Asthma In School-aged Children Research Articles

"Detailed characterization and impact of small airway dysfunction in school-age asthma".

Small airway dysfunction (SAD) is increasingly recognized as an important feature of pediatric asthma yet typically relies on spirometry-derived FEF25-75 to detect its presence. Multiple breath washout (MBW) and oscillometry potentially offer improved sensitivity for SAD detection, but their utility in comparison to FEF25-75, and correlations with clinical outcomes remains unclear for school-age asthma.We investigated SAD occurrence using these techniques, between-test correlation and links to clinical outcomes in 57 asthmatic children aged 8-18 years. MBW and spirometry abnormality were defined as z-scores above/below ± 1.96, generating MBW reference equations from contemporaneous controls (n = 69). Abnormal oscillometry was defined as > 97.5th percentile, also from contemporaneous controls (n = 146). Individuals with abnormal FEF25-75, MBW, or oscillometry were considered to have SAD.Using these limits of normal, SAD was present on oscillometry in 63% (resistance at 5-20 Hz; R5-R20; >97.5th percentile), on MBW in 54% (Scond; z-scores> +1.96) and in spirometry FEF25-75 in 44% of participants (z-scores<-1.96). SAD, defined by oscillometry and/or MBW abnormality, occurred in 77%. Among those with abnormal R5-R20, Scond was abnormal in 71%. Correlations indicated both R5-R20 and Scond were linked to asthma medication burden, baseline FEV1 and reversibility. Additionally, Scond correlated with FENO and magnitude of bronchial hyper-responsiveness.SAD, detected by oscillometry and/or MBW, occurred in almost 80% of school-aged asthmatic children, surpassing FEF25-75 detection rates. Discordant oscillometry and MBW abnormality suggests they reflect different aspects of SAD, serving as complementary tools. Key asthma clinical features, like reversibility, had stronger correlation with MBW-derived Scond than oscillometry-derived R5-R20.

Early exposure to sunlight and allergic morbidity: The PARIS birth cohort

The relationship between sunlight and allergies in children has received limited attention from researchers. We sought to explore how early exposure to solar radiation is associated with allergic morbidity within the PARIS birth cohort study.Our research dealt with children who attended at least one of two health checkups: at 18 months (n = 2012) and at 8–9 years (n = 1080). Early exposure to solar radiation was assessed using meteorological data (e.g., solar radiation, temperature, and relative humidity). Children with similar meteorological exposure trajectories were grouped by a longitudinal and multidimensional cluster analysis. The association between solar radiation exposure and allergic morbidity (i.e., allergic sensitization at 18 months and 8–9 years; current asthma, rhinitis, and eczema at 8–9 years) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D supplementation during pregnancy was tested. Four meteorological exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitization at 8–9 years compared to the trajectory with the lowest exposure (p = 0.06). The association was statistically significant in the vitamin D supplementation group. Solar radiation during prenatal and postnatal periods was significantly associated with a lower risk of sensitization at 8–9 years (for one interquartile range (IQR) increase, adjusted odds ratio (aOR): 0.47; 95 % confidence interval (CI): 0.25–0.87 and 0.84; 0.7–1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower risk of asthma at 8–9 years (for one IQR increase, aOR: 0.32; 95 % CI: 0.1–0.96).Early sunlight exposure may reduce the risk of sensitization and asthma in school-aged children, especially in those prenatally exposed to vitamin D. These findings highlight the importance of vitamin D in preventing allergic diseases in children, either through supplementation or sunlight exposure.

