[Development over 3 years of asthma recently diagnosed in a cohort of children (ASMA study). Factors related to improvement in clinical status].
OBJECTIVE
The objective of the ASMA study was to describe the evolution of light to moderate asthma, newly or recently (12 Pounds months) diagnosed in private pneumology centers, and to search for the predictive factors.


METHODS
In 1995, 251 private pneumologists, throughout Metropolitan France, recruited 396 asthmatic children, 6 to 12 years old (64% boys). The 334 patients eligible for the study were examined every 4 months during 3 years (a mean of 6 controls were conducted out of the expected 9). The data were collected on standardized questionnaires completed by the physicians and notebooks filled-in by the patients the week before each control. This questionnaire comprised two asthma 'control' criteria: "control" of the clinical state, defined as asthma attacks < 1 per week AND nocturnal awakening < 1 per week AND absence of asthma symptoms between attacks on every control visit; "control" of the need for b2 mimetics on request, defined as the non-use throughout the week preceding the control visit.


RESULTS
The global clinical state of the cohort rapidly improved once care was initiated: the proportion of children exhibiting at least one attack of asthma per week rapidly dropped to 43% on inclusion and to 13% on the first control visit (4 months), 10% on the second control visit, and then fluctuated at around 8% up until the last control visit. A similar evolution was noted regarding nocturnal asthma attacks. The proportion of patients with prescriptions for inhaled corticosteroids and long-lasting b2-mimetics increased over the three years of follow-up. Analysis of the factors related to the individual 'control' of the clinical state showed a negative effect in family histories of asthma (father) and the presence of smokers in the home, but above all a positive effect of compliance to treatment and particularly its understanding (OR = 2.5; p = 0.03) and respect of the doses (OR = 2.7; p < 0.01). The positive effect of compliance was confirmed by analysis of the factors related to the use of b2 mimetics on request.


CONCLUSIONS
Smoking should be avoided in the home. Compliance to treatment could be improved by making sure that the patients and their parents fully understand the disease and its treatment, and by persuading them to strictly follow the treatments prescribed.
Liard
R
R
INSERM U408 Epidémiologie, Faculté de Médecine X, Bichat, B.P. 416, 75870 Paris Cedex 18, France. neukirch@bichat.inserm.fr
Soussan
D
D
Zureik
M
M
Touron
D
D
Lepage
T
T
Martinat
Y
Y
Rogeaux
Y
Y
Neukirch
F
F
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016902:Air Pollution, Indoor / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy / Q000473:pathology*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002940:Circadian Rhythm; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012720:Severity of Illness Index
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents