Introduction On the 5th of December 2009, at the 40th Union World Conference on Lung Health in Cancun, Mexico, the American Thoracic Society and the Forum of International Respiratory Societies declared 2010 as the “Year of the Lung”. Asthma features amongst the “big five” of the respiratory diseases worldwide. It is estimated that South Africa has the 25th highest asthma prevalence in the world and the 5th highest case fatality rate in the world. Asthma has been reported as one of the most serious common chronic condition affecting young children. The South African media and government reports states that one in eight children in South Africa has asthma. Children spend a considerable amount of time at school. Teachers are often recognised as in loco parentis at school. Therefore, it is imperative that primary schoolteachers have some knowledge of asthma and its management to ensure that asthmatic school children can be assisted. Aim The aim of this study was to elucidate asthma knowledge and management in primary schools in Umdoni subdistrict. Methods A cross sectional study design was used. Two hundred and twenty six schoolteachers’ from 19 primary schools participated in this paperless survey. An asthma knowledge questionnaire was developed by the researcher in consultation with a paediatric asthma specialist and was fielded using the Mobile Researcher mobile application channel, provided by Clyral. The survey was conducted using cellular telephones that were used to capture teachers’ responses during face-to-face interviews with fieldworkers. The completed surveys were uploaded using general packet radio service (GPRS) to the web-based “Research Centre”. Data were exported to a Microsoft Excel spreadsheet, cleaned and then imported into SPSS 15.10 for analysis. Results This study found that although the majority of primary schoolteachers (61.5%) had above 50% correct answers in the asthma knowledge test, the vast majority (95.1%) felt asthma education was necessary for schoolteachers. The results suggest that although teachers have reasonable knowledge on certain areas regarding asthma, however there is huge gap in their knowledge on the care of a child with an acute exacerbation of asthma. The lack of medical or nursing personnel at these schools means that the initial management of the child during an asthma attack will be in the hands of school personnel. In light of this, it is important to note that 38.5% of participants scored less than 50% on an asthma knowledge test, which denoted poor or limited knowledge of asthma and its management. This study also showed that teachers’ knowledge of asthma and sports was deficient and teachers do have misconceptions about asthmatic children’s abilities. None of the schools had written material to guide the management and care of asthmatic children. Such materials would be necessary, especially in circumstances when prompt action is required in a severe acute asthma attack. Conclusion The results conclude that primary schoolteachers’ knowledge in Umdoni subdistrict is deficient especially in the knowledge of the care of a child with an acute exacerbation of asthma. Teachers in Umdoni subdistrict are in contact with and exposed to asthmatic schoolchildren on a regular basis. Teachers have to cope with asthmatic children who have diverse needs. The importance of enhancing school based asthma health promotion strategies is highlighted by the following recommendations: asthma education training for school personnel, participation and support from Departments of Health and Education and the development and implementation of sound asthma policies in schools. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (Ph.D.)--University of Western Australia, 2005.