Uncontrolled asthma in school-aged children—a nationwide specialist care study

BackgroundUncontrolled asthma is different from severe asthma and can be identified in children across all ranges of prescribed treatment. ObjectiveTo characterize uncontrolled childhood asthma in pediatric specialist care. MethodsWe performed a nationwide cross-sectional study of 5497 children (6-17 years) with asthma, treated by pediatricians at out-patient clinics during 2019 and registered in the Swedish National Airway Register. Uncontrolled asthma was defined as Asthma Control Test (ACT) ≤19 and/or ≥2 exacerbations last year and/or FEV1<80% predicted. Treatment was categorized from step 1 to 5 according to the Global Initiative for Asthma (GINA). ResultsUncontrolled asthma (UCA) was identified in 1690 children (31%), of whom 64% had ACT≤19, 20% had recurrent exacerbations and 31% had FEV1<80%. UCA was associated with female sex (OR 1.29, (CI 1.15-1.45)), older age (OR 1.02, (CI 1.00-1.04)), obesity (OR 1.43, (CI 1.12-1.83)) and more treatment using step 1-2 as reference (step 3: OR 1.28 (1.12-1.46), step 4-5 OR 1.32 (1.10-1.57)). UCA in children prescribed step 1-2 treatment (UCA1-2) occurred in 28% (n=887) of all children in this treatment step. Children with UCA1-2 had more often exacerbations compared to children with UCA in children prescribed step 4-5 treatment (24% vs. 15%, p=0.001). ConclusionUncontrolled asthma was common and associated with female sex, increasing age, obesity and higher GINA treatment step. Surprisingly, uncontrolled asthma was also common in children prescribed less than maximum treatment and these children could be considered as under-treated patients.

Urban environment during pregnancy and lung function, wheezing, and asthma in school-age children. The generation R study

The urban environment during pregnancy may influence child's respiratory health, but scarce evidence exists on systematic evaluation of multiple urban exposures (e.g., air pollution, natural spaces, noise, built environment) on children's lung function, wheezing, and asthma development.We aimed to examine the association of the urban environment during pregnancy with lung function, preschool wheezing, and school-age asthma.We included 5624 mother-child pairs participating in a population-based prospective birth cohort. We estimated 30 urban environmental exposures including air pollution, road traffic noise, traffic, green spaces, blue spaces, and built environment during pregnancy. At 10 years of age, lung function was measured by spirometry. Information on preschool wheezing and physician-diagnosed school-age asthma was obtained from multiple questionnaires. We described single-exposure associations with respiratory outcomes using an exposome-wide association study. We also identified patterns of urban exposures with hierarchical clustering on principal components analysis and examined their associations with respiratory outcomes using multivariate regression models.Single-exposure analyses showed associations of higher particulate matter (PM) with lower mid-expiratory flow (FEF25–75%) (e.g., for PM < 2.5 μm of diameter [PM2.5] z-score = −0.06 [-0.09, −0.03]) and higher forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) (e.g., for PM2.5 FEV1 0.05 [0.02, 0.08]) after correction for multiple-hypothesis testing. Cluster analysis described three patterns of urban exposures during pregnancy and showed that the cluster characterised by higher levels of air pollution, noise, walkability, street connectivity, and lower levels of natural spaces were associated with lower FEF25–75% (−0.08 [-0.17, 0.00]), and higher odds of preschool wheezing (1.21 [1.03, 1.43]).This study shows that the characteristics of the urban environment during pregnancy are of relevance to the offspring's respiratory health during childhood.

Bronchial reactivity and asthma at school age after early-life metapneumovirus infection.

