Bronchial asthma in pre-school children living in urban areas of the Altay Krai: a population-based cross-sectional study

The objective of the study was to investigate prevalence, clinical and allergological features, and risk factors of bronchial asthma in pre-school children living in urban areas of Altay Krai. Methods. This was a cross-sectional study involving 3,205 children (age, 3 to 6 years) attending pre-school facilities in 5 cities of the Altay Krai. Asthma symptoms were defined using the ISAAC questionnaire. Asthma was diagnosed by clinicians according to GINA. Results. Prevalence of asthma in urban children aged 3 to 6 years was 5.7%; 62.7% of them were previously diagnosed with asthma. Majority of children (59.4%) had mild asthma. Sensitization was detected in 70.3% of children with asthma, most of them were sensitized to dust mites Dermatophagoides pteronyssinus (63.3%), birch pollen (46.6%), and cat epithelium (31.1%). Risk factors of asthma were family history of allergy [odds ratio (OR) 3.2; 95% confidence interval (CI) 2.2–4.6], male gender (OR 2.2, 95% CI 1.5–2.3), preterm birth (OR 2.1, 95% CI 1.3–3.3), smoking parents (OR 1.6, 95% CI 1.2–2.9), (contact with pets during the first year of life (OR 1.4, 95% CI 1.0–2.0). Conclusion. The prevalence of asthma in urban children aged 3 to 6 years living in urban areas of Altay Krai was 5.7%. Most common sensitizers were house dust mites, birch pollen and cat epithelium. The risk factors of pre-school asthma are family history of allergy, male gender, preterm birth, passive smoking and contact with pets during the first year of life.

1. Pearce N., Aït-Khaled N., Beasley R. et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007; 62 (9): 758–766. DOI: 10.1136/thx.2006.070169.

2. van den Akker-van Marle M.E., Bruil J., Detmar S.B. Evaluation of cost of disease: Assessing the burden of society of asthma in children in the European Union. Allergy. 2005; 60 (2): 140–149. DOI: 10.1111/j.1398-9995.2005.00692.x.

3. Patelarou E., Tzanakis N., Kelly F.J. Exposure to indoor pollutants and wheeze and asthma development during early childhood. Int. J. Environ. Res. Public Health. 2015; 12 (4): 3993–4017. DOI: 10.3390/ijerph120403993.

4. Huang C., Liu W., Hu Y. et al. Updated prevalences of asthma, allergy, and airway symptoms, and a systematic review of trends over time for childhood asthma in Shanghai, China. PLoS One. 2015; 10 (4): e0121577. DOI: 10.1371/journal.pone.0121577.

5. Indinnimeo L., Porta D., Forastiere F. et al. Prevalence and risk factors for atopic disease in a population of preschool children in Rome: Challenges to early intervention. Int. J. Immunopathol. Pharmacol. 2016; 29 (2): 308–319. DOI: 10.1177/0394632016635656.

6. Okada Y., Kumagai H., Morikawa Y., Akasawa A. Epidemiology of pediatric allergic diseases in the Ogasawara Islands. Allergol. Int. 2016; 65 (1): 37–43. DOI: 10.1016/j.alit.2015.06.010.

7. Branco P.T.B.S., Nunes R.A.O., Alvim-Ferraz M.C.M. et al. Asthma prevalence and risk factors in early childhood at Northern Portugal. Rev. Port. Pneumol. 2016; 22 (3): 146–150. DOI: 10.1016/j.rppnen.2015.11.001.

8. Gavrilov S.M. [Standardized epidemiological studies of allergic diseases in children (Adopted International Study of Asthma and Allergy (ISAAC) in Russia). A Handbook]. Moscow; 1998 (in Russian).

9. Shakhova N.V., Kamaltynova E.M., Lobanov Yu.F. et al. [Prevalence and risk factors of asthma-like syndromes and allergic rhinitis in pre-school children]. Pul'monologiya. 2017; 27 (5): 636–642. DOI: 10.18093/0869-0189-2017-27-5-636-642 (in Russian).

10. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. Updated 2018. Available at: https://ginasthma.org/wp-content/uploads/2019/01/2018-GINA.pdf

11. Heinzerling L., Mari A., Bergmann K.C. et al. The skin prick test – European standards. Clin. Transl. Allergy. 2013; 3 (1): 3. DOI: 10.1186/2045-7022-3-3.

12. Bousquet J., Khaltaev N., Cruz A.A. et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63 (Suppl. 86): 8–160. DOI: 10.1111/j.1398-9995.2007.01620.x.

13. Khaitov R.M., Il'ina N.I., eds. [Allergology. Federal Clinical Guidelines]. Moscow: Pharmarus Print Media; 2014 (in Russian).

