Childhood Asthma and Risk Factors in KSA (Cross Sectional Study)

The goal of this study is to see if there's a link between age, gender, and risk factors including having a smoking parent, allergic rhinitis, skin allergies, food allergies, and a family history of atopy with the diagnosis of childhood asthma. The goal is also to evaluate the prevalence of asthma in the study's pediatric sample, as well as the prevalence of other symptoms and complications in this group. Original Research Article Attia et al.; JPRI, 33(60B): 782-788, 2021; Article no.JPRI.80955 783 A link was discovered between childhood asthma and age, allergic rhinitis, skin allergies, food allergies, and atopy in the family. In most areas of this investigation, the findings are consistent with earlier studies conducted at various periods and in other places for almost identical aims.


INTRODUCTION
Asthma is a chronic inflammatory condition of the airways that causes a restriction in airflow. Asthma causes 10 million school days to be missed each year among children aged 5 to 17 years, costing caregivers $726.1 million per year in lost wages [1].
Asthma has a wide range of signs and symptoms. Regardless, they are frequently seen in the following categories: Wheezing is a melodic, high-pitched whistling sound produced by airflow turbulence. One of the most prevalent asthma symptoms is wheezing. It generally happens during exhalation [2].
Cough: a nonproductive and non-paroxysmal cough. It's possible that it'll coexist with wheezing. Coughing at night or during activity may be the only symptom of asthma, particularly in exercise-induced or nocturnal asthma patients. Coughing is more common after midnight or in the early morning hours in such circumstances [2].
Shortness of breath is another typical asthma symptom, particularly during an asthmatic episode [2].
Chest tightness can occur with or without other asthma symptoms. This is especially true in asthma caused by activity or asthma that occurs at night [2].
Symptoms of an acute asthma attack vary depending on the intensity of the attack. The following traits are seen in infants and young children who have experienced a severe episode: Breathlessness when sleeping, no desire to eat, sitting erect, speaking in words, and anxiety [2].
The youngster exhibits the aforementioned symptoms as well as being tired and disoriented as a result of impending respiratory arrest. Adolescents, on the other hand, may not show these signs until they are in full-fledged respiratory failure [2].
The following are some of the findings in status asthmaticus with impending respiratory arrest: Thoracoabdominal movement that is paradoxical, no wheezing, significant hypoxemia, bradycardia, and no pulsus paradoxus.

Diagnosis
Asthma diagnostic tests include the following: PFTs (pulmonary function tests): Spirometry and plethysmography are two methods for determining lung capacity.
Activity challenge: Includes baseline spirometry, followed by treadmill or bicycle exercise at a heart rate higher than 60% of projected maximum, with ECG and oxyhemoglobin saturation monitoring [3].
Exhaled nitric oxide fraction (FeNO) testing: Marker of airway inflammation that is noninvasive.
Radiography can reveal hyperinflation and enlarged bronchial markings, as well as signs of parenchymal illness, atelectasis, pneumonia, a congenital defect, or a foreign substance [3].
Allergy testing can help to detect allergic variables that may play a role in asthma.
The airways were examined histologically. Inflammatory cell infiltration, constriction of airway lumina, bronchial and bronchiolar epithelial denudation, and mucus plugs are all common findings [3].

Management
The National Asthma Education and Prevention Program's guidelines stress the following aspects of asthma treatment: Monitoring and evaluation: Impairment and risk must be measured in order to monitor asthma control and alter medication; because asthma fluctuates over time, follow-up every 2-6 weeks is first required (after achieving control of the condition), and then every 1-6 months thereafter [4]. Education: Self-management education should emphasize the importance of patients recognizing their own level of control and signs of progressively worsening asthma symptoms, as well as environmental control and avoidance strategies, as well as medication use and adherence (e.g., correct inhaler techniques and other device use) [4].

Control of Environmental Factors and
Comorbid Conditions

Age of presentation
According to the most recent evidence, age of diagnosis for most cases of childhood asthma is before 5 years of age, with more than half developing the symptoms of asthma before 3 years of age. This finding could be misleading in some degree because of difficulty of performing diagnostic tests for asthma on pediatric population [5].

Common symptoms of first presentation
Frequent coughing, wheezing, and congestion are among the top common symptoms of presentation of asthma in childhood. Viral infections can be a trigger of asthmatic attacks in children [6].

