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STUDII CAZUISTICE

11
FACTORI DE RISC PENTRU ASTMUL
BRONIC LA COPIL (6-18 ANI)
Dr. Oana Lzrescu, Dr. Magdalena M. Florea, Dr. Ema Agarniciuc,
Dr. Ileana Ioniuc, Dr. Monica Alexoae, Prof. Dr. Stela Goia
Clinica II Pediatrie, Universitatea de Medicin i Farmacie Gr.T. Popa, Iai

REZUMAT
Astmul bronic este considerat una dintre din cele mai comune boli cronice ale copilului i reprezint o cauz
important de morbiditate i mortalitate, cu prevalen n cretere, conform estimrilor recente. La acest
aspect contribuie subevaluarea diagnosticului la vrst mic. Studiul i propune evaluarea anamnestic i
prin explorri clinico-paraclinice a incidenei factorilor de risc sugestivi pentru suspiciunea de diagnostic de
astm bronic la copil, la vrsta de 6-18 ani, precum i corelaiile acestora cu gradul de severitate a bolii.
Studiul a utililizat chestionare ce au inclus informaii relevante pentru factorii de risc cunoscui ante i
postnatal precum i cei asociai etapelor de via preadolescent i adolescent. Principalii factori de risc
pentru astmul bronic identificai n studiu (n ordinea frecvenei) au fost: prezena atopiei personale, istoric
de wheezing recurent, sexul masculin, mediul urban, expunerea la aeroalergeni de interior (praf, pr de
animale, mucegai), sensibilizarea alergic la aeroalergeni (n special la acarieni), alimentaia artificial,
prezena atopiei familiale, fumatul pasiv. Polisensibilizarea alergic i expunerea la fumul de igar se
asociaz cu forme mai severe de astm. Comorbiditi alergice au fost prezente n majoritatea cazurilor, cea
mai frecvent fiind rinita alergic (78%).

Cuvinte cheie: astm bronic, copil, factori de risc, atopie

INTRODUCERE MATERIAL I METOD


Astmul bronic (AB) este o afeciune complex Studiul retrospectiv s-a desfurat n Clinica II
ce are la baz interaciunea continu dintre factorii Pediatrie (compartimentul alergologie/imunologie)
genetici i de mediu. Incidena sa n cretere n ulti- a Spitalului de Copii Sf. Maria din Iai, n peri-
mele decade la copiii de vrst colar i aduli, mai oada 2006-2010. Au fost inclui n lotul de studiu
ales n rile dezvoltate (1), este cel mai probabil 100 de copii cu vrste cuprinse ntre 6 i 18 ani,
explicat prin modificri ale factorilor de mediu. diagnosticai cu astm bronic pe trepte diferite de
(2) Diagnosticul astmului este tardiv dup vrsta de severitate (conform programului GINA) i dis-
6 ani, chiar dac mai mult de jumtate din cazuri pensarizai prin plan terapeutic. Datele au fost ob-
debuteaz sub vrsta de 5 ani (3), acesta fiind nesus- inute prin studierea foilor de observaie i ches-
pectat i subdiagnosticat din cauza particularitilor tionarea copiilor i prinilor care au fost informai
i dificultilor diagnostice la aceast vrst. Nume- privind scopul acestui studiu i i-au dat consim-
roase evaluri retrospective pe loturi semnificative mntul. Au rspuns la ntrebri relevante pentru
de copii astmatici peste vrsta de 6 ani s-au finalizat factorii de risc ai astmului bronic. Parametrii ur-
prin obinerea de scoruri pentru recunoaterea i mrii au fost:
tratamentul precoce. anamnestic: date demografice (sex, vrst, me-
diu de provenien: urban/rural), statusul socio-
OBIECTIVE economic, antecedente perinatale (greutate mic
la natere, prematuritate, iminena de natere
Evaluarea incidenei factorilor de risc pentru prematur n timpul sarcinii), alimentaia arti-
astmul bronic la copil (6-18 ani) prin studiul a 100 ficial n perioada de sugar, n primele 4 luni
de copii (6-18 ani), precum i corelaiile acestora dup natere, antecedente personale de atopie,
cu gradul de severitate a bolii. antecedente familiale de astm i atopie, wheezing

