Nocturnal asthma in children affects school attendance, school performance, and parents' work attendance

Context: Asthma symptoms that occur at night may signal worse asthma contro l, but the nighttime occurrence may have additional clinical significance. To date, however, there have been few studies of the impact of nocturnal aw akening from asthma on children with the disease, including problems with d aytime functioning. Objective: To determine if school absenteeism and school performance in chi ldren and work absenteeism in their parents are associated with nocturnal a wakenings 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 rare organizations. Intervention: None. Main Outcome Measures: Parent's reports of number of days their child misse d school and parent missed work and how often the child's education suffere d because of asthma in the past 4 weeks. Results: Overall, more than 40% of children had nocturnal awakenings from a sthma in the past 4 weeks. Multivariate analyses were performed that adjust ed for child age, race, overall symptom severity, and use of reliever medic ations. Compared with children who did not awaken from asthma, there were g reater odds of missed school days in children who awakened 1 to 3 nights (o dds 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 childre n 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 I to 3 nights (OR, 4.0; 9 5% CI, 2.27.1), 4 to 7 nights (OR, 6.5, 95% CI, 2.7-16), and more than 7 ni ghts (OR, 3.2; 95% CI, 1.3-7.9).Greater overall symptom severity and high u se 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. Nightti me symptoms have independent prognostic value, even when overall asthma sym ptom severity is accounted for. By addressing whether there are nighttime a wakenings in children with asthma, clinicians may be able to tailor the the rapeutic regimen to counter these symptoms.