Asthma (Italy)

A group of 33 paediatricians subdivided my macroregion (15 north, 10 centre, 8 south/islands) based on paediatric distribution I Italy took part in a retrospective and prospective study on infantile asthma. The project was coordinated by the Pedianet network, with the help of GSK. The paediatricians involved follow 28,856 children below the age of 14, and these were all included in the study. 

The study consists of 2 phases: 

First phase

Retrospective, to estimate the prevalence of asthma in the Italian paediatric population and to identify risk factors for the development of persistent asthma. 
Eligible subjects were identified by an electronic system capable of identifying all patients seen and registered in the family paediatrician’s data base with the diagnosis of asthma, bronchospasm, dispnoea and wheezing in the years 1997-1998. 
1.263 asthmatics were identified with an average prevalence of 4,38%. 811 were males. 
Male prevalence being 5,36% and female prevalence 3,31%. 
A family history of asthma was present in 16,1% of fathers, in 7,5% paternal grandfathers and in 7,8% paternal grandmothers. Also, in 20,3% of mothers, 8,4% maternal grandfathers and 8,8% maternal grandmothers. 
17% of asthmatic children have a brother with asthma and 11,9% a sister wth asthma. 
25,1% asthmatic children have at least 1 member of the father’s family who has asthma and 29,5% at least one member of the mother’s family with asthma. 25,4% has one or more brothers with asthma. 
652 (51,6) had episodic asthma and 596 persistent asthma (47,2%). 
The risk of developing persistent asthma was increased in children between the ages of 4-6 years and > 6years with an OR of 1.6 (95% CI 1,2-2,1) and 1.3 (95% CI 1,0-1,7). 
Other risk factors for the development of persistent asthma seen in our study were being born in May, location of the house (in the suburbs), fuel used at home (gasoline), parents smokers, domestic animals at home, and family history of asthma in mother or father. 
Whereas having a working mother with a medium to high educational level, seperate heating system I the house, and wood as household fuel seemed to decrease the risk of developing persistent asthma. 
These results outline the importance that family history, social and environmental factors have in the development and severity of asthma. 

Second phase

Prospective, (May 1999 –May 2000). 
The objectives were to estimate the incidence of asthma, it’s natural history, quality of life, differences i treatment according to age group, sex and distribution of cases and evaluate if treatment followed international guidelines. 
652 children (51,6%) were classified as having episodic asthma, 567 (44,9%) as mild asthmatics, 20 (0,16%) as persistent moderate asthma, 9(0,08%) as severe persistent asthma. 
Amongst patients suffering from episodic asthma only 18,7% had used short acting B-agonists (SA-BA), 
l'8,3% had used inhalational corticosteroids (ICS) and 6,3% systemic corticosteroids (SCS). SCS were often used long term. 
Patients with persistent asthma used SABA in 45,6% cases, 29% used ICS and 14,9% SCS. The combination of SABA and ICS was used by 4,9% children with episodic asthma and 20,4% children with persistent asthma. 
Patients under the age of 5 years were given SCS more often, but less ICS, cromoglycates, anti-leucotrienes and long acting B-agonists compared to children above the age of 5 years. There was no difference between the two sexes, or different regions. 
Southern Italy uses a lot more cromoglycates, inhaled anticholinergics, SCS, systemic B-agonists and xanthines (independent of age and severity) than in the North and Central areas. In the north there was a higher use of ICS.