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Associations between markers of respiratory morbidity in European children

¹ Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland. ² Harvard School of Public Health, Boston, MA, USA. ³ Dept of Occupational and Environmental Medicine, University Hospital, Lund, Sweden. ⁴ Environmental and Occupational Health Unit, University of Utrecht, Utrecht, The Netherlands

CORRESPONDENCE: B. Brunekreef, Institute for Risk Assessment Sciences, Environmental and Occupational Health Group, PO Box 80176, 3508 TD, Utrecht, The Netherlands. Fax: 31 302535077. E-mail: b.brunekreef@iras.uu.nl

Keywords: atopy, children, lung function, respiratory symptom

Received: October 6, 2000
Accepted October 16, 2001

This study was funded in the framework of the Commission of the European Communities Environment Programme, contracts EV5V-CT92-0220, CIPD-CT-92-5052 and ERBCIPD-CT-93-0046. K.L. Timonen was supported by grants from The Finnish Anti-Tuberculosis Association Foundation and The Ida Montin Foundation. The Finnish, Norwegian and two Swedish centres were funded by grants from the respective Governments.

School-aged children often experience acute respiratory symptoms. In a multicentre European study, the association between chronic respiratory symptoms (reported in a questionnaire), skin-prick test results, and lung function, and the occurrence of acute respiratory morbidity, was examined among children aged 6–12 yrs with chronic respiratory symptoms.

Children with chronic respiratory symptoms, living in 10 European countries, were selected from a parent-completed questionnaire (n=4,307). Atopy was measured with skin-prick tests, and lung function with spirometry. A total of 1,854 (86% of those in the initial cohort) children kept a successful daily diary regarding their respiratory symptoms for 2–3 months.

In multivariate logistic regression analyses, children with asthmatic symptoms, particularly those with doctor-diagnosed asthma, had a greater risk of occurrence of lower respiratory symptoms (odds ratio (OR): 6.12; 95% confidence interval (CI): 4.99–8.35) than children with a dry nocturnal cough as their only symptom. Atopy, particularly a positive reaction to indoor allergens, was significantly associated with occurrence of lower respiratory symptoms. For atopy the OR was 1.62 (95% CI: 1.34–1.96). A reduced level of maximal mid-expiratory flow was associated with an increased risk of lower respiratory symptoms, cough and phlegm. The associations were similar in Scandinavia, Central Eastern, Western and Southern Europe.

To conclude, asthmatic symptoms reported in a questionnaire, atopic status and a reduced level of maximal mid-expiratory flow were associated with the occurrence of acute respiratory symptoms, especially those of lower respiratory symptoms.