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Impact of asthma medication and familial factors on the association between childhood asthma and attention-deficit/hyperactivity disorder: a combined twin- and register-based study
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Neuropediatric unit, Sachs’ Children and Youth Hospital, South General Hospital, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
nstitute of Neuroscience and Physiology, Forensic Psychiatry, University of Gothenburg, Gothenburg, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-6851-3297
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2015 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 45, no 5, 964-973 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Asthma and attention-deficit/hyperactivity disorder (ADHD) are prevalent in childhood and may cause functional impairment and stress in families. Previous research supports an association between asthma and ADHD in children, but several aspects of this relationship are unclear.

OBJECTIVE: Our aim was to study whether the association between asthma and ADHD is restricted to either the inattentive or the hyperactive/impulsive symptoms of ADHD, to explore the impact of asthma severity and asthma medication and the contribution of shared genetic and environmental risk factors on the asthma-ADHD relationship.

METHODS: Data on asthma, ADHD, zygosity and possible confounders were collected from parental questionnaires at 9 or 12 years on 20 072 twins through the Swedish Twin Register, linked to the Swedish Medical Birth Register, the National Patient Register and the Prescribed Drug Register. The association between asthma and ADHD, the impact of asthma severity and medication, was assessed by generalized estimating equations. Cross-twin-cross-trait correlations (CTCT) were estimated to explore the relative importance of genes and environment for the association.

RESULTS: Asthmatic children had a higher risk of also having ADHD [odds ratio (OR) 1.53, 95% confidence interval (CI): 1.16-2.02]. The association was not restricted to either of the two dimensions of ADHD. The magnitude of the association increased with asthma severity (OR 2.84, 95% CI: 1.86-4.35) for ≥ 4 asthma attacks in the last 12 months and was not affected by asthma treatment. The CTCTs possibly indicate that the genetic component in overlap of the disorders is weak.

CONCLUSIONS AND CLINICAL RELEVANCE: Childhood asthma, especially severe asthma, is associated with ADHD. Asthma medication seems not to increase the risk of ADHD. Clinicians should be aware of the potential of ADHD in asthma. Optimal asthma care needs to be integrated with effective evaluation and treatment of ADHD in children with co-existing disorders.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015. Vol. 45, no 5, 964-973 p.
Keyword [en]
asthma; attention-deficit; hyperactivity disorder (ADHD); anti-asthmatic agents; epidemiology; twins
National Category
Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
URN: urn:nbn:se:oru:diva-54613DOI: 10.1111/cea.12529ISI: 000353048000014PubMedID: 25772649Scopus ID: 2-s2.0-84927732306OAI: oai:DiVA.org:oru-54613DiVA: diva2:1064446
Funder
Swedish Research Council, 2011-3060Swedish Heart Lung Foundation
Note

Funding Agencies:

Swedish Initiative for research on Microdata in the Social And Medical sciences (SIMSAM) 340-2013-5867

Swedish Asthma and Allergy Association's Research Foundation

Stockholm County Council

Strategic Research Program in Epidemiology at Karolinska Institutet

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-01-24Bibliographically approved

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CiteExportLink to record
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