الفهرس 
Triggers of bronchial asthmaOnly 14 pages are availabe for public view
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Abstract
Asthma can be generally considered a hyper-responsive airway disease involving chronic inflammation
of varying austerity arising from
· various (genetic and environmental) etiology, (Hang et al, 2003) .
Asthma is a leading chronic illness in children and forms the fourth leading cause of disability .
Since 1980, the prevalence of asthma has increased by 61% and the mortality rate due to asthma has
jumped from 0.91100000, 20 years back to 1.5/100000 uptil 1995. Coming to an alarming 67o/o
increase, the annual healthcare costs resulting from asthma estimated to be 12.6 billion dollars
and asthma leads to 10 million lost school days and 3 million lost work days, (Martin et al, 2000)
.
Researches reported that the regular consumption of fish is associated with a much reduced risk of
developing asthma in childhood. Others suggested that dietary supplementation with fish oil or
other enriched sources rich in omega-3 polyunsaturated fatty acids, eicosapentaenoic acid and
docosahexaenoic acid is beneficial for children with bronchial asthma, (King, 1999) .
So this study aimed at studying the effect of fish oil and cod liver oil supplementation on
asthmatic children.
The study started on September, 2004 to April, 2005 at Shebin Elkom Chest Hospital among children
with bronchial asthma coming to out patients clinic with acute attacks of bronchial asthma and meet
the inclusion criteria (age from 6 to 12 years old, and suffering from bronchial asthma). Subjects
with chronic illness like nephritic syndrome
or cardiac lesion or acute illness like pneumonia or bronchitis wer
excluded.
The children were classified according to the severity of thei asthmatic attacks using
asthma clinical severity score given by, (Needleman et al, 1995).
The study included forty children with acute attack of bronchia. asthma, their age ranged between 6
to 12 years old and they received their standard medical treatment. All children with inclusion
criteria were enrolled in this study and they were divided into 4 equal groups ( 10 for each group
) as follow:
I -Control group: m whom children received their medical treatment only without any dietary
intervention along the trial.
2-Fish oil group: in whom children received their medical treatment plus fish oil as one soft
gelatin capsule/ daily, this capsule contains 1000 mg fish oil (EPA/DHA 30%) and 100 mg wheat germ
oi l. Some children swallowed it with water; and others take it with some milk or juice after
piercing the capsule and squeeze it. The capsule purchased from SEDICO Pharmaceutical Company, 6-
October City Egypt (Its Commercial Name is (Omega - 3 plus).
3-Cod liver oil group: in whom children received their medical treatment plus code liver oil as
syrup 5 ml/daily. This oil purchased from Arab Drug Company, Egypt, and its Commercial Name is
Halorange.
4-Mixed group: in whom children received their medical treatment plus half capsule of fish oil and
2.5ml of code liver oil /daily.
Data about socioeconomic status, health status, food habits and consumption pattern, food intake,
and anthropometric measurements were
obtained, also laboratory investigations was carried out on fresh blood serum for determination
of different biochemical parameters.
Plaine chest x-ray P-A view was done for each child at the start of the study to exclude either
acute or chronic chest illness as pneumonia bronchitis or tuberculosis, etc.
All children were kept under observation by regular meetings in the out-patients clinic every week
to assure and giving his parents the needed amount of the capsule or syrup needed /week.
The collected data were subjected to statistical analysis to find out standard deviations,
significant differences, correlation coefficients between variables , using the computer program
SPSS.
Most of studied children were from rural areas (87.5%). Also, the majority of them were boys’
represents (57.5%). the majority of children were classified as moderate socioeconomic class,
represents 70% among code liver oil, 70% among mixture group, 60% among the control group, and 60%
among fish oil group. the age of groups ranged from (9.2±2.3, 9.2±2.4, and 9.2±2.3 years) for
control, fish oil, and cod liver oil groups respectively to 9.3±2.1 years for mixture group.
Asthma was prevalent among 10%, 10%, and 20% of fathers, brothers, and grandfathers respectively of
control group. While, it was prevalent among 30% and 30% of grandfathers of fish oil and cod livers
oil groups respectively. On the other hand, it was prevalent among 20% and 20% of fathers and
grandfathers respectively of mixture group. However, the asthma was not prevalent in families of
60%, 50%, 60%, and 60% of control, fish oil, cod liver oil, and mixture groups respectively.
Most of asthmatic children in all studied groups had food allerg’, where 70%, 60%, 80%, and 90% for
control, fish oil, cod l iver oil, an j mixture groups suffered from it.
Allergy from egg, representing 10% among each of control, cod liver oil, and mixture groups.
Bananas causing food allergy among 20% of fish oil group. Chocolate & fish were the reason of food
allergy among 10% of each of control, fish oil, and cod liver oil groups. Among fish oi 1 group 10%
had food allergy from fish and bananas.
High percentage of asthmatic children did not eat yogurt. represents 60%, 40o/o, 40%, and 50% of
studied groups. Whi le. considerable percentage 30%, 50%, 40%, and 40% respecti vely o control,
fish oil, cod liver oil, and mixture groups were eating cannec fish. As for preferred method of
cooking fish, the same table showed tha· the majority 70%, 40%, 80%, and 60% of control, fish oil,
cod liver oil. and mixture groups preferred the fried one. While 40% and 30% of fisr oil and
mixture groups were preferred the fried and grilled fish.
It seems that children preferred chocolate and it is one of their major dreams, where 50%, 80%,
60%, and 40% respectively of controL fish oil, cod liver oil and mixture groups.
The mean weight value ranged from 27.3±9.5 for control group to 29.1±11.2 kg for mixture group,
these weight satisfied 88.6% to 93.6% of standard weight (CDC, 2000). the mean body height value
ranged from 128.0±16.6 cm for fish oil group to 132.6±19.9 cm for mixture group, these value
satisfied 95% to 97.9% of standard height given by, (CDC,
2000).
the mean values of energy intakes was higher among mixture group (2011.8±232.8) followed by cod
liver and fish oil groups (1812 ± 275.5 and 1794.5 ± 229.20 respectively), and finally, the control group (1492.1
± 448. 1).
As for total protein, the mean value of fish oil, cod liver oil, and mixture oil groups was
significantly (P<0.05) higher than control group (69.9±6.6, 64.2± 9.9, and 72.6±11.2 respectively
vs. 49.9±14.4).
As for total iron, it was higher among mixture group , 15.7±3.0 mg/day followed by fish oil group
(13.9±3.8 mg/day). Finally control and cod liver groups (11.0±4.3 and 11.9±3.5 mg/day
respectively).
Regarding the mean value of zinc intake it ranged from 10.5±4.00 mg/day for control group to
14.7±2.30 mg/day for mixture group. The LSD showed that the mean value of mixture group was
significantly (P<0.05) higher than control group.
the mean values of vitamin A among fish oil and mixture groups (302.8±180.0 and 302.6±171.6 µg/day
respectively) higher than control and cod liver oil groups (213.9±165.7 and 227.7±152.3 µg/day
respectively),
As for vitamin C, the results indicated that mean value of mixture group was significantly (P<0.05)
higher than control, fish oil, and cod liver oil groups by the mean of 82.5±22.2 vs. 47.9±32.4,
57.4±26.2, and 51.9±26.9 mg/day respectively.
The mean values of vitamin B6 intakes by control, fish oil, and cod liver oils groups was equal
(1.2 mg/day) and very close with mixture oil group (1.4 mg/day). Although. the intakes of vitamin B
12 by experimental groups was higher than control group, but there was no significant differences
as revealed by ANOVA and LSD. On the other hand, the mean intakes of folic acid was higher among
mixture group (262.7±57.9 µg/day) followed cod liver oil and fish oil groups
(224.7±69.2 and 217.9±54.5 µg/day respectively), and finally the control group (177.7±58.10
µg/day) .
