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Asthma has been reported in children as a leading chronic illness in the US and around the world. It is also the third leading cause of hospitalization among children under the age of 15, and is also one of the most common causes of school absenteeism. Children are at higher risk of asthma attacks and they pose a higher burden on health care system. Nearly 20.6% of middle and high school children in Florida have been told they have asthma, this prevalence has grown over 3% from 2006 to 2012. Changes in air pollutant levels are often related to health outcomes, e.g. prevalence of chronic asthma. Exposure to ambient air pollutants have been reported to exacerbate asthma attacks especially in children. Often agencies and governing bodies utilize national level health impact assessments (HIAs) to estimate local levels of health impacts. The US EPA (Environmental Protection Agency) developed the Benefit Mapping and Analysis Program (BenMAP) to estimate impacts on health due to changes in air pollution. Recent studies have shown that assessment of regional exposure is important to understand health impacts of pollutants at the local level. To use BenMAP effectively for HIA in Florida, one may have to update the prevalence rates and concentration response (CR) functions in BenMAP with Florida data. The main purpose of the research was to develop a method which can estimate impact of change in criteria pollutants on childhood asthma outcomes in Florida. The rates present in BenMAP are based on national estimates, which are higher than the rates for Florida. If these rates are used for the HIA method then the change in asthma emergency department visits estimated by BenMAP may be an overestimate with higher uncertainties. There are no baseline rates for asthma exacerbation ED visits in BenMAP, an asthma exacerbation is a more severe and poorly managed case of asthma. Asthma ED visit prevalence rates will tend to overestimate the asthma exacerbation rates by 64%, if used. Detailed review of US-EPA’s BenMAP software and peer reviewed literature was performed to identify the gaps in BenMAP for asthma assessments. The CR functions were developed using local pollutant and outcomes data. CR functions were added to BenMAP to bridge the gaps. The baseline prevalence and exacerbation rates at county level by age group, gender and race ethnicity were developed. This study highlights that an increase of 10 µg/m3 of PM2.5 contributes about 2% to asthma ED visit rate, in children 5-12 and is lower, for 13-18 olds (0.6%). The baseline prevalence and exacerbation rates at county level for asthma in children differed by race/ethnicity. This study publishes the ED rates by county and by gender, race and ethnicity from 2010 to 2014, which are recent rates and have not been published to such granularity by the State or by any other researcher. Current pollutant data in BenMAP is only available through 2008, and EPA has recommended it should be updated for analysis purposes. This study has updated the monitor data in BenMAP for Florida counties for 2010-2014. There are three major contributions of this study. Firstly, the study contributes to publishing childhood emergency department prevalence rates for asthma and exacerbation in the State of Florida by age group, race/ethnicity and gender. Secondly, development of concentration response functions specific to Florida using the time series analysis to show the impact of PM2.5 on asthma exacerbation emergency department visits, incorporating both temporal and spatial variability of PM2.5 during the study period. Finally, the study demonstrates the utility of using local (county-level) baseline asthma prevalence rates and local pollutant data for State HIA in Florida. The local PM2.5 data in BenMAP can be used for other health outcome assessments, researchers will only have to update the prevalence rates for the health outcome used in their study. Estimation using local data will be less prone to uncertainties using National level data, the use of local data has been emphasized by several researchers. The study recommends future work in refining spatial grid resolution in BenMAP to zip code level to facilitate studies at neighborhood level. Another recommendation is to further design research to study SES in context to dietary changes and better understand social injustices in areas with diverse population. A population-based study in conjunction with Florida Asthma Coalition (FAC) asthma cases from doctors’ offices is recommended which will be able to control for misclassifications, and include weather and allergens in analysis while studying individual pattern of exposure and diet.