Risk factors for asthma in schoolchildren in Southern Brazil

Main Article Content

Arnaldo Carlos Porto Neto
Dirceu Solé
Vânia Hirakata
Luiza Salvador Schmid
Caroline Klock
Sérgio Saldanha Menna Barreto


Asthma, Atopy, Children, Epidemiology, Risk factor, International study of asthma and allergies in childhood (ISAAC)


Background: Due to the high prevalence of recurrent wheezing in the pediatric population, it is important to be able to identify environmental risk factors that may affect the etiology of asthma in several regions.

Objective: to identify possible risk factors associated with asthma in children (9-12 years old) in Passo Fundo, Rio Grande do Sul, Brazil.

Material and Methods: A total of 1003 school-age children were selected for the cross-sectional study by applying a standardized written questionnaire from the International Study of Asthma and Allergy, and a supplementary questionnaire (ISAAC phase II) was added to address personal, family and environmental factors. Of these, 125 children were excluded because they did not accept to do the skin prick test, resulting in a sample of 878.

Results: Independent risk factors associated with asthma were bronchiolitis before two years old [OR] = 3.11; 2.23-4.33, current rhinitis [0R] = 2.07; 1.43-3.0; sharing bedroom during the first year of life [OR] = 2.03; 1.36-3.04; atopy [OR] = 1,82; 1.26-2.50; use of paracetamol more than 12 times a year [OR] = 1.68; 1.20-2.31; use of antibiotics in the first six months of life [OR] = 1,57 1;13-2.17; maternal asthma [OR] = 1.75; 1.05-2.78, having an indoor cat during the first year of life [OR] = 1.73, 1.07-2.78; premature birth [OR] = 1.60,1.02-2.50.

Conclusion: our results show that genetic backgrounds, environmental factors, premature birth, use of antibiotics before six months of life, using paracetamol once per month and the presence of co-morbidities such as rhinitis are the risk factors associated with asthma in Brazilian children.

Abstract 23 | PDF Downloads 31


1. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: Executive summary of the GINA dissemination committee report. Allergy. 2004;59(5):469-78.

2. Anandan C, Nurmatov U, van Schayck OC, Sheikh A. Is the prevalence of asthma declining? Systematic review of epidemiological studies. Allergy. 2010;65(2):152-67.

3. Chong Neto H, Rosario NA, Solé D, Latin American ISAAC Group. Asthma and Rhinitis in South America: how different they are from other parts of world. Allergy Asthma Immunol Res. 2012;4(2):62-7.

4. Solé D, Wandalsen GF, Camelo-Nunes IC, Naspitz CK, ISAAC - Grupo Brasileiro. Prevalence of symptoms of asthma, rhinitis, and atopic eczema among Brazilian children and adolescents identified by the International Study of Asthma and Allergies in Childhood (ISAAC) -Phase 3. J Pediatr (Rio J). 2006;84(5):341-6.

5. Cardoso TA, Roncada C, Silva ERD, Pinto LA, Jones MH, Stein RT, et al. The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system. J Bras Pneumology. 2017;43(3):163-8.

6. Porto Neto AC, D’Agostini RA, Wolff NMM, Klein AP, dos Santos FC, Dullius JL, et al. Prevalence and severity of asthma, rhinitis and atopic eczema in 13- to 14-year-old schoolchildren from Southern Brazil. Allergy Asthma Clin Immunol. 2006;2(1):3-10.

7. ibge.gov.br [Internet] Brasil: Instituto Brasileiro de Geografia e Estatística (IBGE); c2012 [cited 2012 Aug 14]. Available from: http://www.Ibge.gov.br.

8. Solé D, Vanna AT, Yamada E, Rizzo MC, Naspitz CK. International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire: validation of the asthma component among Brazilian children. J Invest Allergol Clin Immunol. 1998;8(6):376-82.

9. Vanna AT, Yamada E, Arruda LK, Naspitz CK, Solé D. International study of asthma and allergies in childhood: validation of the rhinitis symptom questionnaire and prevalence of rhinitis in schoolchildren in São Paulo, Brazil. Pediatr Allergy Immunol. 2001;12(2):95-101.

10. Yamada E, Vanna AT, Naspitz CK, Solé D. International Study of Asthma and Allergies in Childhood (ISAAC): validation of the written questionnaire (eczema component) and prevalence of atopic eczema among Brazilian children. J Invest Allergol Clin Immunol. 2002;12(1):34-41.

11. Weiland SK, Björkstén B, Brunekreef B, Cookson WO, von Mutius E, Strachan DP. Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir J. 2004;24(3):406-12.

12. Osterballe O, Weeke B. A new lancet for skin prick testing. Allergy. 1979;34(4):209-12.

13. Hoffman WA, Pons JA, Janer JL. Sedimentation concentration method in schistosomiasis mansoni. Puerto Rico J Publ Health Trop Med. 1934;9:283-98.

14. Moncayo AL, Vaca M, Oviedo G, Erazo S, Quinzo I, Fiaccone RL, et al. Risk factors for atopic and non-atopic asthma in a rural area of Ecuador. Thorax. 2010;65(5):409-16.