Regarding clinical severity of asthma, in fish oi l group the moderate cases (40%) before dietary
intervention becomes (20%), and severe cases diminished from 20% before dietary intervention to
become 10% after dietary intervention. Among cod liver oil groups the moderate and severe cases
were 50% and 20% before dietary intervention, but after dietary intervention becomes 40% and 1Oo/o
respectively. Only, iL mixture and control groups the moderate cases improved from 50’Y> before
dietary intervention to 40% after dietary intervention.
Regarding lgE, the results showed that before dietary intervention there were no significant
differences between values of different group . Also, the same trends were observed after dietary
intervention. However, the dietary intervention resulted in significant decrement of IgE amon 5
each of fish oil group that decreased from; 314.9±52.5 to 264.0±42.6 an d P<0.001; cod liver oil
group that decreased from 328.7±93.8 to 283.7±86.3 and P<0.05; and mixture group that decreased
from 318.0±66.4 to 270.8±70.9 and p<0.01.
The percentage of decrement of lgE level after dietary intervention were 16%, 13.6%, and 15.3%
respectively among fish oil, cod liver oil, and mixture groups.
Our results showed that 27.5% of asthmatic children were fro n low socioeconomic class, whi le the
majority 65.0% were from modera e classes. It could concluded that asthma go through ch ildren
fro’ll moderate and low socioeconomic classes and this results agreed with bo:h of Ernst et al,
(1995) who mentioned that asthma morbidity were more prevalent among children of lower
socioeconomic classes, and Tauleria
and Ron a, (1999) who found that the prevalence of persistent asthma was higher in children
whose fathers of low socioeconomic classes.
Results of our thesis indicated that 25% of asthmatic children in the current study were suffering
from food allergy. According to Roberts et al, (2003) food allergy may predict life threatening
asthma in children , they found that allergy and frequent admission to hospital were independent
risk factors for life threatening asthma.
Also, our results emphasis on the benefits of fish oil (omega-3 capsule) m reducing the severity
of asthma, where before dietary intervention 60% of asthmatic children in fish oil group were
suffering from moderate or sever asthma and 40% had mild one, while after dietary intervention 70%
had mild asthma, 20% had moderate and 10% only had severe asthma. This results were in good
agreement with Naga ku ra et al, (2000) who found among children with bronchial asthma taking fish
oil capsule that asthma symptoms scores decreased and concluded that dietary supplementation with
fish oil rich in omega-3 is beneficial for children with bronchial asthma. Also, it agreed with
Woods et al, (2002) who studied the effect of dietary marine fatty acids (fish oil) of asthma among
adults and children and found that people with asthma were improved by omega-3 and added that there
is no evidence that they are at risk if they do so.
In this year (2005), CAPI published that a study of 468 children by the Sydney Royal Prince Alfred
Institute of Respiratory Med icine has found that children who eat oily fish , including salmon,
tuna and mackerel at least once weakly may avoid asthma
Several studies tried to explain the mechanisms of action of omega-3 fatty acids on asthma.
The leukotrienes and prostaglandin’s are implicated in the
inflammatory cascade that occurs in asthmatic airways. There is evidence of airway inflammation
even in newly diagnosed asthma patients within two to twelve months after their first symptoms,
(Simopoulos, 2002) .
It is clear from our results, that lgE was elevated among asthmatic children , however this results
agreed with several studies such as Sears et al, (1991) who concluded that , the higher the IgE
level , the higher the asthma prevalence. Also , it agreed with Anonymous, (2003} who found that an
elevated level of lgE antibodies in the serum obtained during infancy were significantly associated
with the future expression of asthma in these children.
Our dietary intervention , with fish oil , mixture, and cod liver oil resulted in significant
decrement of lgE level by 16% , 14.8%, and 13.7%, respectively . These favorable effects could be
attributed to that omega-3 containing oils reduces the inflammatory mediators like leukotreines and
prostaglandin’s, and hence reduced the lgE level and overall the immune response .
The results of this study proved that fish oils had a favorable affect on asthma and decreased lgE
values, that reduce the inflammation and relief the symptoms accompanying asthma.
The results of this study emphasis on using fish oil and cod liver oil as routine foods in menus of
asthmatic patients.