The study has the target to explore the relationship between outdoor and indoor polution and incidence of bronchial asthma in pediatric age group

1. Effect of feeding in early
infancy,familial factors and
smoking, on bronchial asthma
in pt,s< five years age

2. Performed by
• Ghassan.A. Shakkoury M.D
,consultant pediatrician,Zarka
state hospital

3. Introduction
Bronchial asthma is a leading
cause of chronic illnesses in
children,responsible for
significant morbidity and
mortality among them.

4. Introduction
The number of
asthma cases in
children increased
significantly in the
recent two decades
all over the world

5. Introduction
The cause Of increased
asthma prevalence is exactly
UNKNOWN

6. POSSIBLE CAUSES
1- increased environmental
(outdoor and indoor) pollution.
2- increased cow milk formula
feeding in early infancy.
3-others

7. Objectives
To find out the relationship between
bronchial asthma in children <five
years AND
1- smoking( as indoor pollutant.)
2- cow milk formula feeding in first six months of life
( cow milk protein may be provocative for the immune
system)
3- Familial factor.

8. DESIGN
Prospective
observational study

9. SETTING AND PARTICIPANTS
All children,admitted to
ZARKA STATE HOSPITAL
((JORDAN) April/30/2013-
April/30/2014

10. Prospective exclusion criteria
• Patients with other lung
diseases(cystic fibrosis,pulmonary
dysplasia ………
• Patients with cardiovascular diseases
• Immunodificient patients

11. Data Collection
• Collected prospectively for each
patient on admission VIA
• Thorough history data collected
from both parents
• complete physical examination

12. DIAGNOSIS OF
ASTHMA
If the patient has had
two or more episodes
of wheezy chest

13. RESULTS
• Total admissions < 5 years age 1017
Male to female ratio =1.5:1
• Total admitted asthmatic patients =89
(9%) Male to female ratio =2.5:1
• 40% of total admissions have at least
one smoker parent and 43% of total
asthmatic patients have at least one
smoker parent

14. % of males and females of total
admissions and asthmatic
children
0 20 40 60 80
Total
admissions
Asthmatic
patients females
Bar 2
males

15. RESULTS
• 423 (42%) of total admissions and 32(36%)
of asthmatic children were breast-fed (in
first 6 months of life)
• 537(53%) of total admissions and 52(58%)
of asthmatic children were on mixed
feeding.(breast &milk formula)
• 57 (5%) of total admissions and 5 (6%) of
asthmatics were only on cow milk
formula.

16. percentage of types of feedings
In total admissions and asthmatic
children
0 10 20 30 40 50 60
total
admissions
Asthmatic
mixed
artificial
breast

17. Feeding in first six months of life
in total admissions
0
100
200
300
400
500
600
total
admission
Breast
artificial
mixed

18. Total
Adm.
(1017)
Num
ber
of
Adm.
% Numb
er of
asthm
atic
%asthmatic
of total
Adm.
May-
July
365 36 29 3
Aug.-
Oct.
105 10 8 0.8
Nov.-
Jan.
236 23 23 2
Feb.-
Apr.
311 31 29 3

19. Percentage asthmatic pt,s of total
admissions in different seasons
0
0.5
1
1.5
2
2.5
3
may-july aug.-oct. nov.-jan feb.-apr.
3-D Column 1
3-D Column 2

20. Total admissions and asthmatic
pts in 3months periods
0
50
100
150
200
250
300
350
400
nov.-july2013 aug-oct2013 nov-jan2014 feb.-apr.2014
total pt,s
Asth.pt,s

21. RESULTS
• 149 ( 15%)of total admissions
have a positive family history.
• 36 (41%) of total asthmatic
children have a positive family
history of asthma

22. Smoker
parents
Children with
asthma
Yes No Total
yes 43 364 407
No 46 564 610
Total 89 928 1017

23. Estimations of O R ,RR
• Risk of a child with smoker parents to
develop asthma =
• the odds =
• Risk of a child with non smoker parents to
develop asthma =
• the odds =
407
43
364
43
610
46
564
46

24. RR AND OR
• Asthmatic child and smoker parents
• Relative risk (RR)= 1.4
• Odds ratio = 1.45
• CI 95% = (.09364- 2.2402)

25. Breast
feeding
Bronchial asthma Total
Yes No
yes 32 391 423
no 57 537 594
Total 89 928 1017

26. Estimation of RR &OR
• Risk of breast fed child to have asthma
=32/423 =.07565
• number of odds =32/391=0.0818
• Risk of a child not breast fed to have
asthma =57/594 =0.09596
• number of odds =57/537=0.1061

27. Relative risk and odds ratio for a child
on mixed or artif. feeding in first six
months for
bronchial asthma
• RR = 1.27
• Odds Ratio=1.30
• CI 95% = (0.8252-2.0383)

28. Family
history
of
asthma
Children with
Bronchial
asthma
total
Yes No
Yes 36 113 149
No 53 815 868
89 928 1017

29. Estimation of RR&OR
• Risk of a child with family history of
asthma to have asthma =36/149=0.2416
• Number of odds =36/113=0.3186
• Risk of a child without family history of
asthma to have asthma =53/868=0.0611
• Number of odds =53/815=0.0650

30. Relative risk and odds ratio for
a child with family history of
bronchial asthma
•RR= 3.95
•Odds Ratio=4.90
•CI 95% =(3.0716-
7.8133)

31. CONCLUSION
• Cow milk formula feeding in early infancy
&
• smoking parents ( as indoor pollutant )
• MAY PLAY SOME ROLE I
N INCREASING RISK OF
ASTHMA IN CHILDREN

32. CONCLUSION
• FAMILIAL FACTOR
• is probably
• THE MOST IMPORTANT
• RISK
• FOR CHILDHOOD ASTHMA

33. conclusion
•53%of total admissions were on
mixed milk feeding(breast&formula
feeding) in the first six months of life.This
may be due to the misconception
among mothers that milk formulas
(support) child,s health!!! THIS SHOULD
BE DISCOURAGED

34. Conclusion
•40%of total admissions have
at least one smoker parent.
• It is AN ALARMING SIGN IN
THE JORDANIAN SOCIETY.
• And should be opposed by
campaigns against smoking

35. THANK YOU