The association between early-life lower respiratory tract infection (LRTI) and asthma is well established. Knowledge about bronchial hyperresponsiveness (BHR) and asthma after metapneumovirus (MPV) LRTI is scarce. The aim of this study was to assess BHR and current asthma in school-aged children after hospital admission for early-life LRTI with MPV, and to compare with more well-known viruses, rhinovirus (RV) and respiratory syncytial virus (RSV), and with controls. A cohort consisting of children admitted for LRTI and controls was followed-up at school age with a clinical research assessment and lung function tests, including a methacholine provocation test. Current asthma was defined based on objective variable airway obstruction and clinical symptoms. BHR and asthma were compared according to viral groups. 135 children (median age 9.3 years) were included (16 MPV, 34 RV, 51 RSV, 13 mixed infections and 21 controls). Compared with controls there was increased BHR after MPV and RV LRTI (provocative dose causing a 20% fall in forced expiratory volume in 1 s and dose-response slope; p<0.05). Using Kaplan-Meier statistics, BHR was increased for MPV compared with both controls and RSV (p=0.02 and p=0.01). The proportion of children with current asthma at follow-up was higher in the LRTI children compared with the controls (46% versus 24%; p=0.06). Among children who had undergone MPV and RV infection, 50% fulfilled the asthma criteria compared with 43% in the RSV group (p=0.37). We found increased BHR and a high prevalence of asthma in school-aged children after early-life MPV infection, and findings were similar to RV, and less to RSV, compared with controls.

T2-low asthma in school-aged children: unacknowledged and understudied

T2-low asthma in school-aged children: unacknowledged and understudied

Exposure to sunlight and allergic morbidity in children (Pollution and Asthma Risk: an Infant Study)

Abstract Background Sunlight relationship with allergies is poorly studied in children. Thus, we examined how early exposure to solar radiation is associated with allergic morbidity in the PARIS birth cohort. Methods This study dealt with children who attended at least one of the two health check-ups: 18 months (n = 2012) and 8/9 years (n = 1080). Early exposure (prenatal and during the first year of life) to solar radiation was assessed using meteorological data (solar radiation, temperature, relative humidity). Children with similar exposure trajectories were grouped by longitudinal and multidimensional cluster analysis. Association of solar radiation exposure with allergic morbidity (i.e. allergic sensitisation at 18 months and 8/9 y., current asthma, rhinitis, and eczema at 8/9 y.) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D (VitD) supplementation during pregnancy was also tested. Results Four exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitisation at 8/9 y. compared to the trajectory with the lowest exposure (p = 0.06). This association was statistically significant in the VitD supplemented subgroup. Solar radiation during pre- and post-natal period was significantly associated with a lower risk of sensitisation at 8/9 y. (for ↗IQR, aOR: 0.47; 95%CI: 0.25-0.87 and 0.84;0.70-1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower asthma risk at 8/9 y. (for ↗IQR, 0.32; 0.10-0.96). Conclusions Early sunlight exposure may reduce the risk of sensitisation and asthma in school-aged children, especially in those prenatally exposed to VitD intake. These findings highlight the importance of VitD in preventing allergic diseases in children, either through supplementation or sunlight exposure. Key messages • Pre-natal and early postnatal exposure to sunlight could reduce the risk of sensitisation and asthma among school-aged children. • The association may be explained by vitamin D immunomodulatory effect, highlighting its importance in preventing allergic diseases in children through supplementation or sunlight exposure.

Saliva contact during infancy and allergy development in school-age children.

Parent-child saliva contact during infancy might stimulate the child's immune system for effective allergy prevention. However, few studies have investigated its relation to allergy development in school-age children. We sought to investigate the relationship between parent-child saliva contact during infancy and allergy development at school age. We performed a large multicenter cross-sectional study involving Japanese school children and their parents. The self-administered questionnaires including questions from the International Study of Asthma and Allergies in Childhood were distributed to 3570 elementary and junior high school children in 2 local cities. Data were analyzed for the relationship between saliva contact during infancy (age <12 months) and the risk of allergy development, specifically eczema, allergic rhinitis, and asthma. For detailed Methods, please see the Methods section in this article's Online Repository at www.jacionline.org. The valid response rate was 94.7%. The mean and median age of children was 10.8± 2.7 and 11 (interquartile range, 9-13) years, respectively. Saliva contact via sharing eating utensils during infancy was significantly associated with a lower risk of eczema (odds ratio, 0.53; 95% CI, 0.34-0.83) at school age. Saliva contact via parental sucking of pacifiers was significantly associated with a lower risk of eczema (odds ratio, 0.24; 95% CI, 0.10-0.60) and allergic rhinitis (odds ratio, 0.33; 95% CI, 0.15-0.73), and had a borderline association with the risk of asthma in school-age children. Saliva contact during infancy may reduce the risk of developing eczema and allergic rhinitis in school-age children.