Adresa de coresponden:
Dr. Oana Lzrescu, Universitatea de Medicin i Farmacie Gr.T. Popa, Str. Universitii Nr. 16, Iai
e-mail: lazarescuoana@yahoo.com

REVISTA ROMN DE PEDIATRIE VOLUMUL LX, NR. 4, AN 2011 389


390 REVISTA ROMN DE PEDIATRIE VOLUMUL LX, NR. 4, AN 2011

recurent la copilul mic, expunerea la fumatul i stabilirii diagnosticului, expunerea la aero-


pasiv, fumatul activ, prezena polurii aerului alergenii din locuin
din locuine prin emisia de fum i gaze, rezultai aspecte clinice: ncadrarea astmului bronic n
din arderea diverilor combustibili folosii pen- trepte de severitate;
tru gtitul alimentelor i nclzirea locuinei (gaz, aspecte paraclinice: determinarea prin spirome-
lemne, crbuni), vrsta debutului simptomelor trie a funciei pulmonare (spirometrie bazal i
de efort), obiectivarea sensibilizrii la aeroaler-
REZULTATE geni sau alergeni alimentari (demonstrat prin
Tabelul 1. Caracteristici generale teste cutanate alergologice, prezena de Ig E
Total copii specifice serice), prezena altor manifestri aler-
Nr. cazuri 100 % gice i a comorbiditilor (rinit i conjunctivit
Grupe de vrst
6-11 ani 57 57% alergic, dermatit atopic).
peste 12 ani 43 43%
Vrst de debut simptome
0-5 ani 72 72%
6-11 ani 25 25% DISCUII
peste 12 ani 3 3%
Vrst diagnostic Studii epidemiologice longitudinale sugereaz
0-5 ani 35 35% existena precoce a inflamaiei alergice (4) n cile
6-11 ani 51 51% respiratorii cu o frecven de 25% la sugar i 75%
peste 12 ani 14 14%
Wheezing recurent 72 72% pn la 3 ani. Analiza statistic complex a evoluiei
Atopie familial 59 59% simptomelor astmatice i a factorilor de risc la 435
Astm n familie 23 23% de copii cu diagnosticul de AB, precizat la vrsta de
Atopie personal 85 85%
Antecedente perinatale 14 14%
7-8 ani, a permis situarea debutului bolii la 60%
Alimentaie articial 59 59% sub vrsta de 1 an, 20% ntre 1-2 ani, 14% la 2-3 ani
Sex masculin 64 64% i 7% la 3-4 ani. Acelai studiu impune ca factor de
Mediu urban 63 63% risc importani 8 parametri: sex masculin, postmatu-
Mediu social defavorizat 16 16%
Expunere poluani n locuin 15 15% ritatea, educaia prinilor, AB la prini, frecvena
Expunere fum de igar 52 52% episoadelor de wheezing, wheezing asociat infec-
Manifestri alergice iilor virale, infecii respiratorii recidivante, eczema
rinit alergic 78 78%
dermatit atopic (0-5 ani) 39 39% (4). Alte studii raporteaz debutul astmului bronic
conjunctivit alergic 29 29% sub vrsta de 5 ani n 80% cazuri. (5) Din datele
alergii alimentare 25 25% obinute (Tabelul 1) debutul AB sub 5 ani poate fi
suspectat la 72% de cazuri, ns precizarea a fost
Tabelul 2. Comorbiditi alergice, expuneri factori de risc
pentru AB i sensibilizri alergice tardiv dup vrsta de 6 ani la 51% din cazuri. Par-
Total copii ticularitile clinice i dificultile de explorare pot
Nr. cazuri 100 % fi incriminate n subestimarea AB la vrst mic.
Comorbiditi asociate Ca i n alte studii (6), se confirm o frecven mai
rinit alergic 78 78%
rinosinuzit 9 9% mare a AB la biei (64%) i a copiilor din mediul
conjunctivit alergic 29 29% urban (64%) (Tabelul 1). Expunerea la poluani i
alergii alimentare 25 25% stilul de via diferit al acestor copii, existena unor
expunere alergeni interior
acarieni 63 63%
factori protectori n mediul rural (expunerea la en-
animale 27 27% dotoxine componente ale membranei bacteriilor
mucegai 25 25% gram negative) stimuleaz L Th1 i inhib L Th2 cu
gndaci de cas 3 3% rol n rspunsul imun atopic. (7) Mediul social de-
sensibilizare alergic
acarieni 63 63% favorizat (16% din lot) amplific riscul de astm i
alimente 10 10% scade accesul la ngrijiri medicale adecvate. (8)
mucegai 21 21%
Alimentaia artificial n perioada de sugar
Tabelul 3. Frecvena mono i polisensibilizrilor n treptele
de severitate AB cunoscut i ca factor de risc (9,10)
Trepte de severitate astm S-a nregistrat la 59% dintre copiii astmatici
Sensibilizare Treapta I Treapta II Treapta III Treapta IV
(Tabelul 1). Alimentaia cu preparate hipoalergenice
alergic Nr. cazuri Nr. cazuri Nr. cazuri Nr. cazuri
mono- la copiii cu risc a avut o frecven foarte redus,
7 45 10 1 dei 39% prezentau dermatit atopic sub vrsta de
sensibilizare
poli- 5 ani i 59% atopie familial (Tabelul 1). Msurile
19 14 4
sensibilizare actuale de reducere a riscului de dezvoltare a
REVISTA ROMN DE PEDIATRIE VOLUMUL LX, NR. 4, AN 2011 391

