Do home circumstances affect asthma control in children from a developing country?

Asthma control is a central focus of the updated version of the GINA Guidelines, in which clinicians are encouraged to concentrate on assessment of control, defined by symptoms, lung function and the presence or history of exacerbations. Control is of critical importance in asthma and is now more important than the actual level of severity. Measures of asthma control do not necessarily perform well and all of them need to be looked at as a whole as studies have shown. Many factors have been found to be associated with poor asthma control ranging from concomitant rhinitis and co morbidities to poor compliance with medications or inappropriate inhaler technique in addition to home or environmental factors. Several factors around the home of asthmatic patients contribute to poor asthma control which includes parental smoking or smoking by other relatives within the home, biomass fuel exposure, exposure to aeroallergens and animal danders which all leads to failure in achieving control despite adequate drug therapy. This cross sectional study was conducted in 115 asthmatics children with the aim of determining the level of asthma control and home circumstances that contributes to poor asthma control. Most patients were males and blacks with 55.65% of patients having controlled asthma. Use of biomass fuel was uncommon in this study and none of the home circumstances was found to be associated with poor asthma control in this study. Day time and nocturnal asthma symptoms were significantly associated with poor asthma control. Good adherence to medications was found to be associated with asthma control similar association was not seen with good inhaler technique. The higher the FEV1 percent predicted the better the asthma control. Day time and nocturnal asthma symptoms were associated with FEV1. Results from this study need confirmation in a representative population study. Further longitudinal study is required to see if home circumstances may affect asthma control in patients that had controlled asthma.
Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, August 2013