Effect of radon exposure on asthma morbidity in the School Inner-City Asthma study.

Radon may have a role in obstructive lung disease outside its known carcinogenicity. Little is known about radon's effects on asthma morbidity. To determine the effect of radon on fractional exhaled nitric oxide (FE NO), asthma symptom-days, and lung function in inner-city asthmatic school children. Two hundred ninety-nine school-aged asthmatic children enrolled in the School Inner-City Asthma Study (SICAS-1) were followed. One and two-month averaged radon was assessed using a spatiotemporal model predicting zip code-specific monthly exposures. FE NO and spirometry were measured twice during the academic year. Asthma symptoms were assessed four times during the academic year. The interaction between indoor radon exposure (Bq/m3 ) and seasonality predicting log-transformed FE NO, forced expiratory volume in 1 s (FEV1 ) % predicted, forced vital capacity (FVC) % predicted, FEV1 /FVC, and asthma symptom-days was evaluated. Participants with high radon exposure had greater change in FE NO from warm to cold periods compared to low radon exposure (interaction p = 0.0013). Participants with >50th percentile radon exposure experience significant FE NO increase from warm to cold weather ( = 0.29 [95% confidence interval [CI]: 0.04-0.54], p = 0.0240). We report a positive association between radon 1-month moving average (incidence rate ratio [IRR] = 1.01, p = 0.0273) and 2-month moving average (IRR = 1.01, p = 0.0286) with maximum asthma symptom-days (n = 299, obs = 1167). In asthmatic children, radon may be associated with increased asthma morbidity, suggesting radon may be a modifiable environmental risk factor for airway inflammation.

Evaluation of fractional exhaled nitric oxide in school-age children with asthma and sensitization to cat allergens

bronchial asthma is a chronic condition that is considerably prevalent among children. According to scientific evidence, cat allergens are most frequently responsible for the onset of asthma manifestations in children. Children are more likely to develop atopic asthma with eosinophilic inflammation. Under these circumstances, specific biomarkers are used as indicators of this inflammation. Fractional exhaled nitric oxide has been identified as a marker of eosinophilic airway inflammation in asthma. The aim of the research was to determine the fractional exhaled nitric oxide concentrations in school-age children with bronchial asthma and sensitization to cat allergens in order to predict asthma control status and assess therapeutic response. A total of 430 children aged between 6 and 17 years with asthma and sensitization to cat allergens participated in the study. The sensitization profile was investigated using a multicomponent molecular allergy diagnostic test (ALEX², Austria). The fractional exhaled nitric oxide levels were evaluated (NIOX VERO, Sweden). A total of 302 patients were enrolled in a retrospective study to find out how likely they were to gain bronchial asthma control over the course of therapy. As a result, a one-factor logistic regression analysis was conducted. A total of 128 children were included in the 12-month prospective research. All patients had a rise in fractional exhaled nitric oxide of &gt; 20 ppb, with children with severe asthma having levels of 35 ppb or higher. The study discovered that changes in the fractional exhaled nitric oxide concentrations at the end of a three-month therapy could be linked to the maintenance of bronchial asthma control after a 12-month treatment period (r = 0.619; p &lt;0.001). After a year of therapy, increasing baseline fractional exhaled nitric oxide levels reduced the probability of establishing bronchial asthma control in children (OR &lt;1; p &lt;0.001). The dynamics of fractional exhaled nitric oxide reduction increased the probability of achieving bronchial asthma control after completion of a three-month therapy (OR&gt; 1; p &lt;0.001). The effect of allergen-specific immunotherapy on the specified indicator of eosinophilic inflammation was demonstrated by a statistically significant difference in the mean values of fractional exhaled nitric oxide after a 12-month treatment period in the group of patients who received allergen-specific immunotherapy in combination with controller therapy versus the group of patients who received only controller therapy (p = 0.012). Thus, among school-age children with asthma and sensitization to cat allergens, the levels of fractional exhaled nitric oxide increased, especially in severe asthma. Not only the baseline fractional exhaled nitric oxide levels but also their dynamics after a three-month therapy should be considered when predicting the probability of establishing asthma control in these children. The inclusion of allergen-specific immunotherapy in the complex treatment of bronchial asthma in school-age children with sensitization to cat allergens has been shown to have a favourable therapeutic effect on the fractional exhaled nitric oxide levels.