dermatitei atopice, wheezingului i astmului la Alte studii raporteaz c 90-95% dintre copiii
copiii cu atopie familial recomand alimentaia astmatici sunt atopici. (22) 85% din cazuri au avut
natural sau preparate hidrolizate de lapte minimum i alte manifestri alergice, precum i comorbiditi
4 luni de la natere. (11) Laptele matern conine nonalergice. (Tabelul 2). Sindromul eczem/der-
factori de protecie antiinfecioi ce inactiveaz matit atopic a fost prezent n antecedentele per-
bacteriile patogene i toxinele acestora, precum sonale la 39% dintre cazuri. (Tabelul 2). Este
citokine i factori de cretere, prevenind sensibili- demonstrat rolul dermatitei atopice i al rinitei
zarea la alergenii de mediu i reducnd susceptibi- alergice n marul atopic la copil. Evoluia na-
litatea la infecii respiratorii i dezvoltarea astmului. tural a simptomelor alergice la copii const n
Antecedentele perinatale predispozante (14% progresia simptomelor de la alergia alimentar la
Tabelul 1) au fost dominate de prematuritate. Vrsta dermatit atopic, ulterior rinit alergic i astm
gestaional mic (12,13) i modificrile precoce bronic; 43% din copiii cu dermatit atopic dez-
ale funciei pulmonare n perioada neonatal (14) volt astm i 45% rinit alergic. (23) Severitatea
se asociaz cu riscul pentru astm n copilrie. Bjerg dermatitei atopice constituie un factor de risc
A. i colab., pe un lot de 3.389 copii din Suedia, predictiv: 70% din copiii cu dermatit atopic se-
arat c greutatea mic la natere (ci aeriene mici, ver dezvolt astm bronic, comparativ cu 30% din
reanimarea) i expunerea antenatal la fumul de cei cu forme uoare i, respectiv, 8% din populaia
igar crete riscul pentru astm de 4-6 ori la copiii general. Rinita alergic raportat cu inciden de
de vrst scolar. (15) Frecvena expunerii la fumul 80-90% copiii astmatici s-a nregistrat la 78%
de igar ante i post natal (52%), demonstrat ca i cazuri (Tabelul 2). Frecvent, precede apariia ast-
factor de risc pentru astm, s-a corelat cu frecvena mului n 32-64% cazuri. (24) Diagnosticul de rinit
mai mare a astmului persistent moderat i sever i alergic poate fi ascuns sub diagnosticul de infecie
rspuns redus la medicaia antiastmatic. Fumatul respiratorie recidivant. Sensibilizarea dovedit la
n timpul sarcinii crete de 4 ori riscul la copil acarieni a avut o frecven de 63% (tabelul 2)
pentru wheezing i sensibilizare alergic. (16), asemntor altor raportri de 65-90% din copiii
afectare ulterioar a funciei pulmonare, inflamaie astmatici. (25,26) Global sensibilizarea alergic a
bronic i astm bronic n copilrie. (17) Fumatul fost demonstrat la 67% cazuri, din care majorita-
pasiv se asociaz cu risc crescut de infecii tea polisensibilizai (37%, Tabelul 3) cu forme mai
