Factors associated with wheezing among Lebanese children: Results of a cross-sectional study
Main Article Content
Keywords
Wheezing, Humidity, Pesticides, Gastroesophageal reflux disease (GERD), Children
Abstract
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.
References
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8. Jackson DJ, Lemanske RF Jr. The role of respiratory virus infections in childhood asthma inception. Immunol Allergy Clin North Am. 2010;30:513-22, vi.
9. Ng MC, How CH. Recurrent wheeze and cough in young children: is it asthma? Singap Med J. 2014;55:236-41.
10. Hallit S, Raherison C, Malaeb D, Hallit R, Waked M, Kheir N, et al. Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children. Pediatr Neonatol. 2019;60:156-65.
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12. Mallol J, Garcia-Marcos L, Sole D, Brand P, Group ES. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65:1004-9.
13. Bessa OA, Leite AJ, Sole D, Mallol J. Prevalence and risk factors associated with wheezing in the first year of life. J Pediatr (Rio J). 2014;90:190-6.
14. Pacheco-Gonzalez RM, Mallol J, SolD, ´ Brand Paul LP, Perez-Fernandez V, Sanchez-Solis M, et al. Factors associated with the time to the first wheezing episode in infants: a cross-sectional study from the International Study of Wheezing in Infants (EISL). NPJ Prim Care Respir Med. 2016;26:15077.
15. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008;32:1096-110.
16. Jurca M, Ramette A, Dogaru CM, Goutaki M, Spycher BD, Latzin P, et al. Prevalence of cough throughout childhood: a cohort study. PLOS ONE. 2017;12:e0177485.
17. Melen E, Kere J, Pershagen G, Svartengren M, Wickman M. Influence of male sex and parental allergic disease on childhood wheezing: role of interactions. Clin Exp Allergy. 2004;34:839-44.
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19. Rullo VE, Arruda LK, Cardoso MR, Valente V, Zampolo AS, Nóbrega F, et al. Respiratory infection, exposure to mouse allergen and breastfeeding: role in recurrent wheezing in early life. Int Arch Allergy Immunol. 2009;150:172-8.
20. Bozaykut A, Paketci A, Sezer RG, Paketci C. Evaluation of risk factors for recurrent wheezing episodes. J Clin Med Res. 2013;5:395-400.
21. Rodriguez A, Vaca M, Oviedo G, Erazo S, Chico ME, Teles C, et al. Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador. Thorax. 2011;66:1043-50.
22. Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy. 2008;2:1-7.
23. Koopman LP, Brunekreef B, de Jongste JC, Neijens HJ. Definition of respiratory symptoms and disease in early childhood in large prospective birth cohort studies that predict the development of asthma. Pediatr Allergy Immunol. 2001;12:118-24.
24. Waked M, Salameh P. Asthma, allergic rhinitis and eczema in 13-14-year-old schoolchildren across Lebanon. J Med Liban. 2006;54:181-90.
25. Waked M, Salameh P. Asthma, allergic rhinitis and eczema in 5-12-year-old school children across Lebanon. Public Health. 2008;122:965-73.
26. Hallit S, Assi TB, Hallit R, Salameh P. Allergic diseases, smoking, and environmental exposure among university students in Lebanon. J Asthma. 2018;55:35-42.
27. Hallit S, Raherison C, Abou Abdallah R, Hallit R, Salameh P. Correlation of types of food and asthma diagnosis in childhood: a case-control study. J Asthma. 2018;55:966-74.
28. Hallit S, Raherison C, Malaeb D, Hallit R, Kheir N, Salameh P, et al. Risk factors scale: a new model to screen for the risk of asthma, allergic rhinitis and atopic dermatitis in children. Med Princ Pract. 2018;27:472-80.
29. Hallit S, Raherison C, Waked M, Hallit R, Layoun N, Salameh P. Validation of the mini pediatric asthma quality of life questionnaire and identification of risk factors affecting quality of life among Lebanese children. J Asthma. 2019;56:200-10.
30. Hallit S, Raherison C, Waked M, Salameh P. Association between caregiver exposure to toxics during pregnancy and childhood-onset asthma: a case-control study. Iran J Allergy Asthma Immunol. 2017;16:488-500.
