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Abstract
Bronchial Asthma is a worldwide problem, with an estimated 300 million affected individuals, 15 million disability-adjusted life years (DALYs) lost annually and 250,000 annual deaths. Three phenotypes have been recognized; transient early wheezing, non-atopic wheezing (infection induced asthma) and atopic asthma. The role of infectious agents in chronic inflammatory disease processes has become an active area of investigation. There are considerable data implicating bacterial organisms, particularly the atypical bacteria, Chlamydia pneumoniae and Mycoplasma pneumoniae, in asthma pathogenesis and exacerbation. H. pylori has been conclusively linked to different forms of gastro-intestinal and extra-gastro-intestinal diseases including asthma. In our study, we aimed at studying the demographic distribution of the different phenotypes of childhood asthma and H. pylori infection. Also, we tried to find out if there is a relation between H. pylori infection and bronchial asthma in Egyptian school children. The study included 86 randomly selected children, aged 6-12 years, 66 patients suffering from bronchial asthma and 20 healthy age and sex matched children taken as a control group. The patients were divided into 2 groups one with atopic and the other with non-atopic asthma. The children were collected from Mansoura University Children Hospital from 1/10/2008 to1/4/2009. We found that the mean age of the atopic patients was significantly higher than that of the non-atopic ones. The prevelance of asthmatic males was more than that of the asthmatic females but the difference was insignificant and no significant difference has been found between the prevalence of asthma in the rural and urban areas. This may be due to rapid urbanization of our rural societies. In our study, atopic asthma was found to be commoner in spring; may be due to the wide spread of pollen grains but, non-atopic asthma was commoner in winter. This may be due to the higher incidence of acute respiratory infections in this season.Our results showed that atopic children first presented in ages significantly older than the non-atopic ones. Also, our study showed significantly higher incidences of other types of atopy and positive family history of atopy in the atopic group versus the non-atopic group. Moreover, we found highly significant increment in the eosinophilic count and serum IgE in the atopic group when compared with the non-atopic and the control groups. Our study declared significantly higher incidences of leukocytosis (80.6%; P<0.001), myeloid shift to the left (61.1%; P<0.001) and elevated CRP (69.4%; P<0.001) in the non-atopic group of patients indicating that infection which affects the Egyptian non-atopic asthmatic children is bacterial in more than 60% of cases and is viral in only 16.7% of them. This may be due to the warm weather usually encountered in Egypt and it may throw a beam of light on the role of antibiotic therapy in the management of some asthma phenotypes in our country. In our study, the prevalence of H. pylori infection was found to be 16.7% in the atopic group, 8.3% in the non-atopic one and 10% among the controls but the differences were not statistically significant. There is a large debate about the interaction between H. pylori and asthma. Some investigators detected inverse relations between H. pylori and asthma and allergy, others stated that H. pylori infection increases the risk of asthma and others found no relation between the two diseases. In our study, we didn’t find any significant differences in the estimate of H. pylori infection between the studied groups. This may be due to the spontaneous clearance of the infection suggested by Abu-Elyazeed et al., (2000) or due to the effect of the frequently used antibiotics throughout early childhood postulated by the Helicobacter foundation in 2006. Also, we found no significant correlation between H. pylori infection and either demographic data (age, sex and residence), atopic manifestations (history of another atopy, family history of atopy, eosinophilia and serum IgE) or markers of infection (total leucocytic count, myeloid shift and CRP) which suggest that there is no relation between H. pylori and the atopic or non-atopic groups separately.