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The prevalence and risk factors of asthma in 13–14-year-old children in East Jakarta
Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85
O11-253 The clinical profiles of congenital laryngomalacia in Ciptomangunkusumo Hospital, Jakarta N. Kaswandani, C. Utami, A. Rahmadhany. FOM University of Indonesia Child Health, Jakarta, Indonesia Background: Laryngomalacia is the major cause of inspiratory stridor in children. Although most cases resolve conservatively, some cases need surgical interventions. Improper management of laryngomalacia can cause disturbance of growth and development. Objective: To describe the clinical manifestations of children with congenital laryngomalacia in Ciptomangunkusumo Hospital, Jakarta. Methods: The retrospective study from medical records of laryngomalacia patients in Department of Child Health, Ciptomangunkusumo Hospital, Jakarta, Indonesia during 2006–2011. Results: Forty-three patients were diagnosed with laryngomalacia during the study period (27 boys [62.7%]). Most were born full-term, while 8 (18.6%) were premature. The chief complaints were noisy breathing (79.1%), dyspnea (18.6%) and retraction (2.3%). They were mostly diagnosed with laryngomalacia at the age of 1–3 monthold; but in 44% patients the complaints of stridor were already started before the age of one month. At admission, 61.3% patients were mild–moderate under-nourished; while 16.1% were severely undernourished and the rest were well nourished. Nineteen out of forty patients were also suffering from comorbid diseases, such as neuromuscular diseases, GERD and congenital heart diseases. Only 29 patients underwent endoscopy, yielding type-1 laryngomalacia in 24 patients, type-2 in 1 patient and type-3 in 4 patients. Patients identified with laryngopharingeal reflux (12 patients) also got proton pump inhibitor. Supraglottoplasty was performed in 5 patients because of severe obstruction and/or failure to thrive after watchful-waiting management. Conclusion: Laryngomalacia patients in majority were type-1, shown to be mild-moderate undernourished and can be managed conservatively. The comorbid diseases that can also occur in laryngomalacia are CHD, reflux and neuromuscular diseases. O12-249 The prevalence and risk factors of asthma in 13–14-year-old children in East Jakarta B. Supriyatno, E. Barnita, H. Gunardi. FOM University of Indonesia Child Health, Jakarta, Indonesia Background: Asthma is the most common chronic disease in childhood. The International Study of Asthma and Allergies in Childhood (ISAAC) is well-known as a unique worldwide epidemiological research programmed to investigate asthma, rhinitis and eczema in children, using standardized questionnaires. Objective: To investigate asthma prevalence among the population of 13–14-year-olds in East Jakarta, along with the severity and risk factors of asthma. Method: This is an analytical–cross sectional study, determining asthma prevalence and risk factors using ISAAC. We conducted the study from February to April 2011. Risk factors were analyzed using chi square or Fisher exact test. Results: Study subjects are 562 children (250 boys and 312 girls). The prevalence of any wheeze 8.9%; last 12-month wheeze 9.4%; asthma physician-diagnosed 9.4%. The prevalence of recurrent wheezing as follows: 1–3 times a month 3.9%; 4–12 times a month 1.1%; >12 times a month 0.2%. Sleep disturbance related wheeze was 3%, and speech disorder related wheeze was 1.8%. The prevalence of current wheezing did not show differences according to gender (p = 0.821; 95% CI 0.59 to 0.92), smoke exposure (p = 0.735; 95% CI 0.55 to 2.34), nor allergic dermatitis (p = 0.054; 95% CI 0.97 to 4.63). The prevalence was significantly higher in children with no sibling (p = 0.015; 95% CI 1.14 to 3.69), middle to high social economy (p = 0.001), and in allergic rhinitis (p < 0.05; 95% CI 2.5 to 10.43). Conclusion: Asthma prevalence in 13–14-year-olds in East Jakarta is 12.5%. Having no sibling, middle to high social economy level,
S83
and allergic rhinitis are risk factors of any wheeze, while gender differences, smoking exposure, and allergic dermatitis are not. Keywords: asthma, prevalence, ISAAC, risk factors, East Jakarta.