31. Hallit S, Raherison C, Waked M, Salameh P. Validation of asthma control questionnaire and risk factors affecting uncontrolled asthma among the Lebanese children’s population. Respir Med. 2017;122:51-7.
32. Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: a pilot study. J Epidemiol Glob Health. 2017;7:147-54.
33. Malaeb D, Hallit S, Sacre H, Malaeb B, Hallit R, Salameh P. Diet and asthma in Lebanese schoolchildren: a cross-sectional study.
Pediatr Pulmonol. 2019;54:688-97.
34. Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978;118 Pt 2: 1-120.
35. Asher MI, Weiland SK. The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steering Committee. Clin Exp Allergy. 1998;28 Suppl. 5:52-66 [discussion 90-51].
36. CDC. Child development: preschooler (3-5 years old) | CDC [Internet]. Centers for Disease Control and Prevention; 2019. Available from: https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html [cited 03.02.20].
37. Salameh PR, Baldi I, Brochard P, Raherison C, Abi Saleh B, Salamon R. Respiratory symptoms in children and exposure to pesticides. Eur Respir J. 2003;22:507-12.
38. Xu X, Nembhard WN, Kan H, Becker A, Talbott EO. Residential pesticide use is associated with children’s respiratory symptoms. J Occup Environ Med. 2012;54:1281-7.
39. Garcia-Marcos L, Batlles-Garrido J, Blanco-Quiros A, GarcíaHernández G, Guillén-Grima F, González-Díaz C, et al. Influence of two different geo-climatic zones on the prevalence and time trends of asthma symptoms among Spanish adolescents and schoolchildren. Int J Biometeorol. 2009;53:53-60.
40. Huang C, Wang X, Liu W, Cai J, Shen L, Zou Z, et al. Household indoor air quality and its associations with childhood asthma in Shanghai, China: on-site inspected methods and preliminary results. Environ Res. 2016;151:154-67.
41. Kurt E, Metintas S, Basyigit I, Bulut I, Coskun E, Dabak S, et al. Prevalence and risk factors of allergies in Turkey: results of a multicentric cross-sectional study in children. Pediatr Allergy Immunol. 2007;18:566-74.
42. Hersoug LG. Viruses as the causative agent related to ‘dampness’ and the missing link between allergen exposure and onset of allergic disease. Indoor Air. 2005;15:363-6.
43. Thakkar K, Boatright RO, Gilger MA, El-Serag HB. Gastroesophageal reflux and asthma in children: a systematic review. Pediatrics. 2010;125:e925-30.
44. Matricardi PM, Illi S, Gruber C, Keil T, Nickel R, Wahn U, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J. 2008;32:585-92.
45. Grad R, Morgan WJ. Long-term outcomes of early-onset wheeze and asthma. J Allergy Clin Immunol. 2012;130:299-307.
46. Savenije OE, Kerkhof M, Koppelman GH, Postma DS. Predicting who will have asthma at school age among preschool children. J Allergy Clin Immunol. 2012;130:325-31.
47. Holt PG, Strickland DH, Sly PD. Virus infection and allergy in the development of asthma: what is the connection? Curr Opin Allergy Clin Immunol. 2012;12:151-7.
2. Ma H, Li Y, Tang L, Peng X, Jiang L, Wan J, et al. Impact of childhood wheezing on lung function in adulthood: A meta-analysis. PLoS ONE. 2018;13:e0192390.
3. Devulapalli CS, Carlsen KC, Haland G, Munthe-Kaas MC, Pettersen M, Mowinckel P, et al. Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age. Thorax. 2008;63:8-13.
4. Hallit S, Leynaert B, Delmas MC, Rocchi S, De Blic J, Marguet C, et al. Wheezing phenotypes and risk factors in early life: The ELFE cohort. PLOS ONE. 2018;13:e0196711.
5. Bacharier LB, Phillips BR, Bloomberg GR, Zeiger RS, Paul IM, Krawiec M, et al. Severe intermittent wheezing in preschool children: a distinct phenotype. J Allergy Clin Immunol. 2007;119:604-10.
6. de Jong BM, van der Ent CK, van Putte Katier N, van der Zalm MM, Verheij TJ, Kimpen JL, et al. Determinants of health care utilization for respiratory symptoms in the first year of life. Med Care. 2007;45:746-52.
