Many asthmatic children 'passive smokers' at home

Parents of children with asthma or wheezing take great precautions to clear their home of substances that can trigger an attack but about 50 per cent still expose their offspring to cigarette smoke.

Stephen Montefort, consultant respiratory physician and senior lecturer in medicine, said recent studies carried out among Maltese households implied that although parents were tuning in to advice to remove mite-harbouring blankets or fitted carpets from their children's bedrooms, in about half of the households children were unwittingly passive smokers.

"There is a strong correlation between passive smoking and wheezing in Maltese children as those who inhaled their parents' cigarette smoke were more likely to experience exercise-induced wheezing and have potentially fatal acute asthmatic attacks," Dr Montefort said.

He also pointed out that it was sad to see mothers who had succeeded in quitting smoking during their pregnancy but who lit up again after the child was born, making their babies more susceptible to wheezing.

"We get a lot of parents asking what they can do to protect their child's health. However, when it comes to smoking or getting rid of a precious pet they are more reluctant to take action," he said.

Pets, especially cats and birds were the greatest contributors to allergies, with cat fur being present in the house up to three months after the animal has left.

This trend is very similar to attitudes witnessed abroad and a recent study by a team of researchers at the University of Michigan cited as an example a situation where parents bought a new mattress to ward off dust mites but then failed to shut the windows to keep out the pollen.

In the first years of their child's life, parents should avoid soft toys and fitted carpets, which harbour dust mites and could cause life-long sensitisation to such allergens.

Dr Montefort said a study carried out among 30 Maltese children with wheezing clearly showed that those who had a heavier load of mites in their bedroom carpets and mattresses, as well as having tested positive for mites in a skin test, were more likely to have a decrease in lung function.

In Malta, wheezing among five to eight-year-olds, which is commonly a symptom of asthma or allergy, has increased by more than 50 per cent in the past seven years, according to figures by the International Study of Asthma and Allergies in Childhood (ISAAC). The incidence has trebled since a 1985 local study on wheezing.

Wheezing is the symptom while asthma is the condition and the most common reason for recurrent wheezing.

"Persistent wheezing normally starts in early childhood and continues into adolescence. In a good 50 per cent of the cases, the symptoms will become so mild that they would just need some reliever inhaled treatment when needed," Dr Montefort said.

"However, a good proportion of children who wheeze in infancy will develop some degree of asthma. If the child has another allergic condition then the chances are much greater."

Inflammation of the airways lining played a major role in asthma and therefore it was imperative that it was treated with anti-inflammatory medication such as small doses of inhaled steroids.

Studies showed parents still held misconceptions on the use of inhalers and inhaled steroids, which if used in the right way and the right dose were extremely safe. "Misconceptions on the safety of these drugs leads to decreased compliance with treatments, which means a patient's respiratory symptoms are not controlled and could lead to life-threatening attacks," he said.

However, not all hope is lost and apart from very effective treatment there are a lot of measures and devices which can be very helpful to alleviate the situation.

Dr Montefort said that in every square metre of carpet or mattress there were more than 100,000 house dust mites, which fed on shed scales of dead skin. The allergy was not towards the mite itself but towards its excrement.

Mattresses with a lot of springs were also a good nest for dust mites and these should be frequently steamed or exposed in the sun as mites cannot cope with extreme temperatures.

It was also important to frequently clean the filters of air-conditioners while ensuring the room temperature was not very cold at night since this could induce coughing.

As Malta remains among the top in the world in the league table of asthma and wheezing, Dr Montefort recommends that the government continue its efforts to enforce the new smoking regulations and have better air monitoring controls.

It was also important to improve the present diagnostic and treatment facilities.

In an attempt to create awareness, the Malta Asthma Society has been set up recently by Dr Montefort and Anna Mallia.

The newly set up committee is made up of asthmatics and their main objective is to support patients and their families, who may feel isolated or discriminated against. The society also aims to raise funds to assist local scientific research in the field. Whoever wishes to join the society can send a membership fee of Lm2 to the Malta Asthma Society c/o St James Hospital, Zabbar.