respiratorii ale cilor aeriene inferioare n perioada severe de astm.
de sugar i mica copilrie. Mai mult de 15% din Copiii de vrst colar vin cu o ncrctur de
cazuri (Tabelul 1) au raportat expunere la poluanii factori de risc pentru astm specifici vrstelor mici,
rezultai din arderea diverilor combustibili folosii care, sesizai n timp, ar putea contribui, dac nu la
pentru gtitul alimentelor i nclzirea locuinei reducerea frecvenei, cel puin la diminuarea seve-
(gaz, lemne, crbuni). Expunerea la poluanii ritii astmului bronic. Cercetri recente susin
atmosferici de interior i rolul lor n apariia msurile de reducere a expunerii la alergeni, ali-
astmului este controversat, dar este considerat ca mentaia natural sau cu formule hipoalergenice de
factor de evoluie sever a astmului bronic. la natere, evitarea fumatului n timpul sarcinii i a
Poluanii atmosferici (NO2, SO2, O3, particule fumatului pasiv la copiii cu risc crescut pentru astm.
diesel, pulberi cu diametru de 10-2,5 microni) Aceste msuri au fost considerate preventive apariiei
reduc funcia pulmonar, dar legtura direct cu sensibilizarii alergice precoce i a astmului (27)
astmul bronic este nc nedemonstrat. (18) Ali
factori propui ca responsabili de reducerea funciei CONCLUZII
pulmonare la vrsta de 14 ani i, ulterior, 50 ani au
Evaluarea retrospectiv i actual a factorilor de
fost greutatea mic la natere, alimentaia arti-
risc pentru astmul bronic pe un lot de 100 de copii
ficial, istoric pozitiv pentru infecii severe n
cu vrsta mai mare de 6 ani a evideniat frecvena
copilrie, statusul socioeconomic sczut, fumatul
mare (peste 50%) pentru urmtorii factori: sexul
activ i pasiv. (19)
masculin, mediul urban, atopia familial, atopia
Wheezingul recurent n mica copilrie a fost
personal, alimentaia artificial, expunerea la fu-
prezent la 72% astmatici (tabelul 1) i/s-a asociat
mul de igar, expunerea la praful de cas, sensi-
cu ali factori de risc importani: antecedente
bilizarea alergic n special la acarieni. Studiul
familiale de astm (23%) i atopie familial (59%).
individualizat al antecedentelor familiale i per-
Atopia familial, criteriu major de suspiciune a
sonale viznd factorii cunoscui implicai n astmul
AB a avut o inciden mai scazut 59% (tabelul 2)
bronic la copilul mic a demonstrat ntrzierea
n comparaie cu alte studii n care este prezent la
diagnosticului i tratamentului la 37% dintre cazuri.
80% din copiii astmatici, atopia pe linie matern
Sensibilizarea alergic i expunerea la fumul de
fiind un factor de risc major pentru astm. (20,21)
igar se coreleaz cu forme mai severe de boal.
392 REVISTA ROMN DE PEDIATRIE VOLUMUL LX, NR. 4, AN 2011

