Pediatric asthma emergency: a peak attendance during the school year

The school year in early September, is associated with a peak attendance of emergency services by children with asthma, U.S. researchers find in the "Archives of Pediatric and Adolescent Medicine."

Asthmatic symptoms varies depending on the season, with rare exacerbations midsummer and more frequent at the beginning of the autumn crisis, find Dr. Robert Silverman, the emergency department at Long Island Jewish Medical Center, and colleagues . They therefore wanted to test whether the fall spike in traffic emergencies by young asthmatics was associated with the school year. To do this, they reviewed the records of persons admitted to the emergency room for asthma exacerbation during the school year (30 days before and 30 days after) consecutive years (1991 to 2002).

Eleven municipal hospitals in New York City participated in the study, which the authors compared the data collected from different groups of children (2-4 years, 5-11 years, 12-17 years) as well as with an aged 22-45 years adult population, using group "control". For each age taken into account, the authors compared the rates of visits to emergency due to recorded during the previous month and the months of the school year asthma. In addition, factors beyond the resumption of classes, but can also affect asthma emergency visits (day of the week, temperature changes ...) were also considered in the analysis.

Various calculations have allowed them to observe the return to school is associated with an increase in the number of emergency room visits for young asthmatics, which amounts to 46% for students enrolled in primary school. If the association between the school year and increased visits to emergency turned up for these young children aged 5 to 11 years, it has also been observed in children aged 2 to 4 years in nursery school (19% of increase in the number of emergency room visits during the fall) and in adolescents 12 to 17 years (13% increase).

However, the increase in the number of emergency room visits during the school year in adults proved markedly less (7% maximum).

The beginning of the school year is associated with an increase in attendance by young asthmatic emergencies, especially for school children in primary school, the authors report, which indicates that this marked increase is preceded by a gradual increase during the period preceding the school year. However, the existence of "a temporal relationship between the school year and an increase in attendance by emergency asthmatic children provided does not establish a causal relationship," they warn.

These results suggest that factors outside of school explain this increase in attendance of emergencies by young asthmatics in early fall. U.S. researchers warn such as respiratory infections, which may be the cause of asthma exacerbations, then begin to manifest and can spread rapidly in a classroom.

In addition, various studies have highlighted in classrooms the presence of allergens from cats and dogs (students with a pet carry unwittingly hairs or feathers on their clothes), or the presence of cockroach allergens in the dust.

But the link between school exposure to these allergens and the development of allergic symptoms has not been demonstrated, note-researchers.

Finally, another parameter that can possibly explain this link: stress. "Emotional factors and stress may influence asthma, although the possibility that stress directly related to schooling influences asthma exacerbations has not been demonstrated," note the authors of this study.

But the main interest of this study lies in the fact that the pattern of worsening asthma autumn could provide an opportunity for intervention.

According to them, these findings underscore the need to determine in a prospective study whether the fact to initiate or enhance a control treatment of asthma before school would alleviate the worsening autumn this respiratory disease .