Background: Asthma exacerbations are a leading cause of school absenteeism and time lost from work, affecting the quality of life (QOL) of children with asthma and their caregivers. Objective: The objective of this study was to determine the relationship between measures of asthma severity and the QOL of children with asthma and their caregivers living in rural Saskatchewan. Methods: Data for this research was previously collected in 2005-2007 using a case-control study design. Children were recruited for the case control study following a cross-sectional school based survey of children aged 6-18 years. Cases with physician-diagnosed asthma (n=77) were then selected to examine associations between asthma severity and QOL, with respiratory information collected from a home visit, clinic visit and two-week home monitoring of diurnal peak flow variability (DPV). During the clinic visit, children underwent spirometry and completed the Pediatric Asthma QOL Questionnaire (PAQLQ). During the home visit, parents completed the Child Health Questionnaire (CHQ-PF50) and the Pediatric Asthma Caregiver QOL Questionnaire (PACQLQ) and were given instructions on how to complete the two-week diurnal peak flow home monitoring. Higher mean scores on measures of QOL questionnaires indicated better QOL. Asthma severity was measured by Forced Vital Capacity (FVC), Forced Expiratory Volume in one Second (FEV1), and mean DPV. Linear regression was used to assess the association between the three QOL measures and measures of asthma severity (mean diurnal peak flow variability and percent predicted lung function adjusting for smoking, parental education and asthma medication use in the last 12 months). Results: The lowest QOL score on the PAQLQ completed by the children was being bothered by physical activity (mean = 5.8, standard deviation = 1.19) whereas the lowest mean score on the PACQLQ completed by parents was feeling helpless or frightened (mean = 6.1, standard deviation = 1.28). No significant relationships were found between QOL scales. When the PACQLQ and the PAQLQ were stratified by age groups, parents reported higher mean scores for children in the 13-17 age group (p = 0.01) on the total score of the PACQLQ and activity and emotional subscales (p = 0.003 and 0.03, respectively). No significant correlations were found between spirometry measurements and the three QOL measures. Significant negative correlations were found between mean DPV and the mean PAQLQ Total Score. In a post hoc analysis, examining minimum morning peak flow expressed as percent recent best and QOL, significant positive correlations were found between the minimum morning peak flow measurements and the mean PAQLQ Total Score and Activity subscale. Conclusions: While findings from this study suggest that the CHQ-PF50 could be used to assess emotional aspects of QOL in children with asthma, overall, it may not be a useful tool in assessing the QOL of children with asthma. Peak flow may be a better measure of asthma severity than spirometry when assessing QOL for children with asthma and their parents.

Several genes are associated with an increased susceptibility to respiratory diseases, including asthma, which may be exacerbated by ambient air pollution. These genes include the Gluthathione-S-Transferase family (GSTM1 and GST1l) and the NAD(P)H quinone oxidoreductase (NQO1). This, the first genetic epidemiological study conducted in Sub-Saharan Africa had 2 main objectives: I) to evaluate whether the above genotypes confer susceptibility to asthma and related phenotypes; and 2) to investigate if polymorphisms in these genes known to modulate the response to or protect from epithelial oxidative damage modify pulmonary response to ambient air pollutants. A total of 369 schoolchildren from seven primary schools in a heavily industrialized region of south Durban and a demographically similar area in north Durban, Kwa-Zulu Natal, South Africa during the period May 2004 - October 2005, participated in the study. DNA was extracted from whole blood using the GENTRA Puregene kit. Genotyping for the GSTM1 (null vs present genotype) was done using multiplex PCR while the GSTP1 (I1e105Val; AA>AG/GG) and the NQO1(Pro/Ser; CC>CT/TT) genotypes were determined using real time PCR and Taqman probes (Applied Biosystems). Persistent asthma and asthma of "any severity" was determined by questionnaires based on the ATS and BRMC questionnaires. Positive atopy was determined by at least one positive skin test reaction to the seven allergens tested. Other health assessments included spirometry, methacholine challenge testing and four cycles of three-week serial peak flow measurements. Acute respiratory measures included within day variability in FEV1 and PF and the lowest valid values on a given day. SO2. NO2, NO and PM10 were measured over a year using ultraviolet fluorescence, gas-phase chemiluminescence and gravimetric methods respectively. STATA (version 9, College Station, TX, USA) was used for data analysis. Multiple logistic models and Pearson's chi-squared tests were used to evaluate the association between asthma, BHR, atopy and genotype. Covariate-adjusted generalised estimating equations (GEE) with lags of 1-5 days were used to evaluate genotype effect modification of exposure-response. The GSTM1 gene deletion (GSTM1null) was detected in 28.9% of the study population while the distribution of GSTP1 AG/GG and the NQO1 CT/IT polymorphisms were 64.9% and 36.0% respectively. Multiple regression with the adjustment for relevant covariates indicated that individuals carrying one or more copies of the GSTP 1 minor allele had a statistically significant risk for persistent asthma. GSTM1 and NQO1 genotypes showed no significant association with any of the respiratory outcomes tested. However, we found a protective effect for those individuals carrying the GSTM1null genotype and at least one Ser allele (NQO1 CT/TT) for persistent asthma and marked BHR (OR = 0.7, Cl: 0.3-1.5 and OR= 0.3, Cl: 0.0-1.9 respectively). This protective effect is consistent with the role of NQO1 in metabolic activation. Children from the south schools had almost twice the risk of persistent asthma (OR=2.0, Cl: 1.2-3.2, p<.005) and 3 times the risk of BHR (OR=3.5, Cl: 1.4-8.4, p<.005) than those from the schools in the north. Based on symptoms, 20.4% of children from the random sample had persistent asthma and 10.3% had marked BHR (PC20< 2mg/ml). The GEE model results were consistent with modification of air pollutant-pulmonary function relationships by oxidative stress associated genotypes. Statistically significant gene*environment interactions with NO2, NO, and PM10 using FEV1 and PEF outcomes in the expected direction were more frequent for GSTP1 AA and NQO1 CC genotypes (interaction p-values <0.05). There were very few gene*environment interactions for SO2 and any of the 3 SNPs tested. The most striking finding in our study was that pollutant exposure, especially oxides of nitrogen and PM10, even at levels below the recommended limits of South African guidelines, is associated with poorer lung function and that this association is significantly modified by an individual's genotype, particularly the GSTMlnull, GSTPIAA and NQOICC genotypes. Children with the GSTMlnull GSTPI AG/GG, GSTPI AG/GG NQOI CC and GSTMlpos NQOICC gene-gene combinations showed a significant interaction with NO2, NO, and PM10 with decrement in lung function measures. The increased risk to air pollution conferred by the GSTPI and GSTMl genotypes may have clinical and public health importance because this variant is common in most populations. The findings suggest that the risk of developing respiratory symptoms is increased when genetic susceptibility is included with environmental exposures. Our models suggest significant gene*environment interactions i.e the response to the level of air pollutants, as indicated by variability in pulmonary function measures, is modified by genotype. The heightened allergic airway response may be a consequence of a decreased capacity to mount an effective cytoprotective response to oxidative stress. Studying genes may inform us about the biology of asthma which may lead to new therapies or preventative strategies. This study supports the importance of further investigation on these and other genotype variants involved in oxidative stress and respiratory phenotypes in larger cohorts. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008.