Structure of sensitization and clinical course of asthma in school-age children sensitized to cat allergens

Background. Asthma is an actual problem of modern pediatrics, and allergy to cats is important in its development. The study was aimed to investigate the structure of sensitization and features of the clinical course of asthma in school-age children sensitized to cat allergens. Materials and methods. The results of a study of 430 children aged 6–17 years with sensitization to cat allergens were analyzed. Results. Sensitization to Fel d 1 was detected in 96.05 % of patients, Fel d 2 — in 6.74 %, Fel d 4 — in 21.63 %, Fel d 7 — in 25.81 %. Sensitization to one of the allergens of cats prevailed, among the combinations — a combination of Fel d 1 and Fel d 7. Concomitant sensitization to pollen, dogs, house dust mites, food, etc. is also shown. There is a strong correlation between sensitization to Fel d 7 cat lipocalin and Can f 1 dog lipocalin. The correlation between the presence of severe asthma and the number of cat allergens, sensitization to three or more cat allergens, to three lipocalin Fel d 4, Fel d 7, Can f 1 is shown. Conclusions. In school-age children with asthma and sensitization to cat allergens, sensitization to uteroglobin Fel d 1 dominates. Sensitization to lipocalin Fel d 7 was detected in 25.81 % of cases. There is a direct correlation between the presence of severe asthma and the number of allergens in cats. The cross-reactivity of cat lipocalin Fel d 7 and the basic canine allergen Can f 1 should be considered. The clinical significance in severe asthma sensitization to three lipocalins Fel d 4, Fel d 7, Can f 1 is shown.

Lung function, allergic sensitization and asthma in school-aged children after viral-coinfection bronchiolitis

Our main objective was to compare the lung function, the rate of allergic sensitization and the prevalence of asthma at 7–9 years in children hospitalized for bronchiolitis with viral coinfection versus single viral infection. Observational study in children with previous bronchiolitis and current age 7–9 years. Clinical data were collected. Fraction of exhaled nitric oxide (FeNO) determination, spirometry and skin prick test for common aeroallergens were performed. A total of 181 children hospitalized for bronchiolitis (40 coinfections and 141 single infections), with median age of 8.3 years (IQR:7.5–9.1) were included. Single-HRV-infections showed lower basal FEV1(%) than coinfections (p = 0.04) and lower z-score FEV1 than single-RSV-infections (p = 0.04) or coinfections (p = 0.02). Also, single-HRV-infections had lower post-bronchodilator FEV1(%) and z-score FEV1 values than coinfections (p = 0.03 and p = 0.03). Single-HRV-bronchiolitis was an independent risk factor for FEV1 < 80% (p = 0.007). FeNO value > 25 ppb was detected in 21(12.5%) cases, without differences between viral groups (p = 0.768). The prevalence of allergic sensitization was similar in coinfections (31.4%) versus single infections (38.7%), (p = 0.428). The highest frequency of allergic rhinitis was observed in single-HRV patients (p = 0.004). The respiratory morbidity at 7–9 years of coinfected patients was similar to the single-HRV ones. In contrast, the likelihood of current asthma was up to 5 times higher in RSV/HRV coinfections than in the single-RSV-infections ones (p = 0.012). The respiratory morbidity at 7–9 years of age after severe bronchiolitis is significantly higher in single-HRV or viral coinfection patients that in single-RSV ones. Single-HRV-bronchiolitis is independently associated with lower lung function at school-age.

