Lower prevalence and greater severity of asthma in hot and dry climate☆

Correia, Marco Aurélio de Valois; Sarinho, Emanuel Sávio Cavalcanti; Rizzo, José Angelo; Sarinho, Silvia Wanick

doi:10.1016/j.jped.2016.05.006

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Original articles • J. Pediatr. (Rio J.) 93 (2) • Mar/Apr 2017 • https://doi.org/10.1016/j.jped.2016.05.006 copy

Lower prevalence and greater severity of asthma in hot and dry climate^☆ ☆ Please cite this article as: Correia Junior MA, Sarinho ES, Rizzo JA, Sarinho SW. Lower prevalence and greater severity of asthma in hot and dry climate. J Pediatr (Rio J). 2017;93:148-55.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment.

Methods:

In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mother's education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables.

Results:

A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p < 0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR = 2.65, p < 0.001) and personal diagnosis of allergic rhinitis (PR = 1.96, p < 0.001) and/or atopic dermatitis (PR = 2.18, p < 0.001).

Conclusion:

Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population.

KEYWORDS
Asthma; Risk factors; Allergic rhinitis; Adolescent; Epidemiology; Prevalence

Questions	Gender
	Male (n = 792)	Female (n = 799)	Total (n = 1591)	p-Value^a a Chi-squared test.
Chest wheezing in the last 12 months	85 (10.7%)	137 (17.1%)	222 (14%)	<0.001
Wheezing episodes in the last 12 months
1-3 episodes	60 (7.6%)	104 (13.0%)	164 (10.3%)	<0.001
>4 episodes	10 (1.3%)	24 (3.0%)	34 (2.1%)
Nocturnal awakenings in the last 12 months	30 (3.8%)	69 (8.6%)	99 (6.2%)	<0.001
Difficulty speaking in the last 12 months	63 (8.0%)	102 (12.8%)	165 (10.4%)	0.002
Chest wheezing after physical exercise	123 (15.5%)	157 (19.6%)	280 (17.5%)	0.539
Nocturnal coughing in the last 12 months	34 (4.3%)	33 (4.1%)	67 (4.2%)	0.863
Has ever had asthma in life	120 (15.2%)	164 (20.5%)	284 (17.9%)	0.006
History of asthma in parents	163 (20.6%)	264 (33.0%)	427 (26.8%)	<0.001
Allergic rhinitis	108 (13.7%)	208 (26.0%)	316 (19.9%)	<0.001
Atopic dermatitis	28 (3.5%)	78 (9.8%)	106 (6.7%)	<0.001
Physical activity level
Inactive	315 (40.9%)	369 (46.7%)	684 (43.8)	0.021

	Prevalence of asthma ISAAC questionnaire
	n	%	[95% CI]	p-Value^a a Chi-squared test.
Gender
Male	85	10.7	08.7-13.0	<0.001
Female	137	17.1	14.4-19.9
Family income
Up to two minimum wages	147	13.8	11.8-15.8	0.388
More than two minimum wages	52	15.8	11.9-19.8
Maternal level of schooling
0-9 years of schooling	80	15.8	12.6-18.9	0.726
10-13 years of schooling	72	12.5	09.8-15.3
> 14 years of schooling	44	15.6	11.7-19.9
Smoker in the household
No	194	13.9	12.2-15.7	0.454
Yes	9	18	08.0-30.0
History of asthma in parents
No	105	9.0	07.5-10.6	<0.001
Yes	117	27.4	23.2-31.8
Allergic rhinitis
No	133	10.4	08.7-12.2	<0.001
Yes	89	28.2	23.7-33.5
Atopic dermatitis
No	184	12.4	10.7-13.9	<0.001
Yes	38	35.8	27.4-45.3
Physical activity level
Active	133	15.2	12.8-17.7	0.084
Inactive	83	12.1	09.8-14.8

Variable	Median	Percentile (25%-75%)	p-Value^a a Mann-Whitney test.
Overall absenteeism
With asthma	33	14-54	0.030
Without asthma	23	11-42
Absenteeism in physical education classes
With asthma	1	00-03	0.036
Without asthma	0	00-02
Overall school performance
With asthma	6.2	4.42-7.35	0.198
Without asthma	6.4	4.68-7.26
Performance in physical education classes
With asthma	7.5	6.68-8.50	0.342
Without asthma	7.75	6.62-8.60

Variable	Unadjusted prevalence ratio			Adjusted prevalence ratio
	PR	(95% CI)	p	PR	(95% CI)	p
Gender
Male	1			1
Female	1.60	1.22-2.09	<0.001	1.08	0.80-1.47	0.603
History of asthma in parents
No	1			1
Yes	3.28	2.47-34.34	<0.001	2.65	1.97-3.55	<0.001
Allergic rhinitis
No	1			1
Yes	2.70	2.06-3.53	<0.001	1.96	1.45-2.65	<0.001
Atopic dermatitis
No	1			1
Yes	2.89	2.04-4.10	<0.001	2.18	1.48-3.22	<0.001
Physical activity level
Active	1			1
Inactive	0.80	0.61-1.05	0.084	0.86	0.64-1.15	0.318

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[1] * Corresponding author. E-mail:marcovalois@gmail.com (M.A. Correia Junior).

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Lower prevalence and greater severity of asthma in hot and dry climate☆ ☆ Please cite this article as: Correia Junior MA, Sarinho ES, Rizzo JA, Sarinho SW. Lower prevalence and greater severity of asthma in hot and dry climate. J Pediatr (Rio J). 2017;93:148-55.

Abstract

Objective:

Methods:

Results:

Conclusion:

Lower prevalence and greater severity of asthma in hot and dry climate^☆ ☆ Please cite this article as: Correia Junior MA, Sarinho ES, Rizzo JA, Sarinho SW. Lower prevalence and greater severity of asthma in hot and dry climate. J Pediatr (Rio J). 2017;93:148-55.