Prevalence of asthma at school age: a clinical population‐based study in eastern Finland

Remes, ST; Korppi, M; Remes, Kyllikki; Pekkanen, Juha

doi:10.1111/j.1651-2227.1996.tb13891.x

Cited by 61 publications

(69 citation statements)

References 18 publications

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“…Recently, a prevalence of 4.4% of doctor-diagnosed asthma was reported among children aged 7-12 yrs in Kuopio, East Finland [6,19], which is consistent with the present results. In Turku, a prevalence of 2.5% of doctor-diagnosed asthma was recently reported among adolescents [16]; which was less than half of that in the present study (7%).…”

Section: Discussionsupporting

confidence: 93%

“…In Finland, the prevalence of childhood asthma has been reported to be lower than in many European countries, and in East Finland lower than in other parts of the country [5]. These variations may be due to true differences in prevalence, but may also be due to differences in the diagnostic criteria and study methods used.Few surveys have included tests for bronchial hyperresponsiveness or clinical examinations, due to their high cost [6][7][8]. Thus, symptom questionnaires have been the principal instrument for measuring asthma prevalence in community surveys [9].…”

mentioning

confidence: 99%

“…Few surveys have included tests for bronchial hyperresponsiveness or clinical examinations, due to their high cost [6][7][8]. Thus, symptom questionnaires have been the principal instrument for measuring asthma prevalence in community surveys [9].…”

mentioning

confidence: 99%

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Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland

Pekkanen¹,

Remes²,

Husman³

et al. 1997

Eur Respir J

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The aim of this study was to determine whether there are regional differences in the prevalence of childhood asthma in Finland. A secondary objective was to assess the concordance between a written and a video questionnaire on asthma symptoms.In 1994-1995, the self-reported prevalence of asthma symptoms in four regions of Finland was studied among 11,607 schoolchildren aged 13-14 yrs, as part of the International Study of Asthma and Allergies in Childhood (ISAAC). The ISAAC written and video (AVQ 3,0) questionnaires were administered in the school settting.The prevalences of any wheezing during the previous 12 months in the ISAAC video questionnaire were 10% in East Finland (Kuopio County, n=2,821), 12% in South Finland (Helsinki area, n=2,771), 12% in Southwest Finland (Turku and Pori County, n=2,983), and 11% in North Finland (Lapland, n=3,032). The prevalences in the ISAAC written questionnaire were 13, 20, 15, and 16%, respectively. The surveys were performed during winter, except in Helsinki where the survey was carried out mainly during the spring pollen season. During autumn, the prevalence in the written questionnaire in Helsinki was 16%. In multivariate analysis, boys had a lower prevalence than girls, and smokers a threefold higher prevalence than nonsmokers.In conclusion, the prevalence of childhood asthma is lower in Finland than in other European countries, and may be even lower in the eastern part of the country. In contrast to the results from some other European countries, prevalences were lower in the video than in the written questionnaire, which suggests that translating the word "wheezing" into other languages, including Finnish, may produce results that cannot be compared. The strong association of smoking with wheeze both in the video and written questionnaires should be considered in further analysis of the ISAAC study. Eur Respir J 1997; 10: 1787-1794 It has been suggested that the incidence and prevalence of asthma among children is increasing in many countries [1][2][3] including Finland [4]. In Finland, the prevalence of childhood asthma has been reported to be lower than in many European countries, and in East Finland lower than in other parts of the country [5]. These variations may be due to true differences in prevalence, but may also be due to differences in the diagnostic criteria and study methods used.Few surveys have included tests for bronchial hyperresponsiveness or clinical examinations, due to their high cost [6][7][8]. Thus, symptom questionnaires have been the principal instrument for measuring asthma prevalence in community surveys [9]. However, differences in wording of questionnaires and problems with translation hamper comparisons between, and sometimes also within, countries. To address these problems, a video questionnaire on clinical signs and symptoms of asthma has recently been developed and also validated [10] for use in the International Study of Asthma and Allergies in Childhood (ISAAC) [11].The aim of the present study was to evaluate regional diff...

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

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Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland

Pekkanen¹,

Remes²,

Husman³

et al. 1997

Eur Respir J

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“…In the Finnish Birth Cohort study, designed to detect the association between asthma and mode of delivery, the incidence of asthma was comparable to that of earlier reports in Finland (33) and elsewhere (34,35). These results again showed that children born by caesarean section had more asthma and positive skin prick tests than those born by normal vaginal delivery.…”

Section: Discussionsupporting

confidence: 74%

Mode of Delivery and Asthma – Is There a Connection?