14. Kim H.Y., Kwon E.B., Baek J.H. et al. Prevalence and comorbidity of allergic diseases in preschool children. Korean. J. Pediatr. 2013; 56 (8): 338–342. DOI: 10.3345/kjp.2013.56.8.338.

15. Cho Y.M., Ryu S.H., Choi M.S. et al. Asthma and allergic diseases in preschool children in Korea: findings from the pilot study of the Korean Surveillance System for Childhood Asthma. J. Asthma. 2014; 51 (4): 373–379. DOI: 10.3109/02770903.2013.876648.

16. Bröms K., Norbäck D., Eriksson M. et al. Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children. BMC Public Health. 2013; 13: 764. DOI: 10.1186/1471-2458-13-764.

17. Tang S.P., Liu Y.L., Wang S.B. et al. Trends in prevalence and risk factors of childhood asthma in Fuzhou, a city in Southeastern China. J. Asthma. 2015; 52 (1): 10–15. DOI: 10.3109/02770903.2014.952434.

18. Dhakar A.S., Kamath R., Pattanshetty S., Mayya S. Prevalence of childhood asthma among 3 – 6 years old children, Udupi Taluk, Karnataka, India. Global J. Med. Pub. Health. 2015; 4 (6): 1–7.

19. Henriksen L., Simonsen J., Haerskjold A. et al. Incidence rates of atopic dermatitis, asthma, and allergic rhinoconjunctivitis in Danish and Swedish children. J. Allergy Clin. Immunol. 2015; 136 (2): 360–366.e2. DOI: 10.1016/j.jaci.2015.02.003.

20. Seneviratne R., Gunawardena N.S. Prevalence and associated factors of wheezing illnesses of children aged three to five years living in under-served settlements of the Colombo Municipal Council in Sri Lanka: a cross-sectional study. BMC Public Health. 2018; 18: 127. DOI: 10.1186/s12889-018-5043-3.

21. Hederos C.A., Hasselgren M., Hedlin G., Bornehag C.G. Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire. Pediatr. Allergy Immunol. 2007; 18 (2): 135–141. DOI: 10.1111/j.1399-3038.2006.00474.x.

22. Önell A., Whiteman A., Nordlund B. et al. Allergy testing in children with persistent asthma: comparison of four diagnostic methods. Allergy. 2017; 72 (4): 590–597. DOI: 10.1111/all.13047.

23. Ozkaya E., Sogut A., Küçükkoç M. et al. Sensitization pattern of inhalant allergens in children with asthma who are living different altitudes in Turkey. Int. J. Biometeorol. 2015; 59 (11): 1685–16890. DOI: 10.1007/s00484-015-0975-0.

24. Duenas-Meza E., Torres-Duque C.A., Correa-Vera E. et al. High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country. Pediatr. Pulmonol. 2018; 53 (10): 1356–1361. DOI: 10.1002/ppul.24079.

25. Bao Y., Chen Z., Liu E. et al. Risk factors in preschool children for predicting asthma during the preschool age and the early school age: a systematic review and meta-analysis. Curr. Allergy Asthma Rep. 2017; 17 (12): 85. DOI: 10.1007/s11882-017-0753-7.

26. Kutzora S., Weber A., Heinze S. et al. Asthmatic/wheezing phenotypes in preschool children: Influential factors, health care and urban-rural differences. Int. J. Hyg. Environ. Health. 2018; 221 (2): 293–299. DOI: 10.1016/j.ijheh.2017.12.001.

27. Liu S.J., Wang T.T., Cao S.Y. et al. [A metaanalysis of risk factors for asthma in Chinese children]. Zhongguo Dang Dai Er Ke Za Zhi. 2018; 20 (3): 218–223 (in Chinese).

28. den Dekker H.T., Sonnenschein-van der Voort A.M.M., de Jongste J.C. et al. Early growth characteristics and the risk of reduced lung function and asthma: a meta-analysis of 25,000 children. J. Allergy Clin. Immunol. 2016; 137 (4): 1026–1035. DOI: 10.1016/j.jaci.2015.08.050.

29. Sonnenschein-van der Voort A.M., Arends L.R., de Jongste J.C. et al. Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children. J. Allergy Clin. Immunol. 2014; 133 (5): 1317–1329. DOI: 10.1016/j.jaci.2013.12.1082.

30. Leung J.Y., Lam H.S., Leung G.M., Schooling C.M. Gestational age, birthweight for gestational age, and childhood hospitalisations for asthma and other wheezing disorders. Paediatr. Perinat. Epidemiol. 2016; 30 (2): 149–159. DOI: 10.1111/ppe.12273.