Category 14. Miscellaneous P01-52 A meta-analysis on efficacy of levodropropizine in children A. Zanasi1 , F. De Blasio2 , L. Lanata3 , P.V. Dicpingaitis4 , F. Saibene3 , R. Balsamo3 . 1 University of Bologna S.Orsola Malpighi Hospital Pneumology Unit, Bologna, Italy; 2 Clinic Center, Private Hospital Respiratory Medicine and Pulmonary Rehabilitation Section, Naples, Italy; 3 Domp`e spa, Milano, Italy; 4 Albert Einstein College of Medicine and Montefiore Medical Center Department of Medicine, New York, USA Introduction: Cough is a very common symptom in children and may have a deep impact on both children’s and parents’ sleep and quality of life, thus often requiring an empiric treatment with antitussive agents. Levodropropizine is a very well tolerated peripheral drug, while central cough suppressants (opioids and non opioids) may be associated with side effects that limit their use especially in children. Objective: Our study is a meta-analysis of published studies performed with the aim to evaluate the overall comparative efficacy of levodropropizine in the pediatric population. Methods: After comprehensive systematic literature search on main electronic databases (PubMed/MEDLINE, EMBASE, and Cochrane Library), we performed a standardized meta-analysis of 4 controlled clinical studies of levodropropizine (3 vs. central antitussives and 1 vs. placebo) assessing efficacy cough outcomes, including a total of 780 children. Main efficacy parameters were cough frequency, severity, and night awakenings. Results: Meta-analysis of all standardized efficacy parameters showed a highly statistically significant difference in the overall antitussive efficacy in favor of levodropropizine vs. control treatments (p = 0.0044). The heterogeneity test for the efficacy outcome was not statistically significant (p = 0.0856). Conclusions: Our meta-analysis indicates that levodropropizine is an effective antitussive drug in children, with statistically significantly better overall efficacy outcomes vs. central antitussives (codeine, cloperastine, dextromethorphan), in terms of reducing cough intensity, frequency and nocturnal awakenings. These results further reinforce the favorable benefit/risk profile of levodropropizine in the management of cough in the pediatric setting. P02-284 Comparison of the in vitro performances of two valved holding chambers N. Boukhettala1,2 , T. Poree ´ 2 . 1 Centre d’Etude des Pathologies Respiratoires INSERM U1100/EA6305, Universit´e Francois ¸ Rabelais de Tours, Facult´e de M´edecine, F-37032 Tours, France; 2 Laboratoire Protec’Som, F-50700 Valognes, France The objectives of this study were to compare the performances of two valved holding chambers having the same shape and to evaluate the influence of the material. In this study, the valved holding chambers are Itinhaler (Protec’som, France) which is made of silicone and Tipshaler (Protec’som, France) which is made of plastic. Salbutamol and fluticasone were delivered with a pressurised metered dose inhaler (GlaxoSmithKline, France) and valved holding chambers. The method according to the European Pharmacopoeia used a constant flow rate (30 L/min) was used. Particle size distribution was measured using a NGI cascade impactor (Copley Scientific, Nottingham, UK). The salbutamol and fluticasone concentrations were assayed by spectrophotometry at 240 nm and 236 nm respectively.
O11-253 The clinical profiles of congenital laryngomalacia in Ciptomangunkusumo Hospital, Jakarta N. Kaswandani, C. Utami, A. Rahmadhany. FOM University of Indonesia Child Health, Jakarta, Indonesia Background: Laryngomalacia is the major cause of inspiratory stridor in children. Although most cases resolve conservatively, some cases need surgical interventions. Improper management of laryngomalacia can cause disturbance of growth and development. Objective: To describe the clinical manifestations of children with congenital laryngomalacia in Ciptomangunkusumo Hospital, Jakarta. Methods: The retrospective study from medical records of laryngomalacia patients in Department of Child Health, Ciptomangunkusumo Hospital, Jakarta, Indonesia during 2006–2011. Results: Forty-three patients were diagnosed with laryngomalacia during the study period (27 boys [62.7%]). Most were born full-term, while 8 (18.6%) were premature. The chief complaints were noisy breathing (79.1%), dyspnea (18.6%) and retraction (2.3%). They were mostly diagnosed with laryngomalacia at the age of 1–3 monthold; but in 44% patients the complaints of stridor were already started before the age of one month. At admission, 61.3% patients were mild–moderate under-nourished; while 16.1% were severely undernourished and the rest were well nourished. Nineteen out of forty patients were also suffering from comorbid diseases, such as neuromuscular diseases, GERD and congenital heart diseases. Only 29 patients underwent endoscopy, yielding type-1 laryngomalacia in 24 patients, type-2 in 1 patient and type-3 in 4 patients. Patients identified with laryngopharingeal reflux (12 patients) also got proton pump inhibitor. Supraglottoplasty was performed in 5 patients because of severe obstruction and/or failure to thrive after watchful-waiting management. Conclusion: Laryngomalacia patients in majority were type-1, shown to be mild-moderate undernourished and can be managed conservatively. The comorbid diseases that can also occur in laryngomalacia are