The purpose of this study was to evaluate Leventhal, Nerenz, and Steele’s (1984) self-regulation model of adaptation to chronic illness when applied to children with asthma and their parents. The self-regulation model posits that illness representations influence coping, and via coping, adaptive outcomes. In the adult literature, illness representations or perceptions of symptoms, cause, time-line, consequences and control of illness have been found to be important determinants of coping and adjustment. No study, however, has examined illness representations in relation to coping and adjustment in children with a chronic illness or their parents. A second goal was to examine the influence of parents on the coping processes of their children. One hundred and twenty-eight children (7-13 years) with asthma and their 120 primary caregivers (96% mothers) were individually interviewed regarding their illness representations, and completed self-report questionnaires of coping and psychological adjustment. For both children and parents, illness representations had a direct association with psychological adjustment that was not mediated by coping. Children and parents who considered the child’s asthma to be a serious condition with frequent symptoms and serious consequences reported poor psychological adjustment, over and above any effect of the clinical severity of the illness itself. Parental illness representations and adjustment were significantly related to these same variables for children. However, after controlling for relevant demographic/asthma variables in regression analyses, only children’s illness representations remained significantly associated with parental illness representations. Children who demonstrated more negative illness representations had parents who also held more negative beliefs about asthma. These findings suggest illness representations to be an important target for psychological interventions.

Thesis (Ph. D.)--University of Nevada, Reno, 2008. / "August, 2008." Includes bibliographical references. Online version available on the World Wide Web.

Thesis (M. Ed.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references (leaves 105-115). Also available via the World Wide Web.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, 2009. / Includes bibliographical references.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Childhood asthma is one of the commonest chronic respiratory conditions in developed communities. Chest physiotherapy has traditionally been one of the interventions used mainly after an attack and for a relatively short-period on an outpatient basis. The purpose of the study was to determine the perceptions of physiotherapists and caregivers about the importance of chest physiotheraphy in asthmatic children in Kigali. To achieve this aim the author attempted to identify the perceived benefits of chest physiotherapy for asthmatic children among caregivers; to determine the perception of physiotherapists about the importance of chest physiotherapy for asthmatic children and; to identify the physiotherapists experiences with doctors referrals and the caregivers compliance in the management of asthmatic children. / South Africa

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