PEDIATRICS Vol. 108 No. 5 November 2001, pp. 1237-1237

Day Care and Asthma?

To the Editor.

I wish to add the following comment to the article by Lanphear et al.¹

It has been well-established that the prevalence of asthma is increasing, both in the United States and worldwide, with the most rapid increase being in the pediatric population. The reason(s) for this increased prevalence is not known, but clearly risk factors such as environmental tobacco smoke (ETS) and indoor allergens play a role. Other factors such as urbanization, access to health care, diesel particles, and race are involved. Unfortunately, there remains a huge gap in our understanding of this most disruptive disease.

The article by Lanphear et al reviews over 8000 children who participated in the Third National Health and Nutrition Examination Survey (NHANES III). As is true of other reviews, their results highlight the incredible correlation between atopy and asthma, both allergy in the patient and in family members. ETS also shows up as a significant risk factor. The authors then incriminate a gas stove or oven in the home, which barely met significance (P = .04), but had nothing to say about the greatly increased risk of a child attending day care (P = .01). They failed to mention day care attendance in their abstract, and there is only a transient reference to it at one point in the discussion.

Martinez et al have published a number of articles, both in pediatric journals as well as allergy journals, following a group of children in Arizona. They clearly show an increased prevalence of asthma in children who have had "wheezy illnesses" as youngsters. Surely the association between day care attendance and frequent infections plays a role that needs to be addressed.

The fact that the authors have downplayed day care is clearly a bias on their part (I guess it is not politically correct anymore to suggest that mothers stay home and take care of their children). Instead, they manipulate the discussion to bring out poor housing, subclinical lead toxicity (whatever that is), and fatal injuriesnone of which have any correlation to asthma or NHANES III. This bias should have been addressed before publication of the article.

Raymond E. Brady, MD
Portland, OR 97209-2696

REFERENCE

1. Lanphear BP, Aligne CA, Auinger P, Weitzman M, Byrd RS Residential exposures associated with asthma in US children. Pediatrics. 2001; 107:505-511 [Abstract/Free Full Text]