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Children with worse asthma control are at an increased risk of being bullied – says study

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Children with asthma who have their disease under control are less likely to be bullied or teased by their peers, according to a study published online in the Archives of Disease in Childhood.

However, the data indicate that children who report bullying or teasing as a result of their asthma are more likely to have poor control as well as constraints on everyday activities.

Many children and adolescents are bullied, but those with chronic illnesses are particularly vulnerable, the researchers report. According to government statistics, 17 percent of 10–15 year olds in the United Kingdom are bullied, and nearly 1 in 10 young people suffer from asthma.

The researchers conducted a review of the available evidence and discovered a consistent correlation between asthma and bullying victimization, but few reasons for why this association occurs, especially given that the majority of data were acquired purely from parental reports.

The team of experts, therefore, used data from the Room to Breathe survey to see whether asthma control was associated with bullying risk, as well as the amount to which parental concerns about their child’s asthma were associated with this.

Nearly 950 8 to 15-year-olds and their parents/caregivers from six countries completed the Room to Breathe questionnaire, which elicited information about parental and child behaviors and beliefs in families with an asthmatic child.

Children were asked if they had ever been teased or bullied for having asthma. The level of asthma control was graded (GINA) on a scale of 0-4 based on whether the child had daytime asthma symptoms more than twice a week; woken during the night due to asthma; had to use a reliever inhaler for symptom relief more than twice a week; or had to limit their activities due to asthma.

Additionally, it was calculated using the Childhood-Asthma Control Test (C-ACT), with a score of 19 or less indicating poorly managed asthma and 20 or more indicating well-controlled asthma.

Children were asked to rate their personal asthma by selecting from the following options: I only get it every now and then; not too bad; quite bad; or very bad. Similarly, parents were asked to describe their child’s asthma, choosing from the descriptors or intermittent, mild, moderate, or severe. 

Additionally, parents were invited to share their level of concern about their child’s health at various points in time and in various scenarios.

358 out of 930 (38.5 percent) children had well-controlled asthma (GINA score) and 312 out of 714 (44 percent) children had well-controlled asthma (C-ACT score).

One in ten children (93) reported being bullied/teased as a result of their asthma, a finding that held true across all age groups and all six nations. Around a third (34, 37 percent) were between 8 and 10, 27 (29 percent) were between 11 and 13, and 32 (34 percent) were aged between 14–15.

Those who stated they had been bullied or teased because of their asthma had worse asthma control.

Children with well-controlled asthma symptoms (GINA) were nearly half as likely as those with poorly-controlled symptoms (49 percent) to report being bullied or teased because of their asthma. A C-ACT score of 20 or higher, which indicates good symptom control, was linked to a 54 percent lower incidence of bullying.

Children who said they were bullied or teased because of their asthma were 74 percent more likely to limit their activities.

Those who described their asthma as ‘quite’ or ‘very bad’ were three times more likely to be bullied or teased about it.

Parental concern about their child’s health was linked to that child reporting bullying, but parental assessment of their child’s asthma management was not linked to a higher risk of bullying/teasing.

“The cross-sectional nature of this study and the exclusion of children without asthma preclude causal inference,” add the researchers. 

But they highlighted: “Bullying is a recognised but under-appreciated complication of asthma. [It] has important, measurable long-term consequences and yet children are hardly ever asked about peer relationships by health professionals.

“In order to identify bullying and bullying risk, clinicians must direct specific questions about asthma control and bullying/teasing to children themselves.”

Source: 10.1136/archdischild-2021-321641

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