7. Ray CG, Minnich LL, Holberg CJ, Shehab ZM, Wright AL, Barton LL, et al. Respiratory syncytial virus-associated lower respiratory illnesses: possible influence of other agents. The Group Health Medical Associates. Pediatr Infect Dis J. 1993;12:15-9.
8. Jackson DJ, Lemanske RF Jr. The role of respiratory virus infections in childhood asthma inception. Immunol Allergy Clin North Am. 2010;30:513-22, vi.
9. Ng MC, How CH. Recurrent wheeze and cough in young children: is it asthma? Singap Med J. 2014;55:236-41.
10. Hallit S, Raherison C, Malaeb D, Hallit R, Waked M, Kheir N, et al. Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children. Pediatr Neonatol. 2019;60:156-65.
11. Garcia-Marcos L, Mallol J, Sole D, Brand PL, Group ES. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol. 2010;21:878-88.
12. Mallol J, Garcia-Marcos L, Sole D, Brand P, Group ES. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65:1004-9.
13. Bessa OA, Leite AJ, Sole D, Mallol J. Prevalence and risk factors associated with wheezing in the first year of life. J Pediatr (Rio J). 2014;90:190-6.
14. Pacheco-Gonzalez RM, Mallol J, SolD, ´ Brand Paul LP, Perez-Fernandez V, Sanchez-Solis M, et al. Factors associated with the time to the first wheezing episode in infants: a cross-sectional study from the International Study of Wheezing in Infants (EISL). NPJ Prim Care Respir Med. 2016;26:15077.
15. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008;32:1096-110.
16. Jurca M, Ramette A, Dogaru CM, Goutaki M, Spycher BD, Latzin P, et al. Prevalence of cough throughout childhood: a cohort study. PLOS ONE. 2017;12:e0177485.
17. Melen E, Kere J, Pershagen G, Svartengren M, Wickman M. Influence of male sex and parental allergic disease on childhood wheezing: role of interactions. Clin Exp Allergy. 2004;34:839-44.
18. Murray CS, Poletti G, Kebadze T, Morris J, Woodcock A, Johnston SL, et al. Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax. 2006;61:376-82.
19. Rullo VE, Arruda LK, Cardoso MR, Valente V, Zampolo AS, Nóbrega F, et al. Respiratory infection, exposure to mouse allergen and breastfeeding: role in recurrent wheezing in early life. Int Arch Allergy Immunol. 2009;150:172-8.
20. Bozaykut A, Paketci A, Sezer RG, Paketci C. Evaluation of risk factors for recurrent wheezing episodes. J Clin Med Res. 2013;5:395-400.
21. Rodriguez A, Vaca M, Oviedo G, Erazo S, Chico ME, Teles C, et al. Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador. Thorax. 2011;66:1043-50.
22. Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy. 2008;2:1-7.
23. Koopman LP, Brunekreef B, de Jongste JC, Neijens HJ. Definition of respiratory symptoms and disease in early childhood in large prospective birth cohort studies that predict the development of asthma. Pediatr Allergy Immunol. 2001;12:118-24.
24. Waked M, Salameh P. Asthma, allergic rhinitis and eczema in 13-14-year-old schoolchildren across Lebanon. J Med Liban. 2006;54:181-90.
25. Waked M, Salameh P. Asthma, allergic rhinitis and eczema in 5-12-year-old school children across Lebanon. Public Health. 2008;122:965-73.
26. Hallit S, Assi TB, Hallit R, Salameh P. Allergic diseases, smoking, and environmental exposure among university students in Lebanon. J Asthma. 2018;55:35-42.
27. Hallit S, Raherison C, Abou Abdallah R, Hallit R, Salameh P. Correlation of types of food and asthma diagnosis in childhood: a case-control study. J Asthma. 2018;55:966-74.
28. Hallit S, Raherison C, Malaeb D, Hallit R, Kheir N, Salameh P, et al. Risk factors scale: a new model to screen for the risk of asthma, allergic rhinitis and atopic dermatitis in children. Med Princ Pract. 2018;27:472-80.
