Fourth year PhD student at the Tulane University National Primate Research Center and former research technician at the Harvard Stem Cell Institute.
As more and more cases of childhood asthma are diagnosed, doctors are becoming increasingly worried.
In 10 seconds? The incidence of childhood asthma continues to increase but the cause and the cure remain elusive.
What is asthma, exactly? Asthma is a condition where a person’s airways become inflamed, mucousy, and constricted, rendering it hard for a person to breathe. There are many types of asthma, and each has a distinct pathophysiology.
Allergic asthma, the most common type in childhood, is induced by the body falsely believing that an air particle is harmful. In response to the particle, the body mounts a large reaction (inflammation) to kill the particle. During the process, certain cells (mast cells) send signals to dilate blood vessels to increase the flow of white blood cells to the area, and this leads to constricted airways. Recruited white blood cells release numerous proteins and chemicals that are designed to kill a foreign invader, but often harm the person in the meantime.
The side effects of this process are what you observe – thickening of the airway lining, extra mucous production to keep the “dangerous” molecule from traversing into your body, and wheezing due to the constricted space.
Why does asthma only affect certain children? Scientists believe that a combination of elements – genetics, the environment, and epigenetics (modifications to DNA that change its ability to function) – cause certain children to develop asthma. However, the risk factors are numerous and paint an unclear picture.
For example, it is now thought that if a child’s grandmother smoked and the mother did not, the child may still have an increased risk of developing asthma. Hygiene, the degree of microbes that a child encounters in early life (including parasites) is also thought to play a key role. Additionally, even psychosocial factors (stress, child abuse) seem to elevate the risk.
Though it is accepted that genetics predispose a child to developing asthma, it is likely that certain environmental triggers are turning a genetic predisposition into reality.
Is there anything that I can do to prevent my children from developing asthma? Unfortunately, science has not been able to find a clear cause for asthma and thus it is not possible to prevent. However, there is a vast amount of research focused on this subject and scientists are optimistic about the future.
Abstract: To identify the predictive factors of early childhood wheezing in children of low socioeconomic status.The Childhood Asthma Prevention Study enrolled 177 low-income children (9-24 months old) with frequent wheezing. At age 7 years, presence of asthma was assessed through caregiver reports of physician diagnosis of asthma (CRPDA) and corroborated by assessment of bronchial hyperresponsiveness (BHR). Lung function, inflammatory markers, and asthma symptom severity were compared for children with ±CRPDA, ±BHR, and asthma. Baseline predictors for CRPDA, BHR, and asthma at 7 years of age were examined.Maternal symptom report strongly differentiated children with +CRPDA (49%) despite comparable airflow measurements (P < .0001), and spirometric lung function measurements were different for +BHR (65%) versus -BHR (P < .005). Univariate analyses revealed different baseline predictors of +CRPDA and +BHR for children at age 7 years. Higher levels of maternal psychological resources were associated with +CRPDA, but not +BHR. Only 39% of children with a history of frequent wheezing met the conservative definition of asthma at age 7 years, with the following significant predictors found: low birth weight, baseline symptom severity, and maternal psychological resources.This low-income, multi-ethnic group of wheezing infants represents a unique population of children with distinct characteristics and risks for persistent asthma. Determination of asthma status at 7 years of age required objective measurement of BHR in addition to CRPDA. The association of maternal psychological resources with +CRPDA may represent a previously unrecognized factor in the determination of asthma status among low-income groups.
Pub.: 06 Oct '12, Pinned: 18 Jun '17
Abstract: The purpose of this work was to determine whether overweight in youth with mild-to-moderate asthma occurs with increased frequency and is accompanied by impaired psychological functioning.The interrelationships among BMI and demographic and psychological characteristics were examined in 1005 children (aged 5-12 years) enrolled in the Childhood Asthma Management Program and seen for repeated visits over 4 1/2 years.Baseline rates of overweight (BMI for age: > or = 95th percentile) were comparable, but rates of overweight risk (BMI for age: 85th to < 95th percentile) among children in the Childhood Asthma Management Program were elevated in comparison with the general population of children in the United States. Rates of overweight and overweight risk did not increase over the course of the longitudinal study. Overweight and overweight risk were more frequent among black and Hispanic than white children, although they were not higher relative to same-race groups in the general population. Overweight at baseline was associated with lower IQ, more social withdrawal, and greater internalized psychological distress. As the children became older, the overweight group demonstrated increased evidence of behavior problems and decreased physical activity.This study identifies an increase in overweight risk but not overweight in children with mild-to-moderate asthma. Comorbidity between asthma and overweight may be underestimated, because children with severe asthma and those from impoverished backgrounds were not represented in this sample. For the 14% of children who were overweight, some associated psychological difficulties were present in childhood, and additional problems were seen during adolescence. These results suggest a need for programs that encourage greater vigilance and intervention for overweight children with asthma.