Are obesity and asthma in school-age children still strongly related to breastfeeding in infancy? - A real-life study.

Although breastfeeding has been suggested as a candidate for the prevention of obesity and allergies, recent studies have reported mixed results. The aim of the study was (1) to assess breastfeeding length in obese children or children with allergic diseases compared to healthy children; (2) to evaluate the impact of the duration of breastfeeding on the incidence of obesity, allergy rhinitis and asthma. 408 children were evaluated (mean age 11.9±3.7 years; M/F 220/188) and divided into three groups (Obesity, n=103; Allergy, n=163; and Healthy, n=142). Breastfeeding history was collected during an interview. Physical examination, anthropometry, allergy (skin prick test with aeroallergens; Allergopharma) and a spirometry (Jaeger) assessment were performed in each participant. Most of the children (75%) were breastfed with a mean duration of 7.5 months (range 0-36; SD=7.9 months). The time of breastfeeding was longer in the healthy compared to the obese and allergic groups (p=0.003) and was correlated with BMI centile in all groups of subjects (R Spearman = -0.2, p<0.05). There was a higher number of subjects with hypersensitivity to the allergen of house dust mites and animals in the non-breastfed compared to the breastfed children (p<0.003, p<0.000, respectively). Non-breastfed children compared to the breastfed presented more often asthma (chi2=3.6 df=1 p=0.05), but not allergic rhinitis (chi2=9.0 df=1 p=0.002). Non-breastfed asthmatics, compared to the breastfed asthmatics, presented a significantly higher severity of asthma (OR=0.43; p=0.008). In multivariate regression models, a short breastfeeding time was associated with a higher risk of both obesity and asthma. School-age children with obesity and asthma were breastfed less often and for a shorter duration than their healthy peers. Longer breastfeeding may result in a reduced number of children with obesity, asthma, and allergy to house dust mites, but further investigation is needed on a larger population of school-age children.

Associations of early-life pet ownership with asthma and allergic sensitization: A meta-analysis of more than 77,000 children from the EU Child Cohort Network

Studies examining associations of early-life cat and dog ownership with childhood asthma have reported inconsistent results. Several factors could explain these inconsistencies, including type of pet, timing, and degree of exposure. Our aim was to study associations of early-life cat and dog ownership with asthma in school-aged children, including the role of type (cat vs dog), timing (never, prenatal, or early childhood), and degree of ownership (number of pets owned), and the role of allergic sensitization. We used harmonized data from 77,434 mother-child dyads from 9 birth cohorts in the European Union Child Cohort Network when the child was 5 to 11 years old. Associations were examined through the DataSHIELD platform by using adjusted logistic regression models, which were fitted separately for each cohort and combined by using random effects meta-analysis. The prevalence of early-life cat and dog ownership ranged from 12% to 45% and 7% to 47%, respectively, and the prevalence of asthma ranged from 2% to 20%. There was no overall association between either cat or dog ownership and asthma (odds ratio [OR]= 0.97 [95% CI= 0.87-1.09] and 0.92 [95% CI= 0.85-1.01], respectively). Timing and degree of ownership did not strongly influence associations. Cat and dog ownership were also not associated with cat- and dog-specific allergic sensitization (OR= 0.92 [95% CI= 0.75-1.13] and 0.93 [95% CI= 0.57-1.54], respectively). However, cat- and dog-specific allergic sensitization was strongly associated with school-age asthma (OR= 6.69 [95% CI= 4.91-9.10] and 5.98 [95% CI= 3.14-11.36], respectively). There was also some indication of an interaction between ownership and sensitization, suggesting that ownership may exacerbate the risks associated with pet-specific sensitization but offer some protection against asthma in the absence of sensitization. Our findings do not support early-life cat and dog ownership in themselves increasing the risk of school-age asthma, but they do suggest that ownership may potentiallyexacerbate the risks associated with cat- and dog-specific allergic sensitization.

