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September 2000

Nocturnal Asthma in Children Affects School Attendance, School Performance, and Parents' Work Attendance

Author Affiliations

From the Divisions of Pulmonary and Critical Care Medicine (Dr Diette) and General Medicine (Dr Wu), and the Department of Pediatrics (Dr Nguyen), School of Medicine, and the Departments of Epidemiology (Drs Diette and Wu) and Health Policy and Management (Ms Skinner and Dr Wu), School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md; and Merck & Co Inc, West Point, Pa (Drs Markson and Algatt-Bergstrom).

Arch Pediatr Adolesc Med. 2000;154(9):923-928. doi:10.1001/archpedi.154.9.923

Context  Asthma symptoms that occur at night may signal worse asthma control, but the nighttime occurrence may have additional clinical significance. To date, however, there have been few studies of the impact of nocturnal awakening from asthma on children with the disease, including problems with daytime functioning.

Objective  To determine if school absenteeism and school performance in children and work absenteeism in their parents are associated with nocturnal awakenings from asthma.

Design  Cross-sectional survey during the winter of 1997 through 1998.

Setting  Three managed care organizations in the United States.

Participants  Parents of 438 children with asthma, aged 5 to 17 years, who were enrolled in managed care organizations.

Intervention  None.

Main Outcome Measures  Parent's reports of number of days their child missed school and parent missed work and how often the child's education suffered because of asthma in the past 4 weeks.

Results  Overall, more than 40% of children had nocturnal awakenings from asthma in the past 4 weeks. Multivariate analyses were performed that adjusted for child age, race, overall symptom severity, and use of reliever medications. Compared with children who did not awaken from asthma, there were greater odds of missed school days in children who awakened 1 to 3 nights (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.1-6.2), 4 to 7 nights (OR, 4.4; 95% CI, 2.0-10.0), and more than 7 nights (OR, 14.7; 95% CI, 5.9-37.0). Similarly, there were greater odds of education suffering in children who awakened 1 to 3 nights (OR, 2.3; 95% CI, 1.4-3.7), 4 to 7 nights (OR, 2.1; 95% CI, 0.9-4.6), and more than 7 nights (OR, 2.3; 95% CI, 1.0-5.4), and parents missing work in children who awakened 1 to 3 nights (OR, 4.0; 95% CI, 2.2-7.1), 4 to 7 nights (OR, 6.5; 95% CI, 2.7-16), and more than 7 nights (OR, 3.2; 95% CI, 1.3-7.9). Greater overall symptom severity and high use of reliever mediation were also associated with missed school, education suffering, and parent absenteeism.

Conclusions  Nighttime awakenings in children with asthma may affect school attendance and performance, as well as work attendance by parents. Nighttime symptoms have independent prognostic value, even when overall asthma symptom severity is accounted for. By addressing whether there are nighttime awakenings in children with asthma, clinicians may be able to tailor the therapeutic regimen to counter these symptoms.