing its occurrence is inadequate.
To measure the prevalence of asthma in schoolchildren in Delhi and study the factors determining its occurrence.
A questionnaire-based study carried out in nine randomly selected schools in Delhi. The age range was 5 to 17 years. The questionnaires were distributed to all the children (n = 21,367) for answering by either parent. The key questions relate to complaints of recurrent wheezing in the past, during the immediate last 1-year, and also wheezing exclusively induced by exercise or colds. In all, 19,456 questionnaires were received back (response rate 91%). Out of these, 18,955 were complete and analyzed.
The prevalence of current asthma was 11.9% while past asthma was reported by 3.4% of children. Exclusive exercise-induced asthma was reported by 2.1% while that associated with colds by 2.4% of children. Boys had a significantly higher prevalence of current asthma as compared with girls (12.8% and 10.7%, respectively). Multiple logistic regression analysis showed that male sex, a positive family history of atopic disorders, and the presence of smokers in the family were significant factors influencing the development of asthma while economic class, air pollution (total suspended particulates), and type of domestic kitchen fuel were not.
The prevalence of current asthma in children in Delhi is 11.9%. Significant risk factors for its development are male sex, a positive family history of atopic disorders, and the presence of smokers in the family.

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^∗: Current address: Respiratory Physician, Wellington Hospital, Wellington, New Zealand.

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Original articleChildhood asthma in New Zealand

Abstract

Lancet

J Allergy

J Allergy Clin Immunol

J Allergy Clin Immunol

Childhood asthma: a psychosomatic disorder?

A national study of asthma in childhood

J Epid Comm Hlth

Prevalence and spectrum of asthma in childhood

Br Med J

The frequency of bronchial asthma in Swedish school children

Acta Paed Scand

The prevalence and incidence of asthma-like symptoms in a general population sample

Am Rev Resp Dis

Prevalence, natural history and relationship of wheezy bronchitis and asthma in children

Original article
Childhood asthma in New Zealand