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-04-23T14:59:21Z No. of bitstreams: 2 Tese - Lusmaia Damaceno Camargo Costa - 2014.pdf: 1127224 bytes, checksum: 0d8abb81e39218ff98c2ffb7471822f8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-04-23T15:01:32Z (GMT) No. of bitstreams: 2 Tese - Lusmaia Damaceno Camargo Costa - 2014.pdf: 1127224 bytes, checksum: 0d8abb81e39218ff98c2ffb7471822f8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-04-23T15:01:32Z (GMT). No. of bitstreams: 2 Tese - Lusmaia Damaceno Camargo Costa - 2014.pdf: 1127224 bytes, checksum: 0d8abb81e39218ff98c2ffb7471822f8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-04-25 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Objective: to describe the prevalence of respiratory viruses in children with asthma during exacerbation and compare with those non-exacerbated and nonasthmatic children during acute respiratory infection. Methods: In this cross-sectional study nasopharyngeal aspirate/swab from children (4-14 years) was collected between August-2012 and August-2013 in a city (Goiânia) in Center-Brazil. There were 92 with exacerbated asthma (EA), 72 non-asthmatic with acute respiratory infection (ARI) in emergency room, and 61 non exacerbated asthmatic (NEA) treated in specialized clinics. The samples were tested to indirect immunofluorescence using the Respiratory Panel I (Chemicon. MA, USA) and RT-PCR kit rhinovirus. The study was approved by the ethics committee of the HC / UFG and statistical analysis performed with the SPSS v.20 software (SPSS Inc., Chicago, IL). The chi-square test was used to compare categorical variables and Kruskal-Wallis test to compare medians, pvalue< 0.05 was considered significant. Results: the sample consisted of 225 children, mostly male (59.5%) with median age of seven years. The viral prevalence was 91.1% and rhinovirus was the most commonly detected (67.6%), with no significant difference in incidence among all groups. Other viruses were identified: influenza A (13.2%), adenovirus (7.5%), influenza B (3.5%), respiratory syncytial virus (2.8%), parainfluenza 2 (2.8%) and parainfluenza 1 (2.5%). Adenovirus were more frequent in ARI (p=0.25). The EA group compared to the NEA group had cough at night (p<0.01), symptoms on exertion (p<0.01), medical visits (p<0.01) and hospitalizations for asthma (p<0.01) in the last 12 months and less use of medication (8.6%) for asthma control (p<0.01). Conclusions: the prevalence of viral detection was high (90.1%) in all patients (EA, NEA and ARI) and rhinovirus was the most prevalent agent, without differences between groups while adenovirus was more common in nonasthmatic children. Children with exacerbated asthma had parameters of uncontrolled disease in the last 12 months. Asthmatic children with nonexacerbated disease had no exacerbation although most of them had viruses in their nasopharynx, probable because of the regular use of inhaled corticosteroids. / Objetivo: descrever a prevalência de vírus respiratórios em crianças asmáticas durante exacerbação e comparar com grupo de crianças asmáticas não exacerbadas e crianças não asmáticas durante episódio de infecção respiratória aguda. Métodos: Em um estudo transversal foram realizadas coletas de aspirado/swabnasofaríngeo de crianças com idade entre 4 e 14 anos no período de agosto/2012 a agosto/2013, na cidade de Goiânia. Foram estudados 92 asmáticas exacerbadas (AE) e 72 crianças não asmáticas com sintomas de infecção respiratória aguda (IRA), atendidas em unidades de emergência em Goiânia-GO. No mesmo período, foram coletadas amostras de 61 crianças asmáticas não exacerbadas (ANE) atendidas em ambulatório especializado. As amostras foram submetidas à reação de imunofluorescência indireta utilizando o kit RespiratoryPanel I (Chemicon. MA, USA) para os vírus influenza A e B, parainfluenza 1 a 3, adenovírus e vírus sincicial respiratório e o RT-PCR para o rinovírus. O trabalho foi aprovado pelo comitê de ética do HC/UFG. A análise estatística foi realizada com o auxílio do software SPSS v.20 (SPSS Inc.; Chicago, IL) e o STATA v 12.0 (StataCorp, CollegeStation, TX, EUA). O teste qui-quadrado foi utilizado para comparar variáveis categóricas e aquelas com p<0,10 foram submetidas à análise de regressão logística. O teste de Kruskal-Wallis foi utilizado para comparar as medianas de idade. Para todos os testes, o valor de p<0,05 foi considerando significativo. Resultados: a amostra final foi constituída por 225 crianças, a maioria do sexo masculino (59,5%) e a mediana de idade foide sete anos. A prevalência de detecção viral foi 91,1% e o rinovírus foi o mais frequente (67,6%), sem diferença significativa entre os três grupos. Outros vírus identificados foram: influenza A (13,2%), adenovírus (7,5%), influenza B (3,5%), sincicial respiratório (2,8%), parainfluenza2 (2,8%) e parainfluenza 1 (2,5%). O adenovírus foi mais frequente no grupo com IRA (p=0,25). O grupo AE quando comparado ao grupo ANE apresentou mais tosse noturna (p<0,01), sintomas aos esforços (p<0,01), consultas (p<0,01) e internações por asma (p<0,01) nos últimos 12 meses e menor uso de medicamento (8,6%) para controle da asma (p<0,01). Após análise de regressão, os parâmetros consulta prévia (≥3) no último ano (p= 0,42) e ausência de uso de corticosteróide inalatório (p<0,01) permaneceram significativamente associados à exacerbação. Conclusões: prevalência de identificação viral foi elevada (91,1%) de forma homogênea entre os pacientes (AE, ANE e IRA) e o rinovírus foi o agente mais prevalente, em todos os grupos. O adenovírus esteve mais presente nas crianças não asmáticas com sintomas de infecção respiratória (IRA). As crianças exacerbadas apresentavam parâmetros de não controle da doença e menor uso de corticosteroide inalatório, enquanto as não exacerbadas, apesar de apresentarem o vírus na secreção nasofaríngea, não apresentaram exacerbação, possivelmente pelo uso regular de corticosteroide inalatório.