Risk factors for asthma in children (6-18 years)


Oana Lazarescu, MD; Magadalena Florea, MD; Ema Agarniciuc, MD;
Ileana Ioniuc, MD; Monica Alexoae, MD; Stela Gotia, MD, PhD
2thPediatric Clinic, Gr.T. Popa University of Medicine and Pharmacy, Iasi

ABSTRACT
Asthma is one of the most common diseases in children and an important cause of morbidity and mortality, with
recent increased prevalence. Asthma diagnosis in children is often underestimated in early childhood. The aim of
present study is to anamnestically assess using clinical and specific paraclinic exploration the incidence of the risk
factors highly suggestive of asthma in children (6-18 years) and the correlation with disease severity. The
questionnaires used in this study included relevant information to known risk factors for asthma during pre and
postnatal period, preadolescence and adolescence stage. The principal risk factors for asthma identified in
descending order of frequency were: personal atopy, recurrent wheezing, male gender, urban environment, indoor
air allergens exposure (house dust, domestic animals, house mold) allergic sensitization to indoor allergens
(house-dust mites), infant artificial feeding, family atopy, exposure to second hand tobacco smoke. Allergic
polisensitization and tobacco smoke exposure are associated with severe asthma. The majority of cases were
affected by asthma-related comorbid conditions and allergic rhinitis was the most frequent comorbidity.

Key words: asthma, child, risk factors, atopy

BACKGROUND The parameters followed were:


history: demographic data (age, gender, urban/
Asthma is a complex disease due to continuous rural area, socioeconomic status, exposure to
interaction of genetic and environmental factors. second hand smoke, active smoking, age of on-
Continued increase in the prevalence of asthma set and diagnosis, perinatal risk factors (prema-
over the last decades in school children and adults, turity, low birth weight child, risk of preterm
especially in developed countries (1), is most likely labour during pregnancy), artificial feeding dur-
explained by the changes in environmental factors ing first 4 months of life, personal and family
(2) Children are diagnosed with asthma after 6 years history of atopy, recurrent wheezing in early
of age, even if disease onset is often before 5 years of childhood, indoor allergen exposure, indoor air
age, in this case asthma being misdiagnosed or under pollution resulting from cooking and heating us-
diagnosed due to the difficulty in making asthma di- ing combustion sources (gas, coal, wood)
agnosis in this age group. Clinical asthma prediction clinical aspects: the the classification of asthma
scores were developed as result of many retrospec- severity
tive evaluations of an important study population of paraclinical aspects: spirometry to determine
asthmatic children aged over 6 years. lung function (basal and after effort spirometry),
sensitization to allergens by determining specif-
OBJECTIVE ic serum IgE or skin allergy testing (skin prick
test), presence of asthma-related comorbid con-
To identify risk factors for developing childhood
ditions
asthma (6-18 years) and the correlation with dis-
ease severity.
RESULTS
MATERIAL AND METHODS Table 1. General characteristics
All children
A retrospective study was performed on 100 chil- Nr. cases 100 %
dren (6-18 years) diagnosed with asthma of varying Age group distribution
>12 years 57 57%
degrees of severity in II-nd Pediatric Clinic (immu- 43 43%
nology/allergology department of St. Mary Hospi- Age at onset of symptoms
tal Iasi, in 2006-2010. Asthma disease severity was 0-5 years 72 72%
6-11 years 25 25%
assessed using GINA guideline diagnostic criteria >12 years 3 3%
(Global Initiative for Asthma). The information was Age at diagnosis
collected from children personal health records and 0-5 years 35 35%
6-11 years 51 51%
questionnaire interviews conducted with both chil- >12 years 14 14%
dren and parents. They were asked to answer to rel- Recurrent wheezing 72 72%
evant questions to asthma risk factors. Family atopy 59 59%
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All children From our data (Table 1) asthma onset within 5


