The changing picture of childhood asthma

Cesarean section and risk of severe childhood asthma: a population-based cohort study

OBJECTIVE

To explore the possible association between delivery by cesarean section (CS) and later development of asthma.

STUDY DESIGN

A population-based cohort study of 1,756,700 singletons reported to the Medical Birth Registry of Norway between 1967 and 1998, followed up to age 18 years or the year 2002. Exposure was the mode of delivery (spontaneous vaginal, instrumental vaginal, or CS, with planned and emergency CS separately from 1988 onward). Outcome was asthma registered in the National Insurance Scheme, which provides cash benefits to families of children with severe chronic illnesses. We used multivariate Cox proportional hazard models to examine associations between exposure and outcome.

RESULTS

The cumulative incidence of asthma was 4.0/1000. Children delivered by CS had a 52% increased risk of asthma compared with spontaneously vaginally delivered children (adjusted hazard ratio [HR] = 1.52; 95% confidence interval [CI] = 1.42 to 1.62). Between 1988 and 1998, planned and emergency CS was associated with a 42% (HR = 1.42; 95% CI = 1.25 to 1.61) and 59% (HR = 1.59; 95% CI = 1.44 to 1.75) increased risk of asthma, respectively.

CONCLUSION

We found a moderately increased risk of asthma in the children delivered by CS. The possibly stronger association with emergency CS compared with planned CS could be worth pursuing to investigate possible causal mechanisms.

The characteristics of complementary and alternative medicine use by parents of asthmatic children in Southern Israel

AIM

The aim of this study was to estimate the rate and describe the characteristics of complementary and alternative medicine (CAM) use by children with asthma in a paediatric primary care clinic in southern Israel.

METHOD

A cross-sectional study including 252 asthmatic children aged 2-12-years was conducted. Socio-demographic data and asthma history were collected using a telephone questionnaire. Computerized medical records were used to complete the data.

RESULTS

Sixteen percent (95% CI 11.5-20.5) of the asthmatic children participating in this study used CAM; most popular were homeopathy (36.6%) and reflexology (14.6%). According to multivariate model, CAM use was more prevalent in families in which fathers had professional training (OR = 4.9, 95% CI 1.82-13.02, p = 0.002), mothers were employed (OR = 4.1, 95% CI 1.018-16.1, p = 0.047), and origin of maternal grandfathers was European (OR = 4.7, 95% CI 1.86-11.8, p = 0.001). Families who used CAM, also more frequently sought rabbinical advice (OR = 11.9, 95% CI 2.94-47.7, p = 0.001).

CONCLUSIONS

The prevalence of CAM use found in this study is lower than seen in other Western countries. The 'average family' using CAM to treat its asthmatic child includes an educated father, an employed mother and maternal grandfather from Europe, and would more often seek rabbi's advice.