Exposure to birds and rural areas can protect children from asthma

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According to research published in the journal AllergiesChildren in rural China had a lower frequency of asthma and atopic disease than children in urban Hong Kong, indicating a protective effect on rural lifestyle.

Asthma is one of the most common chronic diseases of childhood, and its prevalence has increased in recent decades. One of the most consistent epidemiological findings is that children living in an agricultural environment are protected from developing asthma and allergies. In light of this information, the aim of the study was to compare the prevalence of asthma and related atopic disorders in children in rural and urban areas of China, respectively, using the valid ISAAC Phase III questionnaires. Researchers also aim to identify environmental factors that may provide protection against the development of asthma in rural China.

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A cross-sectional community-based epidemic was studied. Symptoms of asthma and allergies as well as environmental exposures were examined.

The written ISAAC Phase III questionnaires were distributed to all children aged 5 to 8 years in the invited day care / schools and were completed at home by the parents (or guardians). The questionnaire was based on ISAAC Phase III questionnaires translated into Chinese using a standard protocol. “Current” symptoms refer to the symptoms of the last 12 months; “Ever asthma” was defined as a person who has been diagnosed with asthma in life; Other atopic and diagnostic symptoms such as “allergic rhinitis (AR)”, “rhinoconjunctivitis” and “flexural eczema” were defined by previous studies. “Asthma Ever” was used as a result variable and its connection with various environmental and lifestyle factors was evaluated.

The result

The survey included 14,118 children (average age, 6.6 years; 53.5% boys) from Kanghua and 3,145 children (average age, 6.5 years; 52.6% boys) from Hong Kong, all aged 5 to 5 years. 8 years.

The results of the study showed that the current odor (in the previous 12 months) was significantly lower in rural Conghua than in Hong Kong (1.7%). Vs. 7.7%, p <0.001). A lower frequency of asthma has also been reported in rural children than in urban children (2.5%). Vs. 5.3%, p <0.001). Also, 3.4% of urban children and 0.5% of rural children had sleep-disturbed shortness of breath (Disagreement ratio [OR] 7.1; P <0.001).

Urban children also had a higher frequency of exercise-induced shortness of breath compared to rural children (10.5%). Vs. 6.9%), symptoms of rhinoconjunctivitis (22.2%) Vs. 2.7%), flexible eczema (8.4%) Vs. 4.3%) and asthma medication use (14.8%) Vs. 1.7%) in the previous 12 months (all, P <0.001). Urban children also had a higher frequency of diagnosing asthma in their lifetime (5.3%). Vs. 2.5%), history of shortness of breath (16.9% vs. 5.8%), allergic rhinitis (39.9%) Vs. 8.7%), eczema (28.7%) Vs. 21.7%) and asthma medication at some point in life (25.5%) Vs. 4%) compared to children living in rural areas (all, P <0.001).

Researchers have noticed that fewer children live on a farm Vs. Children who have never lived on a farm develop asthma (2.1%) Vs. 3.1%; Or = 0.67; P <0.001). Children living on farms were less likely to use asthma drugs (3.7%) Vs. 4.6%; Or = 0.81; P = 0.01) and those who did not live on the farm were less likely to have allergic rhinitis (OR = 0.59; P <0.001). Furthermore, even children who had never been to a farm had significantly less lifelong allergic rhinitis (10%) than rural children who only came in contact with their neighbors. Vs. 12.8%; Or = 0.75; P <0.001) and asthma medication use (4%) Vs.. 5.2%; Or = 0.77; P = 0.03).

After adjusting for confounders, exposure to agriculture (Disagreement ratio Permanent [aOR] 0.74, 95% confidence interval [IC 95%] 0.56–0.97) and poultry (0.75, 95% CI 0.59–0.96) were the most important factors associated with the protective effect of the disease in rural areas. Additional analyzes adjusted for trend scores indicate that such protection provided by life in a rural environment is primarily responsible for bird exposure.

The use of foam pillows (aOR = 2.12; 95% CI, 1.14-3.93) and room humidity (aOR = 1.58; 95% CI, 1.27-1.98) increase the risk of asthma in children with congestion. Other risk factors for asthma diagnosed by physicians in this population include synthetic fiber bedding, use of antiparasitic drugs, and carpet flooring.


The study confirmed a significantly lower incidence of asthma in rural Chinese children than in urban Hong Kong children. According to the researchers, unexplained causes of exposure to or related to poultry and agriculture may explain the low incidence of childhood asthma in rural children. For them, the data will complement the results obtained from different rural populations around the world. However, the author argues that further studies are needed to determine the possible biological processes that explain the protection afforded to birds.

Please comment

Asthma is a chronic disease that affects millions of patients worldwide. This study opens the door to a new understanding of the disease, which will enable the development of better and more practical strategies for early prevention and improved quality of life.


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