Pub.: 03 Oct '07, Pinned: 18 Jun '17
Abstract: Obesity has been proposed to be a risk factor for the development of childhood asthma.We sought to examine weight status from birth to age 5 years in relation to the occurrence of asthma at ages 6 and 8 years.Two hundred eighty-five full-term high-risk newborns with at least 1 asthmatic/atopic parent enrolled in the Childhood Origin of Asthma project were studied from birth to age 8 years. Overweight was defined by weight-for-length percentiles of greater than the 85th percentile before the age of 2 years and a body mass index percentile of greater than the 85th percentile at ages 2 to 5 years.No significant concurrent association was found between overweight status and wheezing/asthma occurrence at each year of age. In contrast, longitudinal analyses revealed complex relationships between being overweight and asthma. Being overweight at age 1 year was associated with a decreased risk of asthma at age 6 (odds ratio [OR], 0.32; P = .02) and 8 (OR, 0.35; P = .04) years, as well as better lung function. However, being overweight beyond infancy was not associated with asthma occurrence. In fact, only children who were overweight at age 5 years but not at age 1 year had an increased risk of asthma at age 6 years (OR, 5.78; P = .05).In children genetically at high risk of asthma, being overweight at age 1 year was associated with a decreased risk of asthma and better lung function at ages 6 and 8 years. However, being overweight beyond infancy did not have any protective effect and even could confer a higher risk for asthma.
Pub.: 06 Nov '10, Pinned: 18 Jun '17
Abstract: The Childhood Asthma Control Test (C-ACT) has been proposed as a tool in assessing the level of disease control in asthmatic children. To evaluate the position of C-ACT in the clinical management of asthmatic children, in relationship to the level of airway inflammation as assessed by fractional exhaled nitric oxide (FeNO) and with lung function.A total of 200 asthmatic children were included in the study: 47 children with newly diagnosed asthma ('New') and without any regular controller therapy; and 153 children with previously diagnosed asthma, treated according to GINA guidelines, and evaluated during a scheduled follow-up visit ('Follow-up'). Childhood Asthma Control Test, FeNO and lung function [forced expiratory volume 1 (FEV1) and forced vital capacity (FVC)] were evaluated.In New vs Follow-up participants, C-ACT score (P < 0.001), FVC (P < 0.005) and FEV1 (P < 0.05) were significantly lower, and FeNO (P = 0.011) were significantly higher. In New, but not in Follow-up participants, significant correlations were observed between C-ACT score and FeNO (r = -0.51; P < 0.001), FEV1 (r = 0.34; P = 0.022) and FEV1/FVC (r = 0.32; P = 0.03). This lack of correlation in Follow-up visits seemed attributable to dissociation between inadequately controlled asthma by C-ACT ratings with normalization of other measures such as FeNO levels.This study confirms and expands the concept that C-ACT is complementary to, but not a substitute for, other markers of disease control in asthmatic children, especially in the context of follow-up visits.
Pub.: 29 Aug '09, Pinned: 18 Jun '17
Abstract: Few studies have characterized the atopic profile of toddler-aged children with recurrent wheezing at high risk of the development of persistent asthma. Objective We sought to determine the atopic profile of toddler-aged children with frequent wheeze at high risk for the development of persistent asthma who either had a parental history of asthma, a personal history of atopic dermatitis, or both.Participants enrolled in the Prevention of Early Asthma in Kids study (n = 285) on the basis of a modified Asthma Predictive Index were characterized on the basis of allergy and asthma questionnaire responses and allergy skin puncture test results.The majority of the children (60.7%, n = 148) were sensitized to either food or aeroallergens. Male children were significantly more likely to be sensitized to aeroallergens ( P = .03) and to have a blood eosinophil level of 4% or greater ( P = .03) and a total serum IgE level of greater than 100 IU/mL ( P = .0004). Additionally, eosinophilia and total serum IgE level had the strongest correlation with aeroallergen sensitization.The high prevalence of aeroallergen sensitization in this high-risk cohort suggests that aeroallergens might have an important role in the early development of asthma. As such, the Prevention of Early Asthma in Kids cohort appears to be an appropriate cohort in which to test whether early intervention with an inhaled corticosteroid can significantly attenuate, or perhaps even prevent, the allergic march from the initial stages of allergic sensitization to the subsequent development of asthma in toddlers with episodic wheezing.
