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Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador

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ArduraGarcia, Cristina, Vaca, Maritza, Oviedo, Gisela, Sandoval, Carlos, Workman, Lisa, Schuyler, Alexander J, Perzanowski, Matthew S, Platts-Mills, Thomas AE and Cooper, Phil (2015) 'Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador'. Pediatric Allergy and Immunology, Vol 26, Issue 5, pp. 423-430.

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Abstract

Background

Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children.

Methods

A matched case-control study was done in a public hospital serving a coastal city. Children with acute asthma were age- and sex-matched to non-asthmatics. A questionnaire was administered and blood, as well as stool, and nasopharyngeal swabs were collected.

Results

60 cases and 119 controls aged 5-15 years were evaluated. High proportions of cases were atopic with population attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51-50 kU/L vs. <0.70kU/L - OR 4.56, 95% CI 1.48-14.06, P=0.008; >50kU/L vs. <0.70kU/L - OR 41.98, 95% CI: 8.97-196.39, P<0.001). Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95%CI 3.26-465), parental educational level (adj. OR 1.26, 95%CI: 1.08-1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00-337 while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01- 0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, P=0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control.

Conclusions

A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WF Respiratory System > WF 140 Diseases of the respiratory system (General)
WF Respiratory System > WF 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1111/pai.12401
Depositing User: Lynn Roberts-Maloney
Date Deposited: 29 Jun 2015 08:35
Last Modified: 06 Feb 2018 13:10
URI: http://archive.lstmed.ac.uk/id/eprint/5216

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