Allergies and asthma are a continuing health problem in most developed countries, but just how do these ailments develop over the course of a childhood? In a population-based study designed to help answer this question, researchers at the Norwegian University of Science and Technology (NTNU) found that 40 per cent or two of five — of nearly 5,000 two-year-olds had at least one reported allergy-related disorder. The most common symptom was wheezing, which was reported in 26 per cent of all children in the study, says Ingeborg Smidesang, a PhD candidate in the university’s Faculty of Medicine, and the primary author of the study.

Researchers are careful to point out that there is no guarantee that children who wheeze at two years old will grow up with asthma. “One of the challenges here is that we don’t know which wheezers will develop asthma“, Smidesang says.

The findings are among the first to illustrate the scope of allergy-related problems in such a young group of children, and the challenges that these problems pose for both families and for public health systems overall. “If you think about something like moderate atopic eczema, which can involve quite a few doctor’s visits, and a lot of work on the part of parents, it is quite a big deal”, she says. “This can be quite a burden.”

The study has been published in an online version of Pediatric Allergy and Immunology, a peer-reviewed academic journal. Among the findings reported is that fully 21 per cent of the 5000 children in the study, or about 1000 children, had been tested for allergies. Roughly 60 per cent of these 1000 children were reported by their parents to have had a positive allergy test. However, when researchers randomly selected 390 children for allergy testing, only eight per cent had a positive test. The allergy-related disorders that were studied were eczema, asthma, asthma-like symptoms and hay fever. Researchers found that boys were more likely than girls to have an allergy-related disorder, Smidesang said.

Allergy-related disorders vary widely within countries and between countries. For example, children in northern Norway are more likely than children in southern Norway to have atopic dermatitis, Smidesang said, probably because the winters are longer in the north than in the south. Another comparison between Sweden and the UK in 2002-2003 showed that asthma symptoms in children were roughly 10 per cent in Sweden compared to 21 per cent in the UK. Researchers can make conjectures about what causes these variations, but the bottom line is that medical researchers really don’t understand what causes children to develop allergies and what can be done to prevent them.

Smidesang’s study is a part of a larger effort called PACT (Prevention of Allergy among Children in Trondheim), which began in 2000 to try to better understand how allergy-related symptoms develop in children and to investigate the effectiveness of risk-factor intervention, including increasing omega-3 fatty acid intake, reducing parental smoking and indoor dampness. A control group of 14 000 children, from which the current study is drawn, was established to track fluctuations in risk factor levels and to provide comparison data. A second group of roughly 3000 children was recruited for a proactive intervention effort. The programme started during pregnancy and continued until the children reached the age of 2. The 390 children who were randomly selected for skin prick allergy testing will be followed up when they are 6 years old.

Source: The Norwegian University of Science and Technology (NTNU)

Pharmacists are being urged to identify and refer patients with chronic lung and other conditions who have problems with their medication, following research showing that two thirds of asthma and COPD patients are under-using preventer inhalers and risking unnecessary breathing problems.

The research, discussed at the Royal Pharmaceutical Society’s annual event, the British Pharmaceutical Conference in Manchester, showed that 64% of patients with asthma or COPD in a Cheshire PCT were under-using their preventer inhalers. They made them last days or weeks longer than would be expected if they were using them correctly.

This meant that the patients, who live in a part of the country with the highest asthma-related hospital admission rate in the UK, were missing out on essential corticosteroid drugs which form the backbone of preventive treatment for asthma and COPD. It is estimated that poorly controlled asthma costs the NHS £900m every year1.

“Maximum benefit from these important medicines is only achieved by regular use, even when patients are symptom free. The fact that so many patients aren’t using their preventer inhalers means that we must look for new ways to identify those who need extra help with their medicines,” explained Dr Ian Cubbin, of Liverpool John Moores University.

He suggested that pharmacists could play an important role in monitoring repeat prescriptions and referring patients who are under-using medication, as well as advising on good technique when using an inhaler:

“Patients with chronic diseases, such as asthma and COPD, see their community pharmacist more often than their GP. Through clinical medication reviews, pharmacists can help or refer patients who are having problems with their medicines before these become more serious, and thus help to reduce hospital admissions,” he added.

Notes
The study was called An investigation into how poor compliance traditionally associated with corticosteroid therapy in asthma and chronic obstructive pulmonary disease can be improved to enhance long-term management and patient care. Authors: E. Marsden, I Cubbin and A McAlavey. It involved patients in the former Ellesmere Port and Neston Primary Care Trust. A total of 2, 340 patients with a diagnosis of either asthma or COPD were included in the study. Of these, 64% were under-using their corticosteroid inhaler and therefore receiving the drug at sub-therapeutic levels. A further 3% were over-using their inhaler and the remaining 33% were found to be compliant.

About asthma
5.4 million people currently receive treatment for asthma in the UK, and there are over 80,000 asthma-related admissions to hospital each year1. At least 75% of these admissions could be prevented with appropriate primary care management1.

About COPD
Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic bronchitis, emphysema and other lung diseases which result in damage to the airways, making it hard to breathe normally. An estimated 3 million people in the UK have COPD2, although many remain undiagnosed.