Daniel Yam Thiam Goh

International consensus on (ICON) pediatric asthma

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re‐evaluate and fine‐tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype‐specific treatment choices; however, this goal has not yet been achieved.

Cross-cultural differences in infant and toddler sleep

BACKGROUND To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries. METHODS Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire. RESULTS Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China). CONCLUSIONS Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.

Prevalence and severity of asthma, rhinitis, and eczema in Singapore schoolchildren.

This study was part of an international effort to evaluate the epidemiology of asthma and allergic diseases around the world. The aim was to assess the prevalence and severity of these disorders in Singapore schoolchildren. The international study of asthma and allergies in childhood (ISAAC) written questionnaire was administered to 6238 schoolchildren. The respondents were parents of a 6-7 year cohort (n = 2030), and schoolchildren aged 12-15 years (n = 4208). The overall cumulative and 12 month prevalence of wheezing were 22% and 12%, respectively. The prevalence of doctor diagnosed asthma was 20%. Rhinitis was reported by 44% and chronic rashes by 12%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with males, and subjects of higher socioeconomic status (based on type of housing and total family income). More severe asthma related symptoms were present in Malays and Indians than in the Chinese. Allergic disorders are common in Singapore and prevalence is comparable to some populations in the West. Demographic and socioeconomic factors appear to influence the prevalence and severity of these disorders.

Sensitization to local dust-mite fauna in Singapore.

Background: Recent studies showed the presence of a unique dust‐mite fauna in the indoor environment of Singapore. Immediate hypersensitivity to these dust mites, along with other known indoor allergens, may play a role in the pathogenesis of allergic respiratory diseases. This study evaluated the sensitization rates of the local atopic population to these allergens.

The prevalence of asthma and allergies in Singapore; data from two ISAAC surveys seven years apart

Background and Aims: Over the past few decades, the prevalence of asthma has been increasing in the industrialised world. Despite the suggestion of a similar increase in Singapore, the 12 month prevalence of wheeze among schoolchildren in 1994 was 2.5-fold less than that reported in western populations. It was hypothesised that with increasing affluence in Singapore, the asthma prevalence would further increase and approach Western figures. A second ISAAC survey was carried out seven years later to evaluate this hypothesis. Methods: The cross-sectional data from two ISAAC questionnaire based surveys conducted in 1994 (n = 6238) and in 2001 (n = 9363) on two groups of schoolchildren aged 6–7 and 12–15 years were compared. The instruments used were identical and the procedures standardised in both surveys. Results: Comparing data from both studies, the change in the prevalence of current wheeze occurred in opposing directions in both age groups—decreasing in the 6–7 year age group (16.6% to 10.2%) but increasing to a small extent in the 12–15 year age group (9.9% to 11.9%). The 12 month prevalence of rhinitis did not change; there was an increase in the current eczema symptoms in both age groups. Conclusion: The prevalence of current wheeze, a surrogate measure of asthma prevalence, has decreased significantly in the 6–7 year age group. Eczema was the only allergic disease that showed a modest increase in prevalence in both age groups.

Prevalence and distribution of indoor allergens in Singapore

Background and aims Immediate hypersensitivity to indoor allergens is known to be associated with allergic asthma. This study evaluated the prevalence and distribution of six indoor allergens in 956 dust samples obtained from homes, childcare centres, schools, and a hospital in tropical Singapore. Seasonality of mite allergens was also assessed.

Association of ambient air‐pollution levels with acute asthma exacerbation among children in Singapore

Background: Air‐pollution levels have been shown to be associated with increased morbidity of respiratory diseases.

Evaluation of the allergenicity of tropical pollen and airborne spores in Singapore

Background: Sensitization to pollen and spores of the Southeast Asian tropical region is not well documented. This study evaluated the allergenicity of the tropical airspora in Singapore.

Sleep education in medical school curriculum: A glimpse across countries

BACKGROUND The objective of this study was to assess the prevalence of education about sleep and sleep disorders in medical school education and to identify barriers to providing such education. METHODS Surveys were sent to 409 medical schools across 12 countries (Australia, India, Indonesia, Japan, Malaysia, New Zealand, Singapore, South Korea, Thailand, United States, Canada and Viet Nam). RESULTS Overall, the response rate was 25.9%, ranging from 0% in some countries (India) to 100% in other countries (New Zealand and Singapore). Overall, the average amount of time spent on sleep education is just under 2.5h, with 27% responding that their medical school provides no sleep education. Three countries (Indonesia, Malaysia, and Viet Nam) provide no education, and only Australia and the United States/Canada provide more than 3h of education. Paediatric topics were covered for a mere 17 min compared to over 2h on adult-related topics. CONCLUSION These results suggest that there continues to be very limited coverage of sleep in medical school education despite an incredible increase in acknowledgement of the importance of sleep and need for recognition of sleep disorders by physicians.

Perception of picky eating among children in Singapore and its impact on caregivers: a questionnaire survey

BackgroundPicky eating is relatively common among infants and children, often causing anxiety for parents and caregivers. The purpose of this study was to determine the key aspects of picky eating and feeding difficulties among children aged 1 to 10 years in Singapore and the impact on their parents or caregivers.MethodsIn this survey, 407 parents or grandparents who are the primary caregivers of children aged 1 to 10 years in Singapore were interviewed via telephone using a structured questionnaire of 36 questions. Respondents were randomly selected from the Singapore Residential Telephone Directory to meet a pre-set interlocked quota of race, sex, and age to represent the population. Quantitative data collected included demographics, body weight and height, respondents’ perceptions of the duration of picky eating, the child’s eating habits and perceived health status, respondents’ attitudes towards picky eating, coping strategies and the impact on family relationships. Bonferroni z-test and t-test were used to indicate significance across groups or demographics, while Pearson correlation coefficient was used to measure the strength of association between variables.ResultsOne-half of the respondents reported that the child was ‘all the time’ (25.1%) or sometimes (24.1%) a picky eater. When aided with a list of typical behaviours, the respondent-reported prevalence of picky eating or feeding difficulties occurring ‘all the time’ increased to 49.6%. The highest number of respondents first noticed the child’s picky eating behaviours or feeding difficulties as early as 1 year (20.0%). Children 3 to 10 years [p = 0.022], children of professional respondents (p = 0.019), and children with a family history of picky eating (p = 0.03) were significantly more likely to be picky eaters. Overall, all ‘picky eating’ and all ‘feeding difficulty’ behaviours occurring ‘all the time’ were significantly associated with caregiver stress when feeding (p = 0.000026 and p = 0.000055, respectively) and with a negative impact on family relationships (p = 0.011 and p = 0.00000012, respectively).ConclusionsThe perceived prevalence and duration of picky eating behaviours and feeding difficulties are high. The impact on the respondent and family relationships appears to be significant in Singapore. Parental concerns about picky eating should be adequately assessed and managed in routine clinic consultations.