Validation of the mini pediatric asthma quality of life questionnaire and identification of risk factors affecting quality of life among Lebanese children

Association of behaviors and asthma control in a sample of Lebanese adolescents with asthma

BACKGROUND

The relationship between behavioral problems and asthma is bidirectional; while the presence of a chronic disease such as asthma might predispose the person to stress, anxiety, and other behavioral issues, behavioral problems might in turn cause uncontrolled asthma through nonadherence to asthma management strategies. In Lebanon, behavioral problems and uncontrolled asthma could be of significant concern for adolescents. Consequently, we found it necessary to evaluate association between behavioral problems and uncontrolled asthma in a sample of Lebanese adolescents.

METHODS

Data for this cross-sectional study were collected using the snowball sampling technique in July 2023. The questionnaire was developed with Google Forms and distributed to participants via social media platforms and messaging applications. The Asthma Control Test (ACT) was used to check for uncontrolled asthma, and the Youth Self-Report (YSR) scale was used to assess behavioral problems. It yields nine subscales (anxious-depressed, withdrawn-depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score.

RESULTS

When taking each behavior score as an independent variable, older age was associated with lower ACT scores (more controlled asthma); F(15, 186) = 3.66, P = 0.014, and 95% Confidence Interval (CI) [-0.85, -0.10]. Living in a rural area, compared to urban was associated with higher ACT scores, P = 0.018, and 95% Confidence Interval (CI) [0.28, 2.94]. The intake of the COVID-19 vaccine, P = 0.003 and 95% CI [0.73, 3.55]; waterpipe smoking, P = 0.017 and 95% CI [0.38, 3.85]; and having more somatic complaints, P = 0.005 and 95% CI [0.04, 0.25], also were significantly associated with higher ACT scores (more uncontrolled asthma). When taking the total behavior score as an independent variable, higher YSR scores were associated with higher ACT scores (more uncontrolled asthma), F(10, 191) = 4.30, P = 0.038, and 95% CI [0.003, 0.10].

CONCLUSION

Our findings support the inclusion of mental health treatments for better asthma control and point to a link between behavioral issues and uncontrolled asthma. In a developing nation without a clear established strategy for asthma prevention, the findings of this study could help develop potentially beneficial public health treatments.

Improvement of quality of life in a family of a child with asthma after using the Written Asthma Action Plan (WAAP)

Background

Asthma is a common childhood disease that leads to impairment of quality of life (QOL) of both the children affected by the disease and their caregivers. Management of asthma includes pharmacotherapy along with education about asthma and its self-management, which is most often given verbally. There is limited evidence regarding the benefits of using a written asthma action plan (WAAP) that has been improved using pictorial representation.

Objective

The study aimed to assess the effectiveness of a WAAP in improving the QOL of children with bronchial asthma and also of their caregivers. It also educates the patients and families about various triggers and danger signs of an acute attack of asthma.

Methods

This was an interventional study with the aim of improving the quality of asthma management. Children of age group 7-17 years in whom the diagnosis of asthma was made and those parents and children who could read and answer the questionnaire (mini-PAQLQ and PACQLQ) were included in the study. Subjects were randomized into Case and Control groups. The intervention was to give the randomly selected patients (Case group) an individualized WAAP along with standard asthma care to both groups. Both groups were followed up to assess and record variations in the quality of life.

Results

The P value was highly significant in the following parameters post-intervention: missed doses of controller medication (P value = 0.001), need for rescue medication (<0.001), ACT score (0.001), total PAQLQ (<0.001), and PACQLQ (<0.001) score. Though statistical significance was not established, improvement was also observed in the number of unscheduled OPD visits (P value = 0.082) and hospitalization events (P value = 0.554).

Conclusion

On being provided with the WAAP, the frequency of acute asthma events, treatment compliance, and QOL improved. There was a significant increase in the primary outcomes-PAQLQ and PACQLQ scores. Significant improvement in the secondary outcomes-number of missed school days, missed doses of controller medication, need for rescue medication, and ACT score was also observed.

