Asthma had the worst impact on Canadian children, who were more likely to report feeling sad and to express regret at being unable to participate in sports than were children in other parts of the world, Dr. William D. Carroll of Derbyshire Children's Hospital in Derby, England, and colleagues reported at the CHEST meeting here.
The universal nature of bullying, though, was "really quite startling," Carroll told MedPage Today.
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"It's not something as a physician we ask our children," he noted in an interview. "We think kids wouldn't do that, but it appears we're wrong and it is quite common."
The findings overall emphasize the need to talk to pediatric asthma patients about bullying specifically as well as what other impact their disease may be having on their life, he said.
The Room to Breathe study included 1,284 kids with asthma and their parents interviewed by phone in Canada, Greece, Hungary, the Netherlands, and Britain and in face-to-face interviews in South Africa. Children ages 8 to 15 were interviewed themselves while parental interviews were used for 4- to 8-year-olds.
Based on symptoms reported in the interview, complete asthma control was achieved by only 15.3 percent of the children overall.
The lack of complete control "may be due to steroid fear of parents or underestimation of the impact of asthma on children," the researchers noted in the presentation.
Carroll said one big message for physicians was the need to have conversations about medications and how they work.
"Lots [of parents] are still worried about side effects," he told MedPage Today.
Perceived asthma severity differed substantially between parents and children. For example, Canadian parents matched their children's opinion in just 46% of cases.
Control of asthma was similar for Canadian kids -- representing North America in the study -- as for the rest of the world.
However, Canadian children were more likely to say they feel sad and left out than those in other countries, although the number who claimed those feelings was under 20 percent.
But only about 30 percent of Canadian kids with asthma felt "no different" than other kids, whereas elsewhere in the world the rate was about 50 percent.
Asthma also has an impact on family lifestyle, with 66 percent of Canadian parents interviewed reporting changes such as forbidding smoking in the house, removing potential allergens, and avoiding artificial or chemical triggers.
Sports participation was a big complaint worldwide, with about 55 percent of Canadian kids and 45 percent of those in other countries with asthma saying they wished they could play.
The reason for the difference in Canada might be the popularity there of cold weather sports, such as hockey, Carroll suggested, noting, "cold air is a specific trigger for asthma."
Coaches and teachers might be mostly responsible for the restrictions in sports participation, Carroll speculated.
"Parents were telling us they didn't restrict their activity terribly," he explained in the interview.
British kids with asthma showed a "high" rate of participation in sports, he noted.
Demographics and rates of asthma in America are similar to those in Canada and Britain and most of the results likely generalize from those countries to the U.S., Carroll said, although on which side U.S. kids fall on sports participation isn't clear.