Алельний поліморфізм гена eNOS у дітей, які страждають від бронхіальної астми, за еозинофільного та пауцигранулоцитарного субтипу запалення бронхів

Метою роботи було вивчити вплив алельного поліморфізму гена eNOS, що кодує активність ендотеліальної NO-синтази та синтез монооксиду нітрогену в дихальних шляхах, на окремі клінічно-параклінічні показники бронхіальної астми в дітей шкільного віку за еозинофільного і пауцигранулоцитарного запального фенотипу. Обстежені 22 хворі на бронхіальну астму з еозинофільним характером запалення дихальних шляхів та 15 пацієнтів — із пауцигранулоцитарним. Проведено імунологічні, спірометричні дослідження, генотипування ендотеліальної NOS.Тяжкість бронхіальної астми у хворих із різним типом запалення бронхів суттєво не залежить від алельного поліморфізму гена eNOS. Відсутність мутацій гена eNOS у вигляді генотипу GG виявилася характернішою для хворих із пауцигранулоцитарним характером запалення бронхів, алельний поліморфізм GT/TT — для дітей з еозинофільним запаленням. За наявності алельного поліморфізму гена eNOS за генотипу GT/TT дітям із пауцигранулоцитарним характером запалення бронхів були притаманні частіші клінічні прояви атопічного дерматиту й алергічного риніту, більший індекс лабільності бронхів та нижча концентрація метаболітів NO в конденсаті повітря, що видихається.

Factors Influencing the Asthma Control among Children

Background: Bronchial sensitive individuals are prone to develop many health issues from airborne allergens, and viral and bacterial respiratory infections. Studies have shown that airborne allergen causes allergies and asthma in the susceptible population. Some other environmental factors such as tobacco smoke, air pollution and diet have also been linked to an increased risk for the onset of asthma. The burden of asthma is increasing day by day but the exact etiology of asthma is yet unknown. Some genetic predisposition and environmental factors are thought to play a role in causation of disease, yet how they interact to cause asthma it is still being investigated. Methods &amp; Study Design: A Cross- sectional analytical study design was used to determine the various environmental factors that can trigger asthma and their association with asthma control among school aged asthmatic children, 4-12 years age. A questionnaire was used to find out various environmental factors that can trigger asthma attacks. Data was represented in the form of tables and the chi square test was used to determine the association of various environmental factors with asthma control. Results: A total of 196 asthmatic children and their parents participated in this study. The chi-square test showed that female parents control asthma more effectively as compared to male parents. The majority of parents 118 (60.2%) were living in urban areas, 180 (91.8%) parents had low income adequacy level, 119 (60.7%) parents' homes had 1-2 rooms, and 118 (60.2%) homes were congested/poor ventilated. Environmental factors had a direct link with asthma. Children exposure to passive-smoking 106 (54.08%), exercise (p =.035*), sports (p =.015*), cold weather (p =.002*), seasonal allergy (p =.002*), allergic rhinitis (p =.004*), small homes (p =.008*) and, uneducated parents (no education or primary only) (p =.035*) are factors that are associated with high asthma rates. Conclusion: Asthma is influenced by environmental factors. By modifying environmental factors, we can improve the number of asthma episodes among asthmatic children.