15. Barreto ML, Cunha SS, Fiaccone R, Esquivel R, D Amorin L, Alvim S, et al. Poverty, dirt, infections and non-atopic wheezing in children from a Brazilian urban center. Respir Res. 2010; 11:167.

16. Pitrez PM, Stein RT. Asthma in Latin America: the dawn of a new epidemic. Curr Opin Allergy Clin Immunol. 2008;8(5):378-83.

17. Pereira MU, Sly PD, Pitrez PM, Jones MH, Escouto D, Dias AC, et al. Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children. Eur Respir J. 2007;29(6):1154-60.

18. Pastorino AC, Rimazza RD, Leone C, Castro AP, Solé D, Jacob CM. Risk factors for asthma in adolescents in a large urban region of Brazil. J Asthma. 2006;43(9):695-700.

19. Cooper Philip J. Interactions between helminth parasites and allergy. Curr Opin Allergy Clin Immunol. 2009;9(1):29-37.

20. Rodrigues LC, Newcombe PJ, Cunha SS, Alcantara-Neves NM, Genser B, Cruz AA, et al. Early infection with Trichuris trichiura and allergen skin test reactivity in later childhood. Clin Exp Allergy. 2008;38(11):1769-77.

21. Weinmayr G, Weiland SK, Björkstén B, Brunekreef B, Büchele G, Cookson WO, et al. Atopic sensitization and the International variation of asthma symptoms prevalence in children. Am J Respir Crit Care Med. 2007;176(6):565-74.

22. Chatkin MN, Menezes AMB. Prevalence and risk factors for asthma in schoolchildren in southern Brazil. Pediatric J. 2005;81(5):411-6.

23. Lau S, Illi S, Sommerfeld C, Niggemann B, Bergmann R, von Mutius E, et al. Early exposure to house dust mite and cat allergens and development of childhood asthma: a cohort study. Multicentre Allergy Study Group. Lancet. 2000;356(9239):1392-7.

24. Melén E, Wickman M, Nordvall SL, van Hage-Hamsten M, Lindfors A. Influence of early and current environmental exposure factors on sensitization and outcome of asthma in pre-school children. Allergy. 2001;56(7):646-52.

25. Wegienka G, Johnson CC, Havstad S, Ownby DR, Nicholas C, Zoratti EM. Lifetime dog and cat exposure and dog- and cat-specific sensitization at age 18 years. Clin Exp Allergy. 2011;41(7):979-86.

26. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) uptade. Allergy. 2008;63 Suppl 86:8-160.

27. Solé D, Camelo-Nunes IC, Wandalsen GF, Melo KC, Naspitz CK. Is rhinitis alone or associated with atopic eczema a risk factor for severe asthma in children? Pediatr Allergy Immunol. 2005;16(2):121-5.

28. von Mutius E, Nicolai T, Martinez FD. Prematurity as a risk factor for asthma in preadolescent children. J Pediatr. 1993;123(2):223-9.

29. Brooks AM, Byrd RS, Weitzman M, Auinger P, McBride JT. Impact of low birth weight on early childhood asthma in United States. Arch Pediatr Adolesc Med. 2001;155(3):401-6.

30. Arshad SH. Primary prevention of asthma and allergy. J Allergy Clin Immunol. 2005;116(1):3-14.

31. Friedman NJ, Zeiger RS. The role of breast-feeding in the development of allergies and asthma. J Allergy Clin Immunol. 2005;115(6):1238-48.

32. McBride JT. The association of acetaminophen and asthma: prevalence and severity. Pediatrics. 2011;128(6):1181-5.

33. Farquhar H, Stewart A, Mitchell E, Crane J, Eyers S, Weatherall M, et al. The role of paracetamol in the pathogenesis of asthma. Clin Exp Allergy. 2010;40(1):32-41.

34. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009;181(9):181-90.

35. Kummeling I, Stelma FF, Dagnelie PC, Snijders BE, Penders J, Huber M, et al. Early life exposure to antibiotics and subsequent development of eczema, wheeze, and allergic sensitization in the first years of life: the KOALA Birth Cohort Study. Pediatrics. 2007;119(1):225-31.

36. Ahmadizar F, Vijverberg SJH, Arets HGM, de Boer A, Turner S, Devereux G, et al. Early life antibiotic use and the risk of asthma and asthma exacerbations in children. Pediatr Allergy Immunol. 2017;28(5):430-7.

37. Yamamoto-Hanada K, Yang L, Narita M, Saito H, Ohya Y. Influence of antibiotic use in early childhood on asthma and allergic diseases at age 5. Ann Allergy Asthma Immunol. 2017;119(1):54-8.

38. Strömberg Celind F, Wennergren G, Vasileiadou S, Alm B, Goksör E. Antibiotics in the first week of life were associated with atopic asthma at 12 years of age. Acta Paediatr. 2018;107(10):1798-804.

39. Strachan DP. Family size, infection and atopy: the first decade of the ‘‘hygiene hypothesis’’. Thorax. 2000;55(Supp 1): S2-10.