Kero

Gissler

Grönlund³

et al. 2002

Pediatr Res

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Genetic factors cannot explain the recent rapid increase in the incidence of atopic diseases. The phenomenon has been explained by environmental factors, and there are data for and against the hypothesis that a decline in the pressure of microbial stimulation early in life could be behind the allergy epidemic. Changes have also occurred in maternity care, among them a rise in the caesarean section rate, which could diminish initial microbial exposure and thereby alter T helper 1 cell/T helper-2 cell development and affect the risk of developing atopy. In this study, we sought to establish whether mode of delivery does influence the development of atopic asthma. Finnish 1987 Medical Birth Register (n ϭ 59,927 live births) information was linked between several national health registers to obtain information on asthma and mode of delivery in children registered. The data were adjusted for maternal age, previous deliveries, child's sex, and birth size. Atopy was evaluated in the second study (Turku Birth Cohort), which involved 219 children born by vaginal delivery (n ϭ 106) or caesarean section (n ϭ 113); history of atopic symptoms was established by questionnaire and a clinical examination was conducted, including skin prick testing and determination of total and allergen-specific IgE in serum.The register study showed the cumulative incidence of asthma at the age of seven to be significantly higher in children born by caesarean section (4.2%) than in those vaginally delivered (3.3%), the adjusted odds ratio (OR) for confounding variables being 1.21 (1.08 -1.36), p Ͻ 0.01. In the second study, significantly more positive allergy tests were reported in questionnaires in the caesarean (22%) than in the vaginal delivery group (11%), OR 2.22 (1.06 -4.64), p Ͻ 0.01, and a trend toward more positive skin prick reactions was documented at clinical examination; 41% versus 29%, OR 1.31 (0.65-2.65), p ϭ 0.11. In conclusion, these results suggest that caesarean section delivery may be associated with an increased prevalence of atopic asthma. During the past two decades the incidence of asthma and other atopic diseases has increased in industrialized countries (1-7). Notwithstanding the marked hereditary element in atopy, this rapid increase may well be attributable to changes in environmental factors, and in this context it is of note that the rate of caesarean section deliveries has more than doubled during the past 20 y and this trend seems to continue (8 -10).The question addressed here was, whether the mode of delivery could be one influencing factor in development of asthma and atopy?Hypothesis for the study came from the findings that caesarean section deliveries interfere with a wide range of physiologic and immunologic factors: establishment of normal intestinal microflora is delayed (11,12), number of fetal neutrophils and natural killer cells is decreased (13,14) and activity of phagocytic function is increased, and these modifications may exert their effects beyond the immediate postnatal period (15). For the ris...

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“…11 Asthma was considered to be present when 1) the patient was on continuous maintenance medication for asthma or when 2) she or he had had repeated (Ն2) episodes of wheezing and/or prolonged (Ն4 weeks) cough apart from infection during the preceding 12 months and the exercise challenge test was regarded as positive. 12 The allergens tested by SPTs were (the outdoor allergens) birch, common alder, timothy grass, meadow grass, and mugwort pollens and spores of Cladosporium herbarum; and (the indoor allergens) cat and dog epithelial dander and home dust mites Dermatophagoides pteronyssinus and D farinae. The concentration of a nonstandardized extract of C herbarum spores was 1:20 wt/vol.…”

Section: Methodsmentioning

confidence: 99%

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

Kotaniemi‐Syrjänen¹,

Reijonen²,

Romppanen³

et al. 2003

PEDIATRICS

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ABSTRACT. Objective. To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma.Methods. Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel.Results. Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >0.70 proved to be significant. Inhalant allergen-specific IgE of >0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age.Conclusions. When present in wheezing infants, specific IgE of >0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations. A pproximately 20% of all children experience wheezing in infancy, 1 and these children are at increased risk for asthma in later childhood. On the basis of recent prospective follow-up data, up to 40% of them experience asthma at school age. 2 The majority of children with asthma have clinically evident atopic manifestations in later childhood, although allergies may not be apparent in infancy. 2,3 Total serum immunoglobulin E (IgE), 2 blood eosinophilia, 2 and serum eosinophil cationic protein (ECP) 4 are markers that are often used to determine subclinical atopy and susceptibility to respiratory allergy. However, these markers are nonspecific, and to point out the allergen-specific responses, skin prick tests (SPTs) or radioallergosorbent tests (RAST) thus far have had to be performed. Both of these tests are qualitative, and for technical reasons, only a restricted number of allergens are applicable in SPTs in young children. These tests may also be susceptible to technical errors and variations as a result of either nonstandardized or nonautomated methods. Consequently, new approaches are needed to screen those prone to atopy or allergen-induced asthma among ...

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Prevalence of asthma at school age: a clinical population‐based study in eastern Finland

Cited by 61 publications

References 18 publications

Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland

Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland

Mode of Delivery and Asthma – Is There a Connection?

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

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