title: Common behavioral problems among children with asthma: is there a role of asthma treatment?
abstract: BACKGROUND
  An increased prevalence of behavioral problems has been described among children with asthma.
  
  
  OBJECTIVE
  To investigate those associations between common behavioral problems and asthma, with an emphasis on the roles of medications used for asthma.
  
  
  METHODS
  We studied 409 children who had been followed-up in pediatric allergy clinics and 157 age-matched healthy controls. A diagnostic and statistical manual disorder-referenced symptom inventory was used to assess "attention deficit-hyperactivity disorder" (ADHD), "attention deficit" (AD), "hyperactivity and impulsivity" (HI), and "oppositional defiant disorder" (ODD) behavioral problems.
  
  
  RESULTS
  The study group consisted of 409 patients (male: 251, female: 158), with a mean age of 9.0 ± 2.67 years, and the control group consisted of 157 children (male: 75, female: 82), with a mean age of 9.0 ± 2.86 years. Prevalences of AD, hyperactivity, ADHD, and ODD were not significantly different between the study and control groups. Among those patients receiving leukotriene antagonist (LA) drugs adjunctive to inhaled corticosteroids (ICS), duration of treatment was correlated with total scores calculated for hyperactivity (P = .035, r = 0.432), AD (P = .044, r = 0.414), ADHD (P = .042, r = 0.418), and ODD (P = .032, r = 0.439). Among patients with asthma, children with ODD had a significantly longer duration of LA+ICS use (P = .024) compared with those with no ODD. Patients with hyperactivity had a longer duration of ICS+LA use compared with those with no hyperactivity (P = .009). Patients with asthma receiving LA+ICS treatment had a higher risk for oppositional behavior (4.282 times compared with the control group [P = .042, confidence interval (CI): 1.542-15.949]) and 8.3 times compared with patients with asthma not using any drug (P = .021, CI: 1.419-48.543).
  
  
  CONCLUSIONS
  Rather than asthma itself, adjunctive use of ICS+LA therapy appears to be related with symptoms of common behavioral problems, including hyperactivity, AD, ADHD, and ODD and to increase the risk of ODD.
authors.affiliation: Pediatric Allergy and Asthma Unit, Yeditepe University School of Medicine, Istanbul, Turkey. hulya_ercan@yahoo.com
authors.forename: Hulya Ercan
authors.initials: HE
authors.lastname: Saricoban
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozen
authors.forename: Koray
authors.initials: K
authors.lastname: Harmanci
authors.forename: Cem
authors.initials: C
authors.lastname: Razi
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Zahmacioglu
authors.forename: Mehmet Reha
authors.initials: MR
authors.lastname: Cengizlier
mesh_terms: D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000139:chemically induced / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D018709:Statistics, Nonparametric
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D020024:Leukotriene Antagonists