LUNG FUNCTION IN EARLY-PERIOD SCHOOL-AGED ASTHMATIC CHILDREN MAY BE A PREDICTOR OF TREATMENT LEVEL AT ADOLESCENCE

Lung function in early-period school-aged children with asthma influences remission in adolescence. However, there are no reports of this in Japan. This study investigated the influence of lung function in early-period school-aged asthmatic children on medication during adolescence. Forty-nine subjects who had visited our hospital at age 6 years or younger were evaluated on March 31, 2018, at the ages of 16 to 18, to determine their asthma treatment step (step 1 to 4). The patients were divided into four groups, and lung function at six years old. The groups for steps 1, 2, 3 and 4 had 11, 13, 6, and 8 participants, respectively. FEV1.0% at six years old for step 1, 2, 3 and 4 had 88.4%, 89.1%, 86.9%, 80.9%, and %V50 had 111.5%, 107.9%, 108.2% and 69.9%, respectively. There were significant differences between the groups of step 4 and 1, 2 regarding FEV1.0% and %V50. As for the patient of treatment step 4 of adolescence, lung function decreased at 6 years old in comparison with step 1, 2 patients. Lung function in early-period school-aged asthmatic children may predict the treatment level at adolescence.

The role of eosinophil-mediated inflammation in the formation of respiratory remodeling in patients with bronchial asthma of school age children

Objective. To investigate the features of inflammatory changes in the airways, taking into account remodeling markers, determined directly in the sputum of school age children with bronchial asthma, and to optimize the management of this disease.Material and methods. To study the features of the formation of airway remodeling 75 children with persistent bronchial asthma were comprehensively examined on the basis of the Regional Communal Non-Commercial Enterprise "Chernivtsi Regional Children's Clinical Hospital". The children were divided into 2 clinical groups depending on the level of vasoendothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) in the sputum supernatant. The first (I) group included 37 schoolchildren whose VEGF concentration exceeded 80.0 ng / ml, and MMP-9 was more than 5.2 ng / ml. The second (II) comparison group was formed by 38 children in whom BA was not accompanied by accumulation of airway remodeling markers in the sputum supernatant above the indicated distribution point.Research results. The features of the formation of airway remodeling based on the accumulation of sputum markers such as VEGF&gt; 80.0 ng / ml, MMP-9&gt; 5.2 ng / ml were established. It was shown that bronchial remodeling is associated with a decrease in the group of patients with mild persistent asthma, loss of control over its symptoms, prevalence of family allergic history burdens according to both parental pedigrees and the negative effect of maternity smoking. The most sensitive marker in the verification of bronchial remodeling turned out to be a high marginal content of total IgE (&gt; 750 IU / ml) in blood serum (test sensitivity - 95.8% (95% CI 89.7-98.8), which is advisable to combine in the diagnostic algorithm with more specific tests to optimize airway remodeling verification and develop personalized treatment strategies.Conclusion. The formation of bronchial remodeling in bronchial asthma in school age children is associated with the eosinophilic nature of bronchial inflammation, which is accompanied by an increase in the level of blood eosinophilia (&gt; 10%) and sputum (on average 10.5 ± 1.0%) with an increase in myeloperoxidase activity and signs of degranulation of acidophilic granulocytes in sputum, as well as a high marginal concentration of total IgE (&gt; 750 IU / ml) in blood serum in 95.8% of patients.

Association between Migraine and Asthma in School Age Children

Background: Asthma and migraine are the most common chronic conditions. Few studies have concurrently evaluated the bidirectional association between asthma and migraine in pedaitric patients. Objective: We aimed to identify the relationship between these conditions. Methods: This retrospective study was carried out in a tertiary center. School-age patients diagnosed with migraine were included in the study by evaluating electronic patient files who complain with headache. These patients were diagnosed with asthma by a pediatric allergist. Results: Of 5242 patients whose medical records were accessed. The number of patients with asthma who were referred to the pediatric neurology department for headache during the study period was 1427 (913 girls/514 boys). Two hundred and thirty-six (15.5%) patients were diagnosed with migraine. At the same period, 3815 (2193 girls/1622 boys) patients without asthma presented to the pediatric neurology department for the evaluation of headