Household triggers of bronchospasm in children aged less than two years with hyperreactive airway: A multicentre experience

Aims and Objective: Bronchospasm is rarely seen in children less than two years of age unless they are genetically predisposed to allergy and atopy. Hyperreactive airway presenting with bronchospasm in such children is commonly misdiagnosed and managed as chest infections. This study therefore aims at examining the trigger factors of bronchospasm in these children. Setting/Method: The study was carried out in two private medical·centres in florin between June 2002 and May 2003. All children below the age of 2 years presenting with cough and breathlessness of sudden onset with audible wheeze were screened historically for the trigger factors of bronchospasm in their environment. Result: Nine hundred and twenty eight patients were recruited for the study over the one year period. The mean age of the children was 5.4 ΁ 1.3 months (range: 3 weeks to 24 months). There are two peaks of seasons during which the condition is common (July to September, and January to March). There is a male preponderance with a M : F ratio of 1.3:1. The presenting symptoms were cough (100%), breathlessness (100%), expiratory wheeze (97%), restlessness (65%), sleeplessness (63%), excessive sweating (57%), excessive crying (45%), family history of asthma / allergy / atopy (42%), inability to eat / suck (33%), running nose (31%), abdominal pain in the older infant (27%), vomiting (13%),and exhaustion (7%). The observed clinical signs are: tachypnoea (100%), recessions (100%), rhonchi (100%), dehydration (27%), cyanosis (5%), and hepatomegaly (3%) identified trigger factors include: insecticide spray in 36%, fumes from frying oil in 12%, smoke from kerosene stove in 10%, firewood smoke in 8%, dust in 9%, exposure to cold air and fan in 9%, perfume spray in 8%, mosquito coil smoke in 3%, and kerosene aspiration in 1%. All the children responded well to nebulised salbutamol, while only 7% required the addition of steroid and other supportive care where necessary. Conclusion: Identified household trigger factors of bronchospasm in children less than two years of age include: insecticide spray, fumes, smoke from stove and firewood, and exposure to cold air. The elimination of these factors from the environment of the affected child would go a long way in preventing the attacks.