Marie Cooper

Questionnaire study of effect of sex and age on the prevalence of wheeze and asthma in adolescence

In early childhood wheezing and asthma are more common in boys than girls.1 This difference has either disappeared or reversed by early adulthood,2 although the age at which the change occurs is unclear. We therefore measured the age and sex specific prevalence of self reported wheeze and diagnosed asthma in 11-16 year old children attending secondary schools in the Nottingham area. In 1996 we completed a prevalence survey of all pupils attending 44 secondary schools in a defined postcode area in and around Nottingham. Questionnaires about lifetime and current wheeze and asthma diagnosed by a doctor (Appendix) were distributed to pupils for self completion during school time. Data were collected on 27 826 pupils (over 80% of registered pupils) aged 11-16 years, 51% of whom were boys. Parental responses to the same questions were obtained for a 1 in 4 random subsample of 3894 pupils (59% response). The self reported lifetime prevalence of wheeze was 30.1% (8317/27 632), with 19.0% …

Local road traffic activity and the prevalence, severity, and persistence of wheeze in school children: combined cross sectional and longitudinal study

OBJECTIVES To investigate the relation between local road traffic activity and the occurrence, severity, and persistence of wheeze in children. METHODS Data on wheeze and asthma were collected in a cross sectional questionnaire survey of 22 968 primary school children (age 4–11) and 27 826 secondary school children (age 11–16) in the Nottingham area. Direct measures of road traffic flow were made in the locality of each school and combined with Local Authority traffic data for major roads to estimate local traffic activity in vehicle metres/day/km2. Assessment of the effects of potential confounders was performed in nested case-control groups of 6576 primary and 5936 secondary children. Data on frequency of wheeze were collected for the cases to study disease severity. Longitudinal data on a historical cohort of 883 children who reported wheeze when aged 4–11 in 1988 were used to study the persistence of wheeze into adolescence. RESULTS Unadjusted prevalence of wheeze in the past year within schools varied widely but was not associated with traffic activity in the school locality (weighted regression coefficient β=−0.01, p=0.93 for primary schools, β=−0.18, p=0.26 for secondary schools). The risk of wheeze in individual primary school children was not associated with traffic activity analysed as a continuous variable, although there was some suggestion of a weak, non-linear plateau effect. Similar effects were found for diagnosed asthma and recent cough. There was no evidence of any relation between traffic activity and risk of wheeze in secondary school children. There were positive but non-significant dose related effects of traffic activity on wheeze severity in primary and secondary children and on persistence of wheeze in the longitudinal cohort. CONCLUSIONS Traffic activity in the school locality is not a major determinant of wheeze in children.

Effects of volatile organic compounds, damp, and other environmental exposures in the home on wheezing illness in children

Background: The effects of indoor exposure to volatile organic compounds (VOCs), including formaldehyde, on respiratory health are not clearly understood. The aim of this study was to determine the independent effects of VOCs and other common environmental exposures in the home on the risk and severity of persistent wheezing illness in children. Methods: Total volatile organic compounds, formaldehyde, nitrogen dioxide, damp (on a four category scale of % wood moisture equivalent), and environmental tobacco smoke (from salivary cotinine) were measured objectively in the homes of 193 children with persistent wheezing illness and 223 controls aged 9–11 years in Nottingham, UK. Results: The risk of wheezing illness was significantly increased only in relation to damp (odds ratio (OR) per increasing category=1.32 (95% confidence interval (CI), 1.00 to 1.75)), and was unrelated to the other exposures measured. Among cases, formaldehyde and damp were associated with more frequent nocturnal symptoms (OR per increasing quartile and category, respectively, 1.45 (1.06 to 1.98) and 1.97 (1.10 to 3.53)), significantly more so in atopic cases, but there was no effect of total volatile organic compounds, nitrogen dioxide, or cotinine. Conclusions: Domestic volatile organic compounds are not a major determinant of risk or severity of childhood wheezing illness, though formaldehyde may increase symptom severity. Indoor damp increases both the risk and severity of childhood wheezing illness.

Increasing prevalence of wheeze and asthma in Nottingham primary schoolchildren 1988-1995

The prevalence of asthma in children has increased substantially in many countries in recent decades, but it is not clear how much this trend has continued into the 1990s. This study aimed to estimate the current prevalence of asthma and wheeze in British primary schoolchildren and to determine whether there has been any increase in the prevalence of these conditions since 1988. The prevalence of self-reported wheeze and asthma was measured by parental questionnaire in 22,968 children aged 4-11 yrs attending primary schools in the Nottingham area of England in 1995, and these estimates were compared with data from a subsample of the same schools in 1988. In 1995, wheezing ever was reported in 24.0% of children, wheezing in the past year in 15.1% and diagnosed asthma symptomatic in the past year in 8.8%. All measures have increased in prevalence since 1988, in absolute terms by 7.7% for wheeze ever, by 2.6% for wheeze in the past year and by 2.7% for asthma. The increases were greater in females than males, but did not vary with age. In conclusion, the prevalence of asthma has continued to rise in British schoolchildren since the late 1980s, particularly in females, and across all ages.

Risk of cryptogenic fibrosing alveolitis in metal workers

We report increased proportional mortality from cryptogenic fibrosing alveolitis in the workforce of a major UK engineering company. Measures of metal exposure from unbiased historical occupational records showed that among employees who have worked with metal, the risk of death from or with cryptogenic fibrosing alveolitis increased in relation to the duration of metal-working.

P-103 A community of practice: building capability to provide high quality dementia care

In recent years there has been a significant increase in policy and guidance, across many countries, to promote palliative and end-of-life care for non-malignant life-limiting conditions. Most notably for people with dementia (PWD) at the end-of-life and facilitate better access to palliative care. PWD, particularly those in the advanced stages, may experience poor end-of-life care because they may not be perceived to have a terminal illness. There is concern in some settings and services that staff are ill – equipped to care for PWD, in respect of knowledge and skills. Both Hospice UK and Dementia UK thus launched the ‘Dementia in palliative and end-of-life care Community of Practice’ to bring together practitioners keen, in the spirit of mutual learning, to share knowledge and practice and provide high quality palliative and end-of-life care for families affected by dementia. At the inaugural meeting a nominal group technique was used to identify learning needs across both groups of clinicians. Thirteen learning needs were identified, of which five were ranked as priorities to be met during future meetings. Shared learning through a community of practice is a way of harnessing the expertise across the two care domains, with the common objective of improving the lives, and deaths of PWD and in better support of their families. We hold two community meetings a year and due to increase in engagement will be hosting a conference in 2017. Events are well evaluated and membership is growing.