الفهرس 
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Abstract
Asthma is a heterogeneous disease, usually characterized by airway inflammation. It is defined by the history of respiratory symptoms such as wheezes, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with expiratory air flow inflammation.
Psychosocial factors play an important role in childhood asthma. Two of the most prominent psychosocial factors that have been linked to childhood asthma are parental stress and depression. For example, parental life stress has been linked to decreases in functional status and increases in hospitalizations, as well as increases in health care service utilization and symptoms in children with asthma.
The current study aimed at exploring the impact of parental psychological status on asthma relevant inflammatory biomarkers in asthmatic children namely serum level of IL-5 compared to age and sex matched healthy children and their patents. To fulfill that aim, the current study included 60 Asthmatic children consecutively recruited from the Outpatient Chest Clinic, Pediatric Hospital, Ain Shams University during the period of clinical part of the study from October 2012 to May 2013. They were 40 males (66.7%) and 20 females (33.3%) aged from 3 to 12 years with a mean age of 7.93±2.47 years. Controls, on the other hand, were 35 healthy children; 22 males (62.9%) and 13 females (37.1%) aged from 3 to 15 years with a mean age of 8.82±2.41years.
All enrolled children were subjected to clinical history taking laying stress on age at onset of asthma, frequency of acute attacks, nocturnal symptoms, drug therapy, hospitalization frequency, and degree of clinical severity. The studied asthmatics was further subdivided according to asthma severity of GINA classification (2007) into mild (n=18), moderate (n=24), and severe (n=18). Full clinical examination was carried out with special emphasis on complete chest and all body systems’ examination to settle asthma diagnosis and exclude any concomitant physical illnesses and or handicaps. Also, laboratory investigations including complete blood count ’CBC’ (total and differential laying stress on absolute esinophilic count), assessment of serum IL-5 and total IgE using ELISA technique, and pulmonary function testing using spirometry were done. Psychometric assessment was carried out using Pediatric Symptoms Checklist (PSC), self esteem, depression, and anxiety scale scores. Also, psychometric assessment of asthmatics’ and controls’ caregivers was carried out using perceived stress scale (PSS) and the depression, anxiety, and isolation scale scores.
Studied groups were well matched as regards age and sex distribution (p>0.05 for both). Also, there were statistically insignificant differences between both studied groups as regards the mean values of maternal and paternal ages; P > 0.05 for both. On the other hand, studied asthmatics had significantly higher frequency of +ve family history of allergy (73.3%) compared to controls (13.3%); p<0.001 while there was statistically insignificant differences between both studied groups as regards the frequency distribution of second hand Smoking; P > 0.05.
Becoming very tired from any minimal effort, coughing all the night, dyspnea while sleeping and playing, inability to play with his siblings for long time, repeated episodes of asthma, repeated hospital admissions, intolerance to exercise, and taking a lot of drugs were the most frequently encountered complaints of studied asthmatics while the main parental complaints included long school absenteeism due to his disease, the child feels very tired from any minimal effort , inability to play with his siblings for long time, inability to concentrate in his study, inability to sleep calmly at night , loss of appetite and loss of weight, delayed puberty and growth, repeated and prolonged hospital admissions, coughing all the night, intolerance to exercise, dyspnea while sleeping and playing, and repeated episodes of asthma.
Studied asthmatics had significantly higher mean values of serum IgE level and absolute esinophilic count, p=0.001 for both while they had significantly lower mean values of assessed spiromatric pulmonary functions (FEV1 & MMEF75/25); p= 0.001& < 0.05 respectively. On the other hand, studied asthmatics had significantly higher serum IL-5 level compared to controls; P > 0.01.
Studied asthmatics’ parents had significantly higher mean values of total scores of anxiety scale, isolation scale, depression scale, and stress scale; p =0.001 for all.
Studied asthmatics had significantly lower mean values of self esteem score and higher mean values of PSC total score as well as its internalization problems and externalization problems sub-scores while the differences were statistically insignificant comparing both studied groups concerning the mean values of anxiety scale and depression scale scores and ADHD sub score of PSC; P > 0.05 for all.
Studied asthmatics parents had higher frequency distribution of all severer grades of clinically manifest isolation, anxiety, depression, and stress.
Studied asthmatics had significantly more encountered poor self esteem, clinically manifest anxiety, and psychosocial impairment while the more frequently encountered clinically manifest depression among them compared to controls was statistically insignificant.
There were statistically insignificant differences between the studied asthmatic sub groups as regards the mean values of age, age of onset, duration of illness, and maternal and paternal ages; (P > 0.05 for all).
There was statistically significant association between severe asthma and positive family history of allergy while such significant association was not reported between severity of asthma and gender distribution and second hand smoking.
Severe asthma was significantly associated with higher serum IgE and absolute esinophililic count and significantly reduced pulmonary functions. Also, severe asthma was significantly associated with higher serum levels of IL-5. On the other hand, severe asthma was significantly associated with more parental isolation and stress and severer anxiety and depression.
Severe asthma was also associated with severer anxiety and depression, poorer self esteem, and more psychosocial impairment in studied asthmatic children but such association was only statistically significant for more anxiety and depression.
Studied asthmatics showed significant positive correlation between serum IL-5 and serum IgE i.e. the higher the IgE, the higher the serum level of IL-5; P<0.01 = statistically significant while there were statistically insignificant correlations between serum level of IL-5 and age, age of onset, duration of illness, maternal age, paternal age, absolute esinophilic count, and assessed pulmonary functions; p > 0.05 for all.
On the other hand, there were statistically insignificant correlations between serum IL-5 of asthmatics and their isolation scale, anxiety scale, depression scale and, stress scale scores; p > 0.05 for all. Meanwhile, studied asthmatics showed significant negative correlation between serum IL-5 and self esteem score i.e. the higher the level of serum IL-5, the poorer the self esteem; P<0.05 but the correlations between serum level of IL-5 and anxiety scale score, depression scale score, PSC total score, and ADHD PSC sub –score were statistically insignificant; p > 0.05 for all.
Receiver operating curve (ROC) of serum IL-5 of studied asthmatics had a cut-off point >8.69 with sensitivity of 63.33% and specificity of 80%.
In conclusion, studied asthmatics had significant elevation of asthma biomarkers; serum IgE level, absolute esinophilic count, and serum IL-5 associated with significant reduction of FEV1 & MMEF75/25 compared to controls. Concerning their psychosocial profile, studied asthmatics had significantly more encountered poor self esteem, clinically manifest anxiety, and psychosocial impairment with significant lowering of self esteem score and increase in PSC total and internalization and externalization problems PSC sub-scores compared to controls. Meanwhile, studied asthmatics’ parents had higher frequency distribution of all severer grades of clinically manifest isolation, anxiety, depression, and stress. On the other hand, severely persistently asthmatics compared to those with mild and moderate persistent asthma showed significant elevation of all studied asthma biomarkers and reduction of assessed pulmonary functions associated with significant elevation of their anxiety and depression scale scores and more parental isolation and stress and severer anxiety and depression. Lastly but by no means least, studied asthmatics in general showed significant negative correlation between serum IL-5 and self esteem score i.e. the higher the level of serum IL-5, the severer the inflammatory process, the poorer the self esteem.