An Assessment of Quality of Life in Patients With Asthma Through Physical, Emotional, Social, and Occupational Aspects. A Cross-Sectional Study

Background

Asthma is a prevalent hyperactive airway disease with physical and emotional impact. Severe asthma is associated with considerable health-related quality of life (HRQoL). The aim of this study is to assess the quality of life through physical, emotional, social and occupational aspects and evaluate the factors affecting HRQoL in patients with asthma.

Methods

This is a cross-sectional multicenter study conducted on adult asthmatic patients enrolled from community pharmacies across different Lebanese geographic areas.

Results

Having wheezing sometimes and most of the time (Beta = -0.144 and -0.552), experiencing anxiety sometimes and most of the time (Beta = -0.205 and -0.573), encountering sleep problems sometimes and most of the time (Beta = -0.270 and -0.553), having previous chest discomfort sometimes and most of the time (Beta = -0.421 and -0.713), and having depression most of the times (Beta = -0.415) were associated with higher lower quality of life scores. On the other side, holding a secondary level of education was associated with a higher quality of life score (Beta = 0.192).

Conclusion

This study highlights that asthma affects adults' quality of life through social, emotional, physical, and occupational impacts. Improved follow-up and patient education may be essential in the future to stop disease progression and achieve ideal therapeutic outcomes.

Factors associated with wheezing among Lebanese children: Results of a cross-sectional study

BACKGROUND

In Lebanon, asthma is underdiagnosed due to low access to healthcare, particularly in rural areas, although asthma diagnosis in children is based mainly on clinical symptoms. Thus, wheezing might be more suggestive of undiagnosed respiratory diseases including asthma in Lebanese children. This study aimed to determine the factors associated with wheezing in Lebanese children without asthma diagnosis.

METHODS

This cross-sectional study was conducted between December 2015 and April 2016, enrolling a total of 1203 schoolchildren.

RESULTS

Out of 1500 prepared questionnaires, 1380 questionnaires were distributed in schools, and 1203 (87.17%) were collected back from the parents of children aged between 4-17 years old. The sample included 42 (3.5%) [95% CI 0.025-0.045] children with reported chronic wheezing. A multivariable analysis was performed taking the presence versus absence of wheezing in children as the dependent variable. The results showed that spraying pesticides at home (aOR=1.91), presence of humidity at home (aOR=2.21) and child reflux (aOR=2.60) were significantly associated with the presence of wheezing in children.

CONCLUSION

The findings of the study suggest that certain environmental factors, such as pesticides, humidity at home and reflux disease, might be associated with wheezing episodes in children. Those factors can be prevented through raising awareness by health care professionals.

Association of pet-keeping in home with self-reported asthma and asthma-related symptoms in 11611 school children from China

OBJECTIVE

We conducted a cross-sectional study to investigate the associations between domestic pets and respiratory health in children.

METHODS

We randomly recruited 11,611 school children from Zhongshan, a southern city in China. Information about the respiratory symptoms and disease history of the recruited children, the status of domestic pets, and other related risk factors were collected from March to July 2016.

RESULTS

We identified cat-keeping at home increases the risk of persistent cough (OR, 1.77; 95%CI, 1.03-3.05); poultry-keeping at home increases the risk of current asthma (OR, 3.87; 95%CI, 1.08-13.92) and allergic rhinitis (OR, 1.84; 95%CI, 1.01-3.37); sleeping with pets increases the risk of persistent phlegm (OR, 5.04; 95%CI, 1.05-24.28), doctor-diagnosed asthma (OR, 3.35; 95%CI, 1.31-8.57) and current asthma (OR, 4.94; 95%CI, 1.05-23.31) in children.

CONCLUSIONS

Cat-keeping and molds on the wall of the house had the multiplicative and additive interaction in doctor-diagnosed asthma. In conclusion, pet-keeping increased the risk of respiratory symptoms in children.