Pub.: 04 Dec '04, Pinned: 18 Jun '17
Abstract: Infections and vaccinations may have a potential role in the normal maturation of the immune system, in the development and balance of regulatory pathways, and in the development and exacerbations of asthma. Asthma exacerbations often result from respiratory viral infections, and, while vaccination towards common viral infections may reduce the occurrence of such exacerbations, there has been concern that vaccinations can increase the risk of asthma. Current studies show that childhood vaccines, including inactivated influenza vaccine, are generally safe. However, there is some concern regarding possible exacerbations in infants or children with frequent wheezing or persistent asthma who are given live-attenuated influenza vaccination. Although severe allergic adverse events attributable to vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, such as egg protein or gelatin. The risks of not vaccinating children far outweigh the risks of allergy and asthma exacerbations. Therefore, childhood vaccination should remain an essential part of child health programs and should not be withheld, even from children with asthma or those predisposed to allergy.
Pub.: 01 Nov '08, Pinned: 18 Jun '17
Abstract: Asthma control represents a major challenge in the management of asthmatic children; however, correct perception of control is poor. The aim of the study was to evaluate the association between subjective answers given to the Childhood Asthma Control Test (C-ACT) and objective evaluation of exercise-induced bronchonstriction (EIB) by standardized treadmill exercise challenge.EIB was evaluated by standardized treadmill exercise challenge and related to C-ACT scores in 92 asthmatic children.Of the 92 studied children only six children had a concordance between a positive challenge test (ΔFEV1 ≥ 13%) and a positive response to the exercise-related issue of the C-ACT questionnaire (C-ACT total score ≤ 19). There was no significant association between the degree of EIB and the scores relative to the single question on exercise-related problems while a significant association was found when considering the whole questionnaire with C-ACT total score > 19 (r = -0.40, P < 0.001). The two single questions showing a significant association were those focusing on nocturnal asthma. The areas under the ROC curve (AUC) for the sum of the scores of these questions in relationship to a positive response to the exercise test was 0.74. The AUC of the C-ACT total score was 0.76 and 0.55 for the specific question on EIB related problems.The discrimination power of the C-ACT total score in relationship to EIB was moderately good, and C-ACT questionnaire was capable of correctly predicting the absence of EIB in children reporting a global score > 19. However, direct questions on EIB are associated with a high number of false positive and negative responses; better associations are found questioning on the presence on nocturnal symptoms.
Pub.: 08 Nov '11, Pinned: 18 Jun '17
Abstract: Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results.We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years).First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes.Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27).Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth.
Pub.: 18 Feb '14, Pinned: 18 Jun '17
Abstract: To discuss current evidence about the relation between prenatal and childhood Mediterranean diet, and the development of asthma and allergies in children.Review of the literature.Four recent studies conducted in Mediterranean countries (Spain, Greece) and one conducted in Mexico evaluated the association between childhood Mediterranean diet and asthma outcomes in children. All of the studies reported beneficial associations between a high level of adherence to the Mediterranean diet during childhood and symptoms of asthma or allergic rhinitis. Individual foods or food groups contributing to the protective effect of Mediterranean diet included fish, fruits, vegetables, legumes, nuts and cereals, while detrimental components included red meat, margarine and junk food intake. Two studies focused on prenatal Mediterranean diet: the first is a birth cohort in Spain that showed a protective effect of a high adherence to the Mediterranean diet during pregnancy on persistent wheeze, atopic wheeze and atopy at the age of 6.5 years; while the second is a cross-sectional study in Mexico, collecting information more than 6 years after pregnancy, that showed no associations between maternal Mediterranean diet during pregnancy and allergic symptoms in childhood except for current sneezing.Findings from recent studies suggest that a high level of adherence to the Mediterranean diet early in life protects against the development of asthma and atopy in children. Further studies are needed to better understand the mechanisms of this protective effect, to evaluate the most relevant window of exposure, and to address specific components of diet in relation to disease.
Pub.: 20 Aug '09, Pinned: 18 Jun '17
Abstract: No quick and easy assessment tool is presently available to measure asthma control and outcome in Chinese children.We translated an established seven-item questionnaire into the Chinese Childhood Asthma Control Test (C-CACT) to measure asthma symptoms and their effect on daily function in 247 children aged 4-11 years enrolled from specialty clinics around Tainan. Subjects were classed as having either intermittent or persistent asthma and were evaluated at two outpatient visits 4-8 weeks apart (baseline and follow-up).C-CACT at baseline correlated significantly with physician evaluation scores (PES) except in predicted peak expiratory flow rate. There were significant differences for mean C-CACT score and mean PES between the intermittent group and persistent group. Internal consistency reliability of the survey was 0.741 at baseline and 0.759 at the follow-up visit. Test-retest reliability among 209 patients with the same specialist rating of asthma control at baseline and follow-up was r = 0.546 (P < 0.001). C-CACT scores of patients whose therapy needed to be stepped up was significantly lower than in those with unchanged or stepped-down therapy (F = 39.61, P < 0.001).C-CACT provides a reliable, valid, and responsive measure of asthma control in Chinese children.
Pub.: 05 Apr '08, Pinned: 18 Jun '17
Abstract: The purpose of this study was to evaluate the association among birth weight, prematurity, and the prevalence of asthma later in childhood and to assess the degree to which this association may differ between black and white children.Michigan Medicaid claims data from 2001 through 2003 were analyzed to determine asthma prevalence for 150,204 children between ages 5 and 18 years. Asthma cases were identified using Healthcare Effectiveness Data and Information Set persistent asthma criteria and included children having claims for any of the following services within a calendar year: at least one inpatient or one emergency department (ED) claim with an asthma primary diagnosis; at least four asthma medication-dispensing events; or at least four outpatient visits with an asthma diagnosis, and at least two asthma medication-dispensing events. Birth weight and gestational age from birth certificate data were matched with Medicaid files to determine size-for-gestational-age criteria.Overall, 8.3% of children had persistent asthma; black children had slightly higher asthma prevalence (8.6%) than white children (7.8%; odds ratio [OR]=1.11, 95% confidence interval [CI]: 1.07-1.15). Children born very preterm (<or=32 weeks) had higher prevalence of childhood asthma (11.7%) compared with term births (8.0%; OR=1.51, 95% CI: 1.40-1.63). However, no significant differences were observed in odds of asthma between black and white children born very preterm, preterm (33-36 weeks), or small for gestational age (SGA).Regardless of race, children born very preterm had an increased risk of childhood asthma. Although overall asthma prevalence is higher among black children enrolled in Medicaid compared with their white counterparts, these differences were attenuated when prematurity or SGA status were taken into account.
Pub.: 23 Feb '08, Pinned: 18 Jun '17
Abstract: Prenatal factors such as prenatal psychological stress might influence the development of childhood asthma.We assessed the association between maternal bereavement shortly before and during pregnancy, as a proxy for prenatal stress, and the risk of childhood asthma in the offspring, based on two samples of children 1-4 (n = 426,334) and 7-12 (n = 493,813) years assembled from the Swedish Medical Birth Register. Exposure was maternal bereavement of a close relative from one year before pregnancy to child birth. Asthma event was defined by a hospital contact for asthma or at least two dispenses of inhaled corticosteroids or montelukast. In the younger sample we calculated hazards ratios (HRs) of a first-ever asthma event using Cox models and in the older sample odds ratio (ORs) of an asthma attack during 12 months using logistic regression. Compared to unexposed boys, exposed boys seemed to have a weakly higher risk of first-ever asthma event at 1-4 years (HR: 1.09; 95% confidence interval [CI]: 0.98, 1.22) as well as an asthma attack during 12 months at 7-12 years (OR: 1.10; 95% CI: 0.96, 1.24). No association was suggested for girls. Boys exposed during the second trimester had a significantly higher risk of asthma event at 1-4 years (HR: 1.55; 95% CI: 1.19, 2.02) and asthma attack at 7-12 years if the bereavement was an older child (OR: 1.58; 95% CI: 1.11, 2.25). The associations tended to be stronger if the bereavement was due to a traumatic death compared to natural death, but the difference was not statistically significant.Our results showed some evidence for a positive association between prenatal stress and childhood asthma among boys but not girls.
Pub.: 17 Nov '11, Pinned: 18 Jun '17
Abstract: Severe asthma exacerbations are often treated with short courses of oral corticosteroids (OCS). This study assessed the incidence of OCS being prescribed in asthmatic children of various age groups and calculated their chances of receiving subsequent OCS prescriptions.Longitudinal Dutch community pharmacy data of 2272 children who were regular users of asthma medication was analyzed retrospectively. Incidence rates for first, second and third prescriptions of OCS were calculated, stratified by age and sex. Probabilities of receiving first, second or third OCS prescriptions were assessed with Kaplan-Meier analysis.Incidence rates for first OCS prescriptions were 4.5 for the 1(st) year of life per 100 person-years (100PY); 3.9 for the 2(nd); 4.6 for the 3(rd); 4.2 for the 4(th), and 4.7 for the 5(th) year of life per 100PY. This was relatively high compared to incidence rates for children between the ages of 6 and 11 (ranging between 2.2 per 100PY (age 9) and 3.7(age 11)). Incidence rates for second and third OCS prescriptions were very high: 78.2(95%CI: 45.0-123.7) and 241.2(95%CI: 81.2-583.4) per 100PY for infants, respectively. The chances of receiving a first OCS prescription was higher in males (P-value <0.01).In the Netherlands, the incidence of OCS being prescribed to children being treated with asthma medication in early childhood is relatively high for first OCS prescriptions and extremely high for second and third OCS prescriptions compared to other ages. Furthermore, there is a high probability of receiving a further OCS prescription shortly after an OCS prescription.
Pub.: 18 May '16, Pinned: 18 Jun '17
Abstract: The Childhood Asthma Control Test (C-ACT), a seven-item, self-administered questionnaire, has been used as a tool to assess the control level in children with asthma. The aim of this study was to determine whether the C-ACT reflects airflow limitation and airway inflammation in addition to clinical manifestations.Asthmatic children aged 5-11 years who were able to perform the lung function test and fractional exhaled nitric oxide (FeNO) evaluation correctly were recruited during their regular visits. Children and their parents were asked to answer the officially developed Japanese version of the C-ACT.Among 258 children (176 boys, median age 9 years), there was a significant positive correlation between the C-ACT score and the percent predicted forced expiratory volume in 1 s (%FEV(1)) (r = 0.317, p < .001). The accuracy of the C-ACT for identifying asthmatic subjects with normal lung function (%FEV(1) >80%) described as the area under the receiver operating characteristic curve was 71.5% (95% CI = 62.8-80.2%, p < .001), and based on the Youden index the optimal cutoff score was 23 (sensitivity of 78% and specificity of 54%). In contrast, there was no relationship between the C-ACT score and the FeNO value.These results suggest that a cutoff score of 23 for the C-ACT could be useful for identifying children with well-controlled asthma and normal lung function. Further studies are warranted to develop an easy-to-use questionnaire to assess the extent of airway inflammation in children.
Pub.: 04 Nov '11, Pinned: 18 Jun '17
Abstract: Little is known about the natural history of wheezing disorders among children at risk for atopy. We examined the relation between early wheeze and asthma at 7 years of age among children with parental history of asthma or allergies followed from birth.Information on wheeze was collected bimonthly from birth to age 24 months and every 6 months thereafter. Recurrent early wheeze was defined as > or =2 reports of wheezing in the first 3 years of life. Frequent early wheeze was defined as > or =2 reports of wheezing per year in the first 3 years of life. At 7 years of age, asthma was defined as physician-diagnosed asthma and wheezing in the previous year.Of the 440 participating children, 223 (50.7%) had > or =1 report of wheeze before 3 years old, 111 (26.0%) had recurrent early wheeze, and 12 (2.7%) had frequent early wheeze. Whereas only 31 (13.9%) of 223 children with > or =1 report of wheeze developed asthma at 7 years of age, 24 (21.6%) of 111 children with recurrent early wheeze developed asthma at 7 years of age. Among the 12 children with frequent early wheeze, 6 (50%) had asthma at 7 years of age. After adjustment for other covariates, recurrent early wheeze in children at risk for atopy was associated with a fourfold increase in the odds of asthma at 7 years of age, and frequent early wheeze was associated with an approximately 12-fold increase in the odds of asthma at 7 years of age. Most (94%) of the children without frequent early wheeze did not develop asthma at 7 years of age.The absence of recurrent early wheeze indicates a very low risk of asthma at school age among children with parental history of asthma or allergies. Early identification of children who will develop asthma at school age is difficult, even in children at risk for atopy. However, children with parental history of asthma or allergies who have frequent early wheeze, in particular, are at greatly increased risk of asthma and merit close clinical follow-up.
Pub.: 03 Jun '06, Pinned: 18 Jun '17
Abstract: While paracetamol exposure in pregnancy and early infancy has been associated with asthma, it remains unclear whether this is confounded by respiratory tract infections, which have been suggested as an alternative explanation. We undertook a systematic review and meta-analysis of longitudinal studies that reported the association between paracetamol exposure during pregnancy or infancy and the subsequent development of childhood asthma (≥5 years).Two independent researchers searched the databases EMBASE and PUBMED on 12 August 2013 for relevant articles using predefined inclusion and exclusion criteria. Study quality was assessed and results were pooled using fixed effect models or random effect models when moderate between-study heterogeneity was observed. We explicitly assessed whether the observed associations are due to confounding by respiratory tract infections.Eleven observational cohort studies met the inclusion criteria. Any paracetamol use during the first trimester was related to increased risk of childhood asthma (5 studies, pooled OR=1.39, 95% CI 1.01 to 1.91) but there was marked between-study heterogeneity (I(2)=63%) and only one of these studies adjusted for maternal respiratory tract infections. Increasing frequency of use of paracetamol during infancy was associated with increased odds of childhood asthma (3 studies, pooled OR=1.15, 95% CI 1.00 to 1.31 per doubling of days exposure), but in these same three studies adjusting for respiratory tract infections reduced this association (OR=1.06, 95% CI 0.92 to 1.22).The association during early pregnancy exposure was highly variable between studies and exposure during infancy appears to be moderately confounded by respiratory tract infections. There is insufficient evidence to warrant changing guidelines on early life paracetamol exposure at this time.
Pub.: 28 Nov '14, Pinned: 18 Jun '17
Abstract: To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program.Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents (< 18 years of age) with asthma or suspected asthma. Patients either enroll in PIPA spontaneously or are referred by pediatricians or primary care physicians. In this retrospective study, we use a standardized protocol to assess PIPA patients.By the end of the study period, 646 patients were being followed. Of those, 298 (46.1%) were ≤ 3 years of age. In this group of patients, recurrent wheezing was identified in 60.7%, and the first episode of wheezing occurred in the first six months of life in 86.0%. Severe wheezing was identified in 29.5% and 45.4% in the children ≤ 3 and > 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling.A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood.
Pub.: 18 Mar '16, Pinned: 18 Jun '17
Abstract: We examined correlations between the two asthma assessment tools, pulmonary function tests, and Childhood Asthma Control Test (C-ACT) scores, in 5-11-year-old children with asthma to determine if the C-ACT scores could predict pulmonary function test results.A total of 172 children with asthma aged 5-11 years completed C-ACT questionnaires and underwent pulmonary function testing. Correlations between these test results were examined. Patients were also placed into two groups, C-ACT scores ≤19 and >19, to determine if patients with scores >19 had better pulmonary function test results.Weak correlations were found between pulmonary function test results and childhood asthma control test scores in 5-11-year-old children with asthma, with or without the use of an asthma controller. These correlations included: 0.061 for FEV1 [confidence interval (CI): -0.022-0.049] and 0.074 for MMEF (CI: -0.013-0.037). The proportions of children with C-ACT test scores ≤19 group and those with scores >19 group were not significantly different.Correlations between C-ACT scores and pulmonary function test results were poor for children aged 5-11 years with asthma. FEV1, FVC, FEF25, FEF50, FEF75, MMEF, and PEFR were not significantly correlated with C-ACT scores.
Pub.: 04 Dec '13, Pinned: 18 Jun '17
Abstract: We sought to compare the accuracy of a newly developed childhood asthma score (CAS) with routine clinical assessment of respiratory status in children with acute asthma in predicting requirements for bronchodilator nebulization.In this prospective observational study in children 2-18 y old with acute asthma, we evaluated the association between the CAS and routine clinical assessment as well as inter-rater agreement.The need for bronchodilator nebulization was assessed during 134 episodes of acute asthma in 47 children. Overall, bronchodilators were administered after routine clinical assessment in 74 episodes (55.2%). The median CAS was 2.5 (interquartile range of 2.0-3.0) for subjects who did not receive nebulization and 6.0 (interquartile range of 4.0-7.0) for subjects who did receive nebulization (P < .001). A CAS cutoff score of 4 yielded a sensitivity of 0.91 (95% CI 0.84-0.97) and a specificity of 0.77 (95% CI 0.66-0.87), with a positive predictive value of 0.83 (95% CI 0.75-0.91) and a negative predictive value of 0.87 (95% CI 0.78-0.96). In 79 episodes, the CAS was assessed by 2 independent raters. With a weighted kappa of 0.77, a good inter-rater agreement was obtained.Using a cutoff value of 4, the newly developed CAS accurately predicts the requirement for bronchodilator nebulization in children with acute asthma without use of auscultative findings.
Pub.: 28 Aug '14, Pinned: 18 Jun '17
Abstract: This paper reports the internal consistency and reproducibility of the Childhood Asthma Questionnaires, measures of quality of life and symptom distress in paediatric asthma. A total of 535 children aged 4–16 years completed age appropriate forms of the questionnaire, over 1-or 3-week intervals. Pearson correlation coefficients between 0.63 and 0.84 for subscales of the questionnaires indicated good test-retest reliability while intraclass correlation coefficients in a very similar range showed that scores also remained at the same level on the two occasions. Comparisons between children with asthma and healthy non-asthmatics indicate that these are likely to be true estimates of stability. Internal consistency varied widely but was higher for older children and longer subscales. Implications of the findings for the use of the questionnaires in the evaluation of new asthma treatments are discussed.
Pub.: 01 Jun '94, Pinned: 18 Jun '17
Abstract: This descriptive study was conducted to determine the prevalence of asthma and related symptoms among 6-7 and 13-14 year old school children in Tehran as a part of International study of Asthma and Allergies in childhood (ISAAC) phase III. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of 2 divisions of the municipality. All 6-7 and 13-14 year old students were enrolled in this study. Results showed that 15% of the 6-7 year olds and 17% of the 13-14 year olds had positive history of wheezing among which 8.6% and 10.6% respectively had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6-7 year olds and 2.6% of the 13-14 age group. Severity of asthma assessed by frequency of speech limitation due to wheeze was positive in 1.5% of 6-7 aged group and 3% of 13-14 year olds. Exercise induced wheeze was detected in 2.3% of the 6-7year old group compared to 15.3% of the 13-14 year olds. Nocturnal cough was more prevalent among 13-14 year olds (18.4%) compared to only 7.2% in the 6-7 year olds. Overall, no significant change in prevalence of asthma symptoms has occurred since 1997 (the last phase of ISAAC) among children of Tehran. The results of our study suggest higher rates of confirmed asthma among 6-7 years old girls compared to boys. However, more extensive and precisely designed studies are needed to further confirm these findings.
Pub.: 16 Feb '07, Pinned: 18 Jun '17
Abstract: Reliable assessment of asthma control is essential for effective treatment. While several validated tools for assessing asthma control in children are currently available, few studies have evaluated the correlations between different asthma control measures in children. This study aimed to determine the correlations between the Childhood Asthma Control Test (C-ACT) and the Global Initiative for Asthma (GINA) guideline-based asthma control measure (ACM) with lung function parameters in children with asthma.Sixty-three children aged 6-11 years with mild-intermittent to severe-persistent asthma were evaluated. They completed the C-ACT, the GINA guideline-based assessment and lung function tests with the help of their caregivers.C-ACT scores and GINA guideline-based ACM were positively correlated. The average C-ACT scores for children with controlled, partly controlled and uncontrolled asthma according to the GINA guidelines were 24.4±0.3, 22.8±0.6 and 21.3±1.0 (mean±SE), respectively. High C-ACT scores were also noted in children with uncontrolled asthma based on the GINA guidelines. The GINA guideline-based ACM was correlated with spot spirometry parameters (forced vital capacity, forced expiratory volume in 1 second, and maximal mid-expiratory flow). Conversely, the C-ACT score was not correlated with these spirometry parameters.The C-ACT may overestimate asthma control in certain circumstances. For children with poorly controlled asthma or poor symptom perception, more frequent visits and serial pulmonary function tests are recommended.
Pub.: 19 Oct '10, Pinned: 18 Jun '17
Abstract: Several self-administered questionnaires have been developed to assess childhood asthma control in a simple and standardized way. This review discusses the most commonly used questionnaires and explores their usefulness in asthma management in children. We conclude that the use of asthma control questionnaires in daily practice and in research contributes to the standardized evaluation of children with asthma and helps to track asthma symptoms, but validation studies in a wider range of settings are needed.
Pub.: 05 Sep '14, Pinned: 18 Jun '17
Abstract: Adequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma.A systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects.CENTRAL, CINAHL, MEDLINE and Web of Science. Search performed in March 2016.Studies using intravenous aminophylline in children with an acute exacerbation of asthma which reported the dosage and clinical outcomes.14 RCTs were included. There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. This study is limited due to its use of indirect evidence.The currently recommended dosage regimens may not represent the optimum safety and efficacy of intravenous aminophylline. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices.
Pub.: 03 Aug '16, Pinned: 18 Jun '17
Abstract: Exercise can provoke asthma symptoms, such as dyspnoea, in children with asthma. Exercise-induced bronchoconstriction (EIB) is prevalent in 40-90% of children with asthma. Conversely, exercise can improve physical fitness. The purpose of this paper is to provide a systematic review of the literature regarding the effects of exercise training in children with asthma, particularly in relation to: EIB, asthma control, pulmonary function, cardiorespiratory parameters and parameters of underlying pathophysiology. A systematic search in several databases was performed. Controlled trials that undertook a physical training programme in children with asthma (aged 6-18 years) were selected. Twenty-nine studies were included. Training had positive effects on several cardiorespiratory fitness parameters. A few studies demonstrated that training could improve EIB, especially in cases where there was sufficient room for improvement. Peak expiratory flow was the only lung function parameter that could be improved substantially by training. The effects of training on asthma control, airway inflammation and bronchial hyper-responsiveness were barely studied. Owing to the overall beneficial effects of training and the lack of negative effects, it can be concluded that physical exercise is safe and can be recommended in children with asthma. A training programme should have a minimum duration of 3 months, with at least two 60 min training sessions per week, and a training intensity set at the (personalised) ventilatory threshold. Further research is recommended regarding the effects of exercise on underlying pathophysiological mechanisms and asthma control in children with asthma.
Pub.: 26 Mar '13, Pinned: 18 Jun '17
Abstract: The relationship between gastroesophageal reflux disease (GERD) and asthma in children has been investigated; however, the nature of the association (if any) between these 2 conditions is unclear.We performed a systematic review of the literature to examine the association between GERD and asthma in children.A search of the medical literature was conducted by using PubMed and Embase (1966 through December 2008). Full-length articles in English that described at least 20 subjects younger than 18 years were included if they reported the prevalence of GERD (symptoms, pH studies, endoscopy/histology) in individuals with asthma or the prevalence of asthma in individuals with GERD. We calculated pooled odds ratios from studies that examined control groups, and we pooled prevalence estimates from all studies.A total of 20 articles that described 5706 patients fulfilled the inclusion and exclusion criteria. Seventeen studies used objective methods for documenting reflux (eg, pH probe, contrast imaging, impedance, esophagogastroduodenoscopy), 2 studies relied on symptom-based questionnaires, and 1 study used diagnostic codes. Most studies (n = 19) examined the prevalence of GERD in 3726 individuals with asthma and reported highly variable estimates (19.3%-80.0%) and a pooled average of 22.8% with GERD symptoms, 62.9% of 789 patients with abnormal esophageal pH, and 34.8% of 89 patients with esophagitis. Only 5 studies included controls and enrolled 1314 case-patients with asthma and 2434 controls without asthma. The average prevalence of GERD was 22.0% in asthma cases and 4.8% in controls (pooled odds ratio: 5.6 [95% confidence interval: 4.3-6.9]).There is a possible association between GERD and asthma in pediatric patients seen with asthma in referral settings. However, because of methodologic limitations of existing studies, the paucity of population-based studies, and a lack of longitudinal studies, several aspects of this association are unclear.
Pub.: 31 Mar '10, Pinned: 18 Jun '17
Abstract: Psychological factors may influence the symptoms and management of asthma in children in many ways. It is, therefore, suggested that psychological interventions may be appropriate for this population. This paper reports a systematic review assessing the efficacy of psychological interventions in improving health outcomes for children with asthma.A review of Randomized Controlled Trials (RCT) was designed. RCTs assessing the effects of a psychological intervention in child participants were included in the review. Outcome measures included healthcare utilization, lung function, asthma symptoms, and psychological health status. The search was conducted until April 2005.Twelve studies, involving 588 children, were included in the review; however, study quality was poor and sample sizes were frequently small. A meta-analysis was performed on two studies, examining the effects of relaxation therapy on PEFR which favored the treatment group (SD 0.82, CI 0.41-1.24). No other meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. In addition, many studies reported insufficient data.This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. We recommend that valid outcome measures for evaluating the effectiveness of psychological interventions for children with asthma need to address adjustment to and coping with asthma, as well as other psychological indicators. The absence of an adequate evidence base is demonstrated, highlighting the need for well-conducted RCTs in this area.
Pub.: 23 Dec '06, Pinned: 18 Jun '17
Abstract: Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship.After a comprehensive literature search, we identified seven peer-reviewed studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional.For each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were either abstracted from published results or calculated based on the data provided. Characteristics regarding the study design and population were also abstracted.We used fixed- and random-effects models to calculate pooled ORs and 95% CIs; measures of heterogeneity were also calculated. A fixed-effects model produced an OR of 1.03 (95% CI, 1.021.04), and random effects model produced an OR of 1.17 (95% CI, 1.011.36), both reflecting an increase of 10 microg/m3 of formaldehyde. Both the Q and I2 statistics indicated a moderate amount of heterogeneity.Results indicate a significant positive association between formaldehyde exposure and childhood asthma. Given the largely cross-sectional nature of the studies underlying this meta-analysis, further well-designed prospective epidemiologic studies are needed.
Pub.: 13 Jan '10, Pinned: 18 Jun '17
Abstract: This article aims to explain the effects of long-term use of asthma medications. It will discuss the effects of asthma on the oral cavity, as well considerations for the dentist when treating asthmatic patients. It will also explain how to manage asthma in the dental setting and provide advice on maintaining oral health for asthmatic patients.
Pub.: 26 Mar '16, Pinned: 18 Jun '17
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