29. Hallit S, Raherison C, Waked M, Hallit R, Layoun N, Salameh P. Validation of the mini pediatric asthma quality of life questionnaire and identification of risk factors affecting quality of life among Lebanese children. J Asthma. 2019;56:200-10.
30. Hallit S, Raherison C, Waked M, Salameh P. Association between caregiver exposure to toxics during pregnancy and childhood-onset asthma: a case-control study. Iran J Allergy Asthma Immunol. 2017;16:488-500.
31. Hallit S, Raherison C, Waked M, Salameh P. Validation of asthma control questionnaire and risk factors affecting uncontrolled asthma among the Lebanese children’s population. Respir Med. 2017;122:51-7.
32. Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: a pilot study. J Epidemiol Glob Health. 2017;7:147-54.
33. Malaeb D, Hallit S, Sacre H, Malaeb B, Hallit R, Salameh P. Diet and asthma in Lebanese schoolchildren: a cross-sectional study.
Pediatr Pulmonol. 2019;54:688-97.
34. Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978;118 Pt 2: 1-120.
35. Asher MI, Weiland SK. The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steering Committee. Clin Exp Allergy. 1998;28 Suppl. 5:52-66 [discussion 90-51].
36. CDC. Child development: preschooler (3-5 years old) | CDC [Internet]. Centers for Disease Control and Prevention; 2019. Available from: https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html [cited 03.02.20].
37. Salameh PR, Baldi I, Brochard P, Raherison C, Abi Saleh B, Salamon R. Respiratory symptoms in children and exposure to pesticides. Eur Respir J. 2003;22:507-12.
38. Xu X, Nembhard WN, Kan H, Becker A, Talbott EO. Residential pesticide use is associated with children’s respiratory symptoms. J Occup Environ Med. 2012;54:1281-7.
39. Garcia-Marcos L, Batlles-Garrido J, Blanco-Quiros A, GarcíaHernández G, Guillén-Grima F, González-Díaz C, et al. Influence of two different geo-climatic zones on the prevalence and time trends of asthma symptoms among Spanish adolescents and schoolchildren. Int J Biometeorol. 2009;53:53-60.
40. Huang C, Wang X, Liu W, Cai J, Shen L, Zou Z, et al. Household indoor air quality and its associations with childhood asthma in Shanghai, China: on-site inspected methods and preliminary results. Environ Res. 2016;151:154-67.
41. Kurt E, Metintas S, Basyigit I, Bulut I, Coskun E, Dabak S, et al. Prevalence and risk factors of allergies in Turkey: results of a multicentric cross-sectional study in children. Pediatr Allergy Immunol. 2007;18:566-74.
42. Hersoug LG. Viruses as the causative agent related to ‘dampness’ and the missing link between allergen exposure and onset of allergic disease. Indoor Air. 2005;15:363-6.
43. Thakkar K, Boatright RO, Gilger MA, El-Serag HB. Gastroesophageal reflux and asthma in children: a systematic review. Pediatrics. 2010;125:e925-30.
44. Matricardi PM, Illi S, Gruber C, Keil T, Nickel R, Wahn U, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J. 2008;32:585-92.
45. Grad R, Morgan WJ. Long-term outcomes of early-onset wheeze and asthma. J Allergy Clin Immunol. 2012;130:299-307.
46. Savenije OE, Kerkhof M, Koppelman GH, Postma DS. Predicting who will have asthma at school age among preschool children. J Allergy Clin Immunol. 2012;130:325-31.
47. Holt PG, Strickland DH, Sly PD. Virus infection and allergy in the development of asthma: what is the connection? Curr Opin Allergy Clin Immunol. 2012;12:151-7.
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Dec 15, 2020
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Malaeb, D., Hallit, S., Sacre, H., Hallit, R., & Salameh, P. (2020). Factors associated with wheezing among Lebanese children: Results of a cross-sectional study. Allergologia Et Immunopathologia, 48(6), 523-529. https://all-imm.com/index.php/aei/article/view/117
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How to Cite
Malaeb, D., Hallit, S., Sacre, H., Hallit, R., & Salameh, P. (2020). Factors associated with wheezing among Lebanese children: Results of a cross-sectional study. Allergologia Et Immunopathologia, 48(6), 523-529. https://all-imm.com/index.php/aei/article/view/117