Nr. cases 100 % years of age could be suspected in 72% of cases,
Family asthma 23 23%
Personal atopy 85 85% but asthma diagnosis was delayed after 6 years of
Perinatal risk factors 14 14% age in 51% of cases. Clinical particularities and dif-
Artificial feeding 59 59% ficulty to investigate asthma in early childhood
Male gender 64 64%
Urban residential area 63 63% could be incriminated in asthma underestimation in
Low socioeconomic status 16 16% children aged 0-5 years.
Indoor air pollution exposure 15 15% High frequency of asthma in boys (64%) and ur-
Tobacco smoke exposure 52 52%
Allergic manifestation ban children (64%) (Table 1) was consistent with
allergic rhinitis 78 78% several other studies. (6) Air pollution exposure
atopic dermatitis 39 39% and different lifestyle, increased childs exposure to
(0-5 years)
allergic conjunctivitis 29 29% endotoxin, a component of the outer membrane of
food allergy 25 25% gram negative bacteria, protects against asthma and
atopy by promoting LTh1 cells and inhibiting LTh2
Table 2. Allergic comorbidities, of study population and risk cells. (7) Low socioeconomic status (16% of chil-
factors exposure and allergic sensitization
dren) (Table 2), increases the risk of having asthma
All children
Nr. cases 100 % and inadequate access to health care. (8)
Related comorbidities Infant artificial feeding already known as risk
allergic rhinitis 78 78% factor for asthma (9,10) was present in 58% of child-
rhino sinusitis 9 9%
allergic conjunctivitis 29 29% hood asthma cases. (Table 1) Hypoallergenic diet
food allergies 25 25% had a reduced frequency in children at risk even if
Indoor allergen exposure 39% of cases had atopic dermatitis within 5 years of
house dust 63 63%
animals 27 27% age and family atopy was present in 59% of asth-
house mold 25 25% matic children. For infants at high risk of developing
cockroaches 3 3% atopic disease exclusive breastfeeding or the use of
Allergic sensitization
dust mites 63 63% extensively or partially hydrolyzed formulas for at
food 10 10% least 4 months decreases the cumulative incidence of
atopic dermatitis, wheezing and asthma. (11)
Table 3. Frequency of mono and polisensitization in Human milk contains numerous components
asthma severity steps
Asthma severity
protecting the infant against infections, including
Allergic Intermitent Mild Moderate Severe factors that provide specific immunity, nonspecific
sensitization Nr cases Nr cases Nr cases Nr cases protective factors that inhibit the binding of bacte-
Mono- 7 45 10 1 rial pathogens and their toxins. In breast milk are
sensitization
present cytokines and growth factors that may play
Poli- - 19 14 4
sensitization a role in modulating the development of asthma by
preventing sensitization to environmental allergens
DISCUSSION and reducing susceptibility to respiratory infections
and asthma. Prematurity was the most important
Longitudinal epidemiological studies suggest perinatal risk factors in 14% cases (Table 1). Low
early presence of airways allergic sensitization with gestational age (12,13) and neonatal early changes
a frequency of 25% in infants and 75% before 3 in pulmonary function (14) are risk factors for de-
years of age. Complex statistic analysis of the asth- veloping childhood asthma.
ma like symptoms evolution and risk factors in 435 According to a Swedish study (Bjerg A et al) on
asthmatic children identified asthma onset in 60% 3.389 children being exposed to smoking during
children within 1 year of age, 20% between 1-2 foetal development and having a low birth weight
years of age, 14% between 2-3 years of age and 7% increases the risk of developing asthma in school
between 3-4 years of age. The same study found 8 children by four to six times. (15) The increased
parameters identified as risk factors for asthma: frequency of smoke exposure (52%, table 2) already
male gender, postmaturity, level of parental educa- demonstrated as risk factor for asthma was corre-
tion, parental asthma, frequency of wheezing epi- lated with severe and moderate asthma and poor
sodes, wheezing with viral respiratory tract infec- response to antiasthmatic medication. Antenatal
tions, recurrent respiratory tract infection, eczema. maternal smoking increases the risk of developing
(4) Other studies report asthma onset within 5 years wheezing and allergic sensitization to 4 times (16),
of age in 80% of the cases. lung function deterioration, airways inflammation
394 REVISTA ROMN DE PEDIATRIE VOLUMUL LX, NR. 4, AN 2011