CHD, reflux and neuromuscular diseases. O12-249 The prevalence and risk factors of asthma in 13–14-year-old children in East Jakarta B. Supriyatno, E. Barnita, H. Gunardi. FOM University of Indonesia Child Health, Jakarta, Indonesia Background: Asthma is the most common chronic disease in childhood. The International Study of Asthma and Allergies in Childhood (ISAAC) is well-known as a unique worldwide epidemiological research programmed to investigate asthma, rhinitis and eczema in children, using standardized questionnaires. Objective: To investigate asthma prevalence among the population of 13–14-year-olds in East Jakarta, along with the severity and risk factors of asthma. Method: This is an analytical–cross sectional study, determining asthma prevalence and risk factors using ISAAC. We conducted the study from February to April 2011. Risk factors were analyzed using chi square or Fisher exact test. Results: Study subjects are 562 children (250 boys and 312 girls). The prevalence of any wheeze 8.9%; last 12-month wheeze 9.4%; asthma physician-diagnosed 9.4%. The prevalence of recurrent wheezing as follows: 1–3 times a month 3.9%; 4–12 times a month 1.1%; >12 times a month 0.2%. Sleep disturbance related wheeze was 3%, and speech disorder related wheeze was 1.8%. The prevalence of current wheezing did not show differences according to gender (p = 0.821; 95% CI 0.59 to 0.92), smoke exposure (p = 0.735; 95% CI 0.55 to 2.34), nor allergic dermatitis (p = 0.054; 95% CI 0.97 to 4.63). The prevalence was significantly higher in children with no sibling (p = 0.015; 95% CI 1.14 to 3.69), middle to high social economy (p = 0.001), and in allergic rhinitis (p < 0.05; 95% CI 2.5 to 10.43). Conclusion: Asthma prevalence in 13–14-year-olds in East Jakarta is 12.5%. Having no sibling, middle to high social economy level,
S83
and allergic rhinitis are risk factors of any wheeze, while gender differences, smoking exposure, and allergic dermatitis are not. Keywords: asthma, prevalence, ISAAC, risk factors, East Jakarta.
Category 14. Miscellaneous P01-52 A meta-analysis on efficacy of levodropropizine in children A. Zanasi1 , F. De Blasio2 , L. Lanata3 , P.V. Dicpingaitis4 , F. Saibene3 , R. Balsamo3 . 1 University of Bologna S.Orsola Malpighi Hospital Pneumology Unit, Bologna, Italy; 2 Clinic Center, Private Hospital Respiratory Medicine and Pulmonary Rehabilitation Section, Naples, Italy; 3 Domp`e spa, Milano, Italy; 4 Albert Einstein College of Medicine and Montefiore Medical Center Department of Medicine, New York, USA Introduction: Cough is a very common symptom in children and may have a deep impact on both children’s and parents’ sleep and quality of life, thus often requiring an empiric treatment with antitussive agents. Levodropropizine is a very well tolerated peripheral drug, while central cough suppressants (opioids and non opioids) may be associated with side effects that limit their use especially in children. Objective: Our study is a meta-analysis of published studies performed with the aim to evaluate the overall comparative efficacy of levodropropizine in the pediatric population. Methods: After comprehensive systematic literature search on main electronic databases (PubMed/MEDLINE, EMBASE, and Cochrane Library), we performed a standardized meta-analysis of 4 controlled clinical studies of levodropropizine (3 vs. central antitussives and 1 vs. placebo) assessing efficacy cough outcomes, including a total of 780 children. Main efficacy parameters were cough frequency, severity, and night awakenings. Results: Meta-analysis of all standardized efficacy parameters showed a highly statistically significant difference in the overall antitussive efficacy in favor of levodropropizine vs. control treatments (p = 0.0044). The heterogeneity test for the efficacy outcome was not statistically significant (p = 0.0856). Conclusions: Our meta-analysis indicates that levodropropizine is an effective antitussive drug in children, with statistically significantly better overall efficacy outcomes vs. central antitussives (codeine, cloperastine, dextromethorphan), in terms of reducing cough intensity, frequency and nocturnal awakenings. These results further reinforce the favorable benefit/risk profile of levodropropizine in the management of cough in the pediatric setting. P02-284 Comparison of the in vitro performances of two valved holding chambers N. Boukhettala1,2 , T. Poree ´ 2 . 1 Centre d’Etude des Pathologies Respiratoires INSERM U1100/EA6305, Universit´e Francois ¸ Rabelais de Tours, Facult´e de M´edecine, F-37032 Tours, France; 2 Laboratoire Protec’Som, F-50700 Valognes, France The objectives of this study were to compare the performances of two valved holding chambers having the same shape and to evaluate the influence of the material. In this study, the valved holding chambers are Itinhaler (Protec’som, France) which is made of silicone and Tipshaler (Protec’som, France) which is made of plastic. Salbutamol and fluticasone were delivered with a pressurised metered dose inhaler (GlaxoSmithKline, France) and valved holding chambers. The method according to the European Pharmacopoeia used a constant flow rate (30 L/min) was used. Particle size distribution was measured using a NGI cascade impactor (Copley Scientific, Nottingham, UK). The salbutamol and fluticasone concentrations were assayed by spectrophotometry at 240 nm and 236 nm respectively.