Abstract Dyspnoea associated with respiratory infection is a common symptom in infancy and early childhood. Inspiratory stridor is the main symptom in cases of croup and expiratory wheezing in cases of bronchiolitis, obstructive bronchitis and acute asthma exacerbations. Dyspnoea associated with respiratory infection is a common cause of emergency department visits and unplanned hospital admissions among infants and preschool children. The assessment of dyspnea associated with acute childhood respiratory infection is largely subjective, and evidence regarding the severity of acute dyspnoea is needed in order to target hospital admissions more accurately. Wheezing associated with respiratory infection in infancy has been recognized as an important predictor of recurrent wheezing and asthma at school age. The aims of this study were to determine the risk factors for croup, to evaluate factors that reliably predict the need for hospitalizing children with acute wheezing and to find out whether respiratory infection with wheezing during infancy has a positive association with the development of asthma during childhood. The work included two register-based surveys and one prospective cohort study. It is concluded that a family history of croup is an exceptionally strong risk factor for croup and its recurrence in childhood. The early phase of bronchiolitis is unstable in infants below 6 months of age. These infants are most likely to need medical interventions in the first 5 days after onset of the disease. A positive respiratory syncytial -virus test result, a fever of more than 38°C and low initial oxygen saturation are predictors of the need for hospitalization and medical interventions. An initial oxygen saturation &gt;93% effectively identifies children aged more than 6 months with mild wheezing, and this limit can be used to avoid unplanned hospital admissions. There is an association between early respiratory syncytial -virus infections and subsequent wheezing and asthma, in that such infections select children who are prone to wheezing and asthma before school age, but the symptoms tend to decrease with time and an early respiratory syncytial -virus infection will not permanently alter bronchial reactivity. / Tiivistelmä Hengitysvaikeus on yleinen oire lapsilla virusten aiheuttamien hengitystieinfektioiden yhteydessä. Kurkunpäätulehdukseen liittyy sisäänhengitysvaikeus. Ilmatiehyttulehdukseen, ahtauttavaan keuhkoputkentulehdukseen ja akuuttiin astmakohtaukseen liittyy uloshengitysvaikeus. Hengitystieinfektioihin liittyvä hengitysvaikeus on yksi yleisimmistä syistä päivystyspoliklinikkakäynteihin ja äkillisiin sairaalahoitojaksoihin lapsipotilailla. Hengitystieinfektioiden taudinkulun tuntemisella ja hengitysvaikeuden vaikeusasteen arvioinnilla on tärkeä merkitys näiden potilaiden hoidon toteuttamisessa. Hengitystieinfektioon liittyvää hengitysvaikeutta on pidetty riskitekijänä astman kehittymiselle. Tämän tutkimuksen tarkoituksena oli selvittää kurkunpäätulehduksen riskitekijöitä ja sairaalahoitoon vaikuttavia tekijöitä hengitystieinfektioon liittyvän uloshengitysvaikeuden hoidossa sekä varhaislapsuudessa sairastetun hengitystieinfektion yhteyttä myöhempään astma- ja allergiasairastavuuteen. Tutkimukseen sisältyi kaksi rekisteriaineistoa ja yksi seurantatutkimusaineisto. Tutkimuksessa todettiin, että kurkunpäätulehduksen uusiutuminen on erittäin tavallista ja sisarusten ja vanhempien sairastama kurkunpäätulehdus on merkittävin riskitekijä kurkunpäätulehdukselle ja sen uusiutumiselle. Alle 6 kuukauden ikäisillä lapsilla ilmatiehyttulehduksen taudinkuva on epävakaa ensimmäisen 5 oirepäivän aikana. Kuume, matala happisaturaatioarvo ja respiratory syncytial -virusinfektio ennustavat osastohoidon ja invasiivisten toimenpiteiden tarvetta ilmatiehyttulehduksen yhteydessä. Yli 6 kuukauden ikäisillä lapsilla happisaturaatioarvo &gt; 93 % ennustaa lievää taudinkuvaa hengitystieinfektioon liittyvän uloshengitysvaikeuden hoidossa. Käyttämällä tätä happisaturaatioarvoa raja-arvona, kun arvioidaan sairaalahoidon tarvetta, voidaan merkittävästi ja turvallisesti vähentää sairaalahoidon tarvetta lasten hengitystieinfektioon liittyvän uloshengitysvaikeuden hoidossa. Alle 6 kuukauden iässä sairastettu respiratory syncytial -virusinfektio on riskitekijä varhaislapsuudessa ilmeneville astmaoireille, mutta tämä riski vähenee iän myötä ja 8 vuoden iässä ei ole havaittavissa eroja astma- ja allergiasairastavuudessa, kun verrataan näitä potilaita muun hengitystieinfektion sairastaneisiin potilaisiin ja terveisiin kontrollipotilaisiin.