and childhood asthma. (17) Second hand tobacco matitis develop asthma comparing to 30% children
smoking is associated with high risk for respiratory with mild forms and 8% of children from general
tract infection in infants and toddlers. More, 15% population. Allergic rhinitis incidence reported in
of children (Table 1) reported exposure to indoor other studies to 80-90% of asthmatic children was
air pollution resulting from cooking and heating us- 78%. (Table 2) Often precedes asthma in 32-64%
ing combustion sources (gas, coal, wood). Expo- cases. (24) Allergic rhinitis can be mistaken for re-
sure to indoor air pollution and the risk of develop- current respiratory tract infection.
ing asthma is controversial. Children exposed to air Home dust mites sensitization was reported in
pollution (NO2, SO2, O3, diesel particles, particu- 65-90% of asthmatic children similar to other stud-
late matter with 10-2,5 micron diameter) have dete- ies. (25,26) Globally, allergic sensitization was
riorated lung function but no direct association with demonstrated in 67% cases and in the majority of
asthma was demonstrated. (18) Several factors act- cases polisensitization (37%, Table 3) was associat-
ing throughout life, childhood severe respiratory ed with severe asthma. Multiple risk factors for asth-
tract infections, low birth weight, artificial feeding, ma specific to infancy and toddlerhood are often
tobacco smoke exposure, low socioeconomic status present in school aged children background. Early
have been associated with reduced adolescence (14 identification of risk factors may help to reduce asth-
years) and adult lung function (50 years). (19) ma frequency and severity. Recent researches sup-
Frequent episodes of wheezing in early child- ported breastfeeding for at least 4 months or the use
hood were present in 72% of asthmatic children of hydrolyzed formulas, environmental control mea-
(Table 1) and were associated with other important sures that will limit allergens exposure and environ-
risk factors asthma parental history (23%) and fam- mental tobacco smoke exposure in children with
ily atopy (59%). Family atopy major suspicion cri- high risk for asthma. Those measures prevent or de-
teria for asthma had a lower incidence (59%, Table lay the occurrence of early allergic sensitization and
1), other studies reporting an incidence of 80%, asthma in childhood. (27)
maternal atopy beeing a high risk factor for asthma.
(21) According to other published reports in the lit- CONCLUSIONS
erature. 90-95% of asthmatic chidren have personal
atopy (22). Personal atopy was present in 85% chil- Retrospective and updated analysis of the asthma
dren and other nonallergic comorbidities. (Table 2) risk factors in 100 children aged 6-18 years showed
History of eczema/atopic dermatitis syndrome increased frequency for the following risk factors:
in early childhood was present in 39% children. male gender, urban residence, familial and personal
(Table 2). It is already demonstrated the role of atopy, artificial feeding, environmental tobacco
atopic dermatitis and allergic rhinitis in chilhood smoke exposure, home dust exposure, dust mites al-
atopic march. The natural history of atopic mani- lergic sensitization, recurrent wheezing history. The
festations is the progression in time from food al- individualized analysis of the family and personal
lergy, atopic dermatitis to wheezing and asthma; history for already known asthma risk factors in
43% of children with atopic dermatitis develop early childhood demonstrated in 37% cases delays
asthma and 45% develop allergic rhinitis. (23) in diagnosis and treatment. Allergic sensitization
Atopic dermatitis severity is a predictive risk factor and environmental tobacco smoke exposure are
for asthma. 70% of children with severe atopic der- correlated with severe forms of asthma.

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