Epidemiological study of school performance and asthma medications among asthmatic Egyptian school children

Abstract

Background: Childhood asthma is a major health problem in Egypt and worldwide. Barriers to reducing the burden of asthma include symptom-based rather than disease-based approaches, tendency of care to be ‘‘acute’’ rather than “regular” and cultural attitudes towards drugs and drug delivery systems. Objective: To measure the disease effect on school performance and to map asthma medications with respect to types, routes and course of use. Methods: This cross sectional study involved 206 Cairene asthmatic school children, enrolled from the school students’ health insurance facility of El-Matareya Teaching Hospital and the pediatric outpatient clinic of Saint Mark Charity Hospital representing different social classes and residential locations. Their ages ranged between 5 and 15 years and they comprised 100 males and 106 females. They were assessed clinically and by peak expiratory flowmetry. Parents or caregivers were interviewed about disease symptoms, school achievement and attendance and medications used including relievers and controllers, route and course of use, whether continuously, intermittently and/or during attacks. Results: Asthma had a strong impact on school achievement and school absence; 77.3% of study population reported school absence due to asthma and 41.3% reported weak to average school achievement. School performance was associated with asthma severity; the majority of moderate asthmatics (64.6%) had average and weak school performance. Number of days of school absence demonstrated highly significant relation with asthma severity; 43.6% of moderate asthmatics had 5-6 absent days/month and 33.4% had 3-4 absent days/month. Combined β2-agonists and xanthines was the most commonly used (54.8%) reliever therapy followed by β2-agonists alone (44.2%) while corticosteroids were the most common controllers used (97.6%). Therapy was taken mainly by oral than inhalation route. Other medications like cromolyns, anti-histamines, anti-leukotrienes and anti-cholinergics were rarely used. Both rectal and injection routes were rarely used also. Conclusion: Asthma has a social burden on asthmatic children as it affects both school achievement and school attendance. Medical management of asthma in Egyptian children still lags behind available medical knowledge. Patients’ and health care givers’ education is a cornerstone in improving the current status of asthma management in Egypt.

Keywords: asthma medications; asthma severity; children; school performance

Egypt J Pediatr Allergy Immunol 2009;7(1):23-32