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Infant asthma in Tunisia
E Khaldi1, M Joulak, F Jawahdou
1Hôpital d'Enfants de Tunis, Service de Médecine Infantile A, Tunis Jebbari, Tunisie.
Insights
Pediatric asthma is often missed. In Tunisian infants, asthma onset occurred around 7 months, frequently following bronchiolitis, with many cases showing persistent symptoms and severe attacks, highlighting the need for early identification.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Pediatrics
Background:
- Asthma is a prevalent but frequently underdiagnosed respiratory condition in infants.
- Understanding the clinical and evolutionary patterns of childhood asthma is crucial for effective management.
- Infantile wheezing disorders require careful evaluation to distinguish from other respiratory conditions.
Purpose of the Study:
- To evaluate the clinical features and disease progression of asthma in hospitalized Tunisian infants.
- To identify risk factors associated with severe asthma and unfavorable outcomes in early childhood.
- To determine the prevalence of atopy and specific allergens in infants diagnosed with asthma.
Main Methods:
- Retrospective analysis of hospitalized infants under 30 months with at least three episodes of wheezing dyspnea.
- Data collection included age of onset, preceding illnesses (e.g., acute bronchiolitis), family history of allergies, and atopic eczema.
- Skin prick tests (SPTs) were performed to identify specific allergen sensitization; treatment outcomes were monitored over 24 months.
Main Results:
- Asthmatic infants constituted 43% of the total pediatric asthma cases studied.
- The mean age of respiratory symptom onset was 6.9 months, with 90% of cases initially presenting as acute bronchiolitis.
- Seventeen percent experienced a severe first asthma attack; 15% had atopic eczema. A positive family history of allergy (60%) and positive SPTs (27%, primarily to dust mites) were common. Twenty-seven percent remained symptomatic after 24 months, with 28 patients having moderate to severe asthma.
Conclusions:
- Early-onset asthma in infants, often linked to bronchiolitis and atopy, can have a persistent and severe course.
- Family history of atopy, positive skin prick tests, and previous severe attacks are predictors of poor asthma prognosis in infants.
- Early identification of infants genetically predisposed to atopy and asthma is essential for implementing timely preventive strategies.
Abstract:
Asthma is a frequent often unrecognized disease. The aim of this study was to assess the clinical and evolutive characteristics of this disorder in a population of Tunisian hospitalized infants. This is a retrospective study of infants less than 30 months of age, presenting at least 3 episodes of wheezing dyspnea. Our results showed that asthmatic infants accounted for 43% of total asthmatic children. The onset of respiratory symptoms was at the age of 6.9 (5.2) months. The disease began by acute bronchiolitis in 90% of cases. The first asthma attack was severe in 17% of cases. Atopic eczema was found in 15% of cases. A positive family history of allergic disease was noticed by 60% of the patients, 48% of them being asthma. Skin prick tests were positive in 27% of cases and the most frequently identified allergens were dust mites. Among 175 infants treated during more than 24 months, 27% of cases are still symptomatic. Twenty-eight patients have moderate or severe asthma. Atopic family history, positive skin pricks test and acute attack precedents were predictive factors of an unfavorable evolution. It will be necessary to identify as early as possible infants who are genetically predisposed to develop atopy and asthma so that preventive measures can be instituted.