L’asthme est connu comme l’une des maladies chroniques les plus fréquentes chez la femme enceinte avec une prévalence de 4 à 8%. La prévalence élevée de l’asthme fait en sorte qu’on se préoccupe de l’impact de la grossesse sur l’asthme et de l’impact de l’asthme sur les issus de la grossesse. La littérature présente des résultats conflictuels concernant l’impact de l’asthme maternel sur les issus périnatales comme les naissances prématurées, les bébés de petit poids et les bébés de petit poids pour l’âge gestationnel (PPGA). De plus, les données scientifiques sont rares concernant l’impact de la sévérité et de la maîtrise de l’asthme durant la grossesse sur les issus périnatales. Donc, nous avons mené cinq études pour réaliser les objectifs suivants: 1. Le développement et la validation de deux indexes pour mesurer la sévérité et la maîtrise de l’asthme. 2. L’évaluation de l’impact du sexe du fœtus sur le risque d’exacerbation de l’asthme maternel et l’utilisation de médicaments antiasthmatiques durant la grossesse; 3. L’évaluation de l’impact de l’asthme maternel sur les issus périnatales; 4. L’évaluation de l’impact de la sévérité de l’asthme maternel durant la grossesse sur les issus périnatales; 5. L’évaluation de l’impact de la maîtrise de l’asthme maternel durant la grossesse sur les issus périnatales. Pour réaliser ces projets de recherche, nous avons travaillé avec une large cohorte de grossesse reconstruite à partir du croisement de trois banques de données administratives du Québec recouvrant la période entre 1990 et 2002. Pour les trois dernières études, nous avons utilisé un devis de cohorte à deux phases d’échantillonnage pour obtenir, à l’aide d’un questionnaire postal, des informations complémentaires qui ne se trouvaient pas dans les banques de données, comme la consommation de cigarettes et d’alcool pendant la grossesse. Nous n’avons trouvé aucune différence significative entre les mères de fétus féminins et de fétus masculins pour les exacerbations de l’asthme pendant la grossesse (aRR=1.02; IC 95%: 0.92 to 1.14). Par contre, nous avons trouvé que le risque de bébé PPGA (OR: 1.27, IC 95%: 1.14-1.41), de bébé de petit poids (OR: 1.41, IC 95%:1.22-1.63) et de naissance prématurée (OR: 1.64, IC 95%:1.46-1.83) était significativement plus élevés chez les femmes asthmatiques que chez les femmes non asthmatiques. De plus, nous avons démontré que le risque d’un bébé PPAG était significativement plus élevé chez les femmes avec un asthme sévère (OR:1.48, IC 95%: 1.15-1.91) et modéré (OR: 1.30, IC 95%:1.10-1.55) que chez les femmes qui avaient un asthme léger. Nous avons aussi observé que les femmes qui avaient un asthme bien maîtrisé durant la grossesse étaient significativement plus à risque d’avoir un bébé PPAG (OR:1.28, IC 95%: 1.15-1.43), un bébé de petit poids (OR: 1.42, IC 95%:1.22-1.66), et un bébé prématuré (OR: 1.63, IC 95%:1.46-1.83) que les femmes non asthmatiques. D’après nos résultats, toutes les femmes asthmatiques même celles qui ont un asthme bien maîtrisé doivent être suivies de près durant la grossesse car elles courent un risque plus élevé d’avoir des issus de grossesses défavorables pour leur nouveau-né. / Asthma is known as one of the most frequent chronic diseases encountered during pregnancy with prevalence estimated between 4 and 8%. The high prevalence of asthma during pregnancy results in some concerns about the impact of pregnancy on