Factors related to under-diagnosis and under-treatment of childhood asthma in metropolitan France

<p>Abstract</p> <p>Background</p> <p>Under-diagnosis and under-treatment of childhood asthma were investigated in France using data collected during the 6 Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood.</p> <p>Methods</p> <p>7,781 schoolchildren aged between 9 and 10 years underwent a medical visit including skin prick tests to common allergens and exercise test for Exercise-Induced Asthma (EIA) and their parents filled in a standardized questionnaire on asthma, management, treatment and potential risk factors.</p> <p>Results</p> <p>903 children reported asthma (11.6%), 377 without a doctor’s diagnosis. Of the 526 participants with a diagnosis of asthma confirmed by a doctor (58.2%), 353 were treated and 76 were not treated during the year preceding the investigation despite their diagnosis. The information on the treatment was missing for the rest of individuals diagnosed with asthma (n = 97). Having a treatment was significantly associated with severe asthma and with the presence of other respiratory and allergic <it>stigmata</it> (atopic eczema, rhinitis, positive skin allergy tests, and EIA). In addition, having a treatment did not correspond to a good control of the disease. Similarly, children with asthma-like symptoms but without doctor-diagnosed asthma had asthma less well controlled than children with diagnosed asthma. They were also more exposed to passive smoking and traffic but had fewer pets. In contrast, diagnosed children reported more frequently a small weight at birth and a preterm birth.</p> <p>Conclusions</p> <p>In France, childhood asthma is still under-diagnosed and under-treated and environmental factors play a role in these phenomena.</p

Factors related to under-diagnosis and under-treatment of childhood asthma in metropolitan France.

International audienceUNLABELLED: ABSTRACT: BACKGROUND: Under-diagnosis and under-treatment of childhood asthma were investigated in France using data collected during the 6 Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood. METHODS: 7,781 schoolchildren aged between 9 and 10 years underwent a medical visit including skin prick tests to common allergens and exercise test for Exercise-Induced Asthma (EIA) and their parents filled in a standardized questionnaire on asthma, management, treatment and potential risk factors. RESULTS: 903 children reported asthma (11.6%), 377 without a doctor's diagnosis. Of the 526 participants with a diagnosis of asthma confirmed by a doctor (58.2%), 353 were treated and 76 were not treated during the year preceding the investigation despite their diagnosis. The information on the treatment was missing for the rest of individuals diagnosed with asthma (n = 97). Having a treatment was significantly associated with severe asthma and with the presence of other respiratory and allergic stigmata (atopic eczema, rhinitis, positive skin allergy tests, and EIA). In addition, having a treatment did not correspond to a good control of the disease. Similarly, children with asthma-like symptoms but without doctor-diagnosed asthma had asthma less well controlled than children with diagnosed asthma. They were also more exposed to passive smoking and traffic but had fewer pets. In contrast, diagnosed children reported more frequently a small weight at birth and a preterm birth. CONCLUSIONS: In France, childhood asthma is still under-diagnosed and under-treated and environmental factors play a role in these phenomena

Postnatal Environmental Tobacco Smoke Exposure Related to Behavioral Problems in Children

International audienceObjectiveThe purpose of this study was to examine the association between pre and post environmental tobacco smoke (ETS) exposure and behavioral problems in schoolchildren.MethodsIn the cross-sectional 6 cities Study conducted in France, 5221 primary school children were investigated. Pre- and postnatal exposure to secondhand tobacco smoke at home was assessed using a parent questionnaire. Child’s behavioral outcomes (emotional symptoms and conduct problems) were evaluated by the Strengths and Difficulties Questionnaire (SDQ) completed by the parents.ResultsETS exposure during the postnatal period and during both pre- and postnatal periods was associated with behavioral problems in children. Abnormal emotional symptoms (internalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.72 (95% Confidence Interval (CI)= 1.36-2.17), whereas the OR was estimated to be 1.38 (95% CI= 1.12-1.69) in the case of postnatal exposure only. Abnormal conduct problems (externalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.94 (95% CI= 1.51-2.50), whereas the OR was estimated to be 1.47 (95% CI=1.17-1.84) in the case of postnatal exposure only. Effect estimates were adjusted for gender, study center, ethnic origin, child age, low parental education, current physician diagnosed asthma, siblings, preterm birth and single parenthood.ConclusionPostnatal ETS exposure, alone or in association with prenatal exposure, increases the risk of behavioral problems in school-age children

RT-qPCR of selected genes.

<p>Gene expression was determined by RT-qPCR in eosinophils isolated from subjects with asthma and healthy controls. Results were normalized to <i>β-actin</i> and expressed as fold change compared with samples from healthy controls. Results are presented as means and SEM. *p<0.05; **p<0.01 (2-tailed non parametric Mann-Whitney).</p

Circulating eosinophils in asthma differ in their gene expression profile when compared to healthy subjects.

<p>Heat map of hierarchical clustering of the top expressed genes of circulating eosinophils from subjects with asthma (<i>n</i> = 4) <i>vs</i> healthy controls (<i>n</i> = 3). The horizontal dendrogram represents the relationship between asthmatic and healthy subjects. The vertical dendrogram represents the relationship between the expression levels of each gene across all the samples. Over-expressed genes are shown in red and under-expressed genes are depicted in green.</p

Gene ontology categories with an enrichment score p<0.01 and > 10% of gene concordance identified using the DAVID database.

<p>Gene ontology categories with an enrichment score p<0.01 and > 10% of gene concordance identified using the DAVID database.</p

Subject characteristics.

<p>Subject characteristics.</p

Eosinophil isolation by FACS generates high quality RNA.

<p><b>(A)</b> Flow cytometry gating strategy for the identification of eosinophils. Eosinophils were identified among a granulocyte suspension (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141740#sec002" target="_blank">Methods</a>) as a CD16 fluorescence negative cell population <b>(B)</b> Purity of sorted eosinophils as assessed by cytospin preparation was close to 100%. <b>(C)</b> Bioanalyzer RNA profile with RNA integrity number (RIN) of an eosinophil sample. All RNA samples included in the expression analysis had a RIN > 8.</p