Aeroallergen sensitization in Lebanese asthmatic children: the results of a cohort national study

Atopic asthma is characterized by the presence of sensitization to common aeroallergens, which tends to have a worse prognosis than non-atopic asthma. The objectives were to determine the prevalence of aeroallergens sensitization in the Lebanese pediatric asthmatic population and determine the relationship between allergens sensitization (indoor and outdoor) and age, area of residence and altitude. A sample, consisting of 919 asthmatic children (aged 1 to 18 years, from 2010 until 2017), underwent skin prick testing (SPT) with 21 common allergens: 5 grasses (cocksfoot, sweet vernal-grass, rye-grass, meadow grass, timothy), Parietaria, olive, Dermatophagoides pteronyssinus and Dermatophagoides farina (DP-DF), dog and cat dander, Alternaria longipens, Aspergillus fumigatus and nidulans, Cupressaceae, pine, German cockroach, and 4 cereals (oat, wheat, barley, maize). Seven hundred fifty-two patients had positive SPT. The distribution of sensitization was as follows: DP-DF 59%; 5 grasses 34%; 4 cereals 33.9%; cat 29.9%; Alternaria 27.9%; Parietaria 23%; dog 21.9%; olive 20.5%; Aspergillus mix 18.6%; Cupressaceae 18.2%; pine 17%; cockroach 15.3%. House dust mites sensitization was frequent at lower altitude (< 900 m) (56.3%) and in the whole country (a median prevalence of 53.05%) except for the Beqaa region (negative HDM in 82.4%). Non-atopic asthma was more frequent in early childhood (40.5% at 1-4 years vs 11.2% at 11-18 years). The sensitization rate increased with age, starting at 5 years. Higher age (aOR = 1.24) and altitude less than 900 m compared with ≥ 900 m (aOR = 2.03) were significantly associated with the presence of aeroallergens in children. House dust mites and grasses are the most common allergens in Lebanese asthmatic children. Non-atopic asthma is more frequent at early age. Lebanese children with asthma showed a polysensitized pattern starting at 5 years.

Factors associated with smoking cessation success in Lebanon

Objective:

The objective is to assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center.

Methods:

A cross-sectional data study, conducted between March 2014 and March 2016 in an outpatient smoking cessation center with 156 enrolled patients. The patient’s nicotine dependence and motivation to quit smoking were evaluated according to the Fagerstrom Test for Nicotine Dependence and Richmond tests respectively.

Results:

The number of packs smoked per year decreased the odds of smoking cessation success (p=0.004, ORa=0.982, CI 0.97-0.994), while the compliance with the offered treatment increased the odds of success by 7.68 times (p<0.001, ORa=7.68, CI 3.438-17.187). Highly dependent and highly motivated smokers had more success in the quitting process compared to those with a lower dependence and motivation respectively.

Conclusion:

Our findings showed that many factors can influence smoking cessation, an experience described as difficult, most significantly the number of packs per year and compliance with the smoking cessation treatment. Moreover, although these outcomes are not representative of the entire Lebanese population, we believe that health authorities could utilize these results when implementing upcoming smoking cessations programs. All attempts at cessation should have a goal of reducing the number of packs smoked per year to improve the chances of ceasing into the future.

The AAA Risk Factors Scale: A New Model to Screen for the Risk of Asthma, Allergic Rhinitis and Atopic Dermatitis in Children

OBJECTIVE

To create an allergic disease risk factors scale score that would screen for the risk assessment of asthma, allergic rhinitis and atopic dermatitis (AD) in children from 3 to 17 years.

METHODS

This case-control study, conducted between December 2015 and April 2016, enrolled 1,274 children. The allergic disease risk factors scale was created by combining environmental, exposure to toxics during pregnancy and breastfeeding and parental history of allergic diseases.

RESULTS

Playing on carpets, male gender, child's respiratory problems or history of eczema before the  age of 2 years, and humidity significantly increased the odds of allergies in the child. Maternal waterpipe smoking, maternal history of rhinitis, history of asthma in the mother or the father, along with the maternal drug intake or alcohol consumption during pregnancy significantly increased the odds of allergies in the child. There was a significant increase in allergy diseases per category of the allergic disease risk factors scale (p < 0.001 for trend). Scores ≤2.60 best represented control individuals, while scores > 5.31 best represented children with allergic diseases.

CONCLUSION

Allergic diseases seem to be linked to several risk factors in our population of school children. Many environmental factors might be incriminated in these allergic diseases.