Study
Year Result Asthma and gender: The female lung [2] 2016 Asthma is more prevalent in females than in males Effects of passive smoking on one's health. 3. The incidence of respiratory problems and asthma in school-aged children as a result of parental smoking. [4] 1997 Exposure to smoke from either parents, increases prevalence and symptoms of asthma in pediatric populations.
The normal course of atopic dermatitis from birth to seven years of age, as well as the link to asthma [5].
2017 Early atopic dermatitis is linked to asthma in school-aged children, although wheezing often occurs before or concurrently with the start of atopic dermatitis in many of these asthmatic children. Food allergy and asthmawhat is the link? [1] 2013 Food allergy is a significant risk factor associated with asthma, and a risk factor for more severe asthmatic attacks and complications. Allergic rhinobronchitis: The asthma-allergic rhinitis link [7] 1999 Allergic rhinitis has a strong association with asthma, both allergic and non-allergic types, with stronger link with the allergic one, and maybe the same mechanisms involved. In-depth Analyses of the Impact on Asthma and Wheeze in 7-to 8-Year-Old Children with a Family History of Asthma and Atopy [5] 2017 Family history of asthma and atopy is associated with prevalence of asthma in siblings 2. METHODOLOGY

Study Design
This is an analytical cross-sectional study.

Study Setting and Period
This is an analytical cross-sectional study conducted at universities, hospitals, malls of the KSA from February 2021until October 2021

Study Population and Sampling
Study participants: Inclusion criteria; Parents of children who are less than 13 years of age.

Sampling Method and Size
The study is carried out by questionnaire. Randomly selected sample is sized 640 cases.
2. Disease-related information: risk factors including passive smoking, co-existant or history of atopy, family history of atopy. Other variables include diagnosis of asthma in childhood, age at diagnosis, First presentation symptom, and different complications of asthma.

Outcome measures:
The outcome measure is by counting the ratio of the number of patients suffering from childhood asthma, and associated risk factors, symptoms of presentation, and complications of asthma.

Fig. 1. Sex distribution
As for risk factors, 217 (33.9%) have at least one smoking parent, 164 (25.6%) have a history of food allergy, 177 (27.7%) have a history of allergic rhinitis, and 334 (52.2%) have a family history of atopy. 80 (9.4%) have an established diagnosis of childhood asthma. The number of children diagnosed with asthma was 60 cases as described in Fig. 2.

Among 60 Cases Diagnosed with Asthma
Age of diagnosis was at: Complications of asthma Complication bronchitis in 1 case (1.7%), shortness of breath in 7 cases (11.7%), chest congestion or tightness in 4 cases (6.7%), and trouble breathing hampering daily activities in 1 case (1.7%). When their parents were asked if they are given regular treatment, 5 cases (8.3%), never received regular treatment, 7 cases (11.7%) receive their treatment seldom, 13 (21.7%) often, and 35 (58.3%) do always. As for complications, they shown in the side-shown figure.
Association is studied between diagnosis of asthma, and age group, gender, and risk factors like having a smoking parent, skin allergy, food allergy and family history of atopy. All of these associations have significant statistical relationship with the diagnosis of asthma except for gender and having a smoking parent.

DISCUSSION
The results of this study are concordant, in some parts, with the results of previous different studies discussing the same associations, between childhood asthma and different variables including age, gender, risk factors like having a smoking parent, feed or skin allergies, allergic rhinitis and family history of atopy. In some parts of study, there is insignificant statistical relationship, this could be due to inequal distribution of cases, sampling errors and bias [8].
There was a significant association between age group and childhood asthma presence among cases involved in this study. This matches well with the results of other studies stating that significant variance of such variables [7].
Also, in this study, there is a significant relationship between certain risk factors and diagnosis of childhood asthma. Of these variables, "having a smoking parent" didn't show any statistical significance. On the other hand, a significant relationship was found with having allergies (skin, food), or family history of atopy. This was also concordant with the results of previous studies done in the same purpose that is to study the relationship with asthma in childhood period. They have shown significant relationship between such variables, and diagnosis of childhood asthma [9].

CONCLUSION
Childhood asthma has an obvious relationship with different variables and conditions, significantly with age, risk factors like skin allergy, food allergy and allergic rhinitis, and family history of atopy among siblings.

CONSENT AND ETHICAL APPROVAL
Administrative approval is sought from the unit of biomedical ethics research committee. Ethical approval is sought from the ethical committee of the faculty of medicine, King Abdulaziz University. An informed consent is sought from the participants.