maternal asthma and also the impact of maternal asthma on perinatal outcomes. The literature presents conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes, such as preterm birth, low-birth-weight (LBW) infant and small-for-gestational-age (SGA) infant. Also, scientific evidence is scarce regarding the impact of asthma severity and control during pregnancy on these perinatal outcomes. We thus conducted a research project composed of five studies to achieve the following objectives: 1. to develop and validate two database indexes, one to measure the control of asthma and the other to measure asthma severity; 2. to evaluate the effect of fetal gender on maternal asthma exacerbations and the use of asthma medications during pregnancy; 3. to evaluate the impact of maternal asthma on adverse perinatal outcomes; 4. to evaluate the impact of the severity of asthma during pregnancy on adverse perinatal outcomes; 5. to evaluate the impact of adequately controlled maternal asthma during pregnancy on adverse perinatal outcomes. A large population-based cohort was reconstructed through the linking of three of Quebec’s (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the women’s life-style habits by way of a mailed questionnaire for the three last studies. We have observed no significant differences between mothers of a female and male fetus as to the occurrence of asthma exacerbations (aRR=1.02; 95% CI: 0.92 to 1.14). We have found that the risk of SGA (OR: 1.27, 95% CI: 1.14-1.41), LBW (OR: 1.41, 95% CI:1.22-1.63) and preterm delivery (OR: 1.64, 95%CI:1.46-1.83) was significantly higher among asthmatic than non-asthmatic women. Moreover, our results showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15-1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10-1.55) than mild asthmatic women. Also, mothers with adequately controlled asthma during pregnancy were found to be at higher risk of adverse perinatal outcomes than non-asthmatic women (SGA (OR:1.28, 95%CI: 1.15-1.43), LBW (OR: 1.42, 95%CI:1.22-1.66), and preterm deliveries (OR: 1.63, 95%CI:1.46-1.83)). According to our results, all asthmatic women even those with adequately controlled asthma should be closely monitored during pregnancy because they are at increased risk of adverse perinatal outcomes.

L’asthme est connu comme l’une des maladies chroniques les plus fréquentes chez la femme enceinte avec une prévalence de 4 à 8%. La prévalence élevée de l’asthme fait en sorte qu’on se préoccupe de l’impact de la grossesse sur l’asthme et de l’impact de l’asthme sur les issus de la grossesse. La littérature présente des résultats conflictuels concernant l’impact de l’asthme maternel sur les issus périnatales comme les naissances prématurées, les bébés de petit poids et les bébés de petit poids pour l’âge gestationnel (PPGA). De plus, les données scientifiques sont rares concernant l’impact de la sévérité et de la maîtrise de l’asthme durant la grossesse sur les issus périnatales. Donc, nous avons mené cinq études pour réaliser les objectifs suivants: 1. Le développement et la validation de deux indexes pour mesurer la sévérité et la maîtrise de l’asthme. 2. L’évaluation de l’impact du sexe du fœtus sur le risque d’exacerbation de l’asthme maternel et l’utilisation de médicaments antiasthmatiques durant la grossesse; 3. L’évaluation de l’impact de l’asthme maternel sur les issus périnatales; 4. L’évaluation de l’impact de la sévérité de l’asthme maternel durant la grossesse sur les issus périnatales; 5. L’évaluation de l’impact de la maîtrise de l’asthme maternel durant la grossesse sur les issus périnatales. Pour réaliser ces projets de recherche, nous avons travaillé avec une large cohorte de grossesse reconstruite à partir du croisement de trois banques de données administratives du Québec recouvrant la période entre 1990 et 2002. Pour les trois dernières études, nous avons utilisé un devis de cohorte à deux phases d’échantillonnage pour obtenir, à l’aide d’un questionnaire postal, des informations complémentaires qui ne se trouvaient pas dans les banques de données, comme la consommation de cigarettes et d’alcool pendant la grossesse. Nous n’avons trouvé aucune différence significative entre les mères de fétus féminins et de fétus masculins pour les exacerbations de l’asthme pendant la grossesse (aRR=1.02; IC 95%: 0.92 to 1.14). Par contre, nous avons trouvé que le risque de bébé PPGA (OR: 1.27, IC 95%: 1.14-1.41), de bébé de petit poids (OR: 1.41, IC 95%:1.22-1.63) et de naissance prématurée (OR: 1.64, IC 95%:1.46-1.83) était significativement plus élevés chez les femmes asthmatiques que chez les femmes non asthmatiques. De plus, nous avons démontré que le risque d’un bébé PPAG était significativement plus élevé chez les femmes avec un asthme sévère (OR:1.48, IC 95%: 1.15-1.91) et modéré (OR: 1.30, IC 95%:1.10-1.55) que chez les femmes qui avaient un asthme léger. Nous avons aussi observé que les femmes qui avaient un asthme bien maîtrisé durant la grossesse étaient significativement plus à risque d’avoir un bébé PPAG (OR:1.28, IC 95%: 1.15-1.43), un bébé de petit poids (OR: 1.42, IC 95%:1.22-1.66), et un bébé prématuré (OR: 1.63, IC 95%:1.46-1.83) que les femmes non asthmatiques. D’après nos résultats, toutes les femmes asthmatiques même celles qui ont un asthme bien maîtrisé doivent être suivies de près durant la grossesse car elles courent un risque plus élevé d’avoir des issus de grossesses défavorables pour leur nouveau-né. / Asthma is known as one of the most frequent chronic diseases encountered during pregnancy with prevalence estimated between 4 and 8%. The high prevalence of asthma during pregnancy results in some concerns about the impact of pregnancy on maternal asthma and also the impact of maternal asthma on perinatal outcomes. The literature presents conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes, such as preterm birth, low-birth-weight (LBW) infant and small-for-gestational-age (SGA) infant. Also, scientific evidence is scarce regarding the impact of asthma severity and control during pregnancy on these perinatal outcomes. We thus conducted a research project composed of five studies to achieve the following objectives: 1. to develop and validate two database indexes, one to measure the control of asthma and the other to measure asthma severity; 2. to evaluate the effect of fetal gender on maternal asthma exacerbations and the use of asthma medications during pregnancy; 3. to evaluate the impact of maternal asthma on adverse perinatal outcomes; 4. to evaluate the impact of the severity of asthma during pregnancy on adverse perinatal outcomes; 5. to evaluate the impact of adequately controlled maternal asthma during pregnancy on adverse perinatal outcomes. A large population-based cohort was reconstructed through the linking of three of Quebec’s (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the women’s life-style habits by way of a mailed questionnaire for the three last studies. We have observed no significant differences between mothers of a female and male fetus as to the occurrence of asthma exacerbations (aRR=1.02; 95% CI: 0.92 to 1.14). We have found that the risk of SGA (OR: 1.27, 95% CI: 1.14-1.41), LBW (OR: 1.41, 95% CI:1.22-1.63) and preterm delivery (OR: 1.64, 95%CI:1.46-1.83) was significantly higher among asthmatic than non-asthmatic women. Moreover, our results showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15-1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10-1.55) than mild asthmatic women. Also, mothers with adequately controlled asthma during pregnancy were found to be at higher risk of adverse perinatal outcomes than non-asthmatic women (SGA (OR:1.28, 95%CI: 1.15-1.43), LBW (OR: 1.42, 95%CI:1.22-1.66), and preterm deliveries (OR: 1.63, 95%CI:1.46-1.83)). According to our results, all asthmatic women even those with adequately controlled asthma should be closely monitored during pregnancy because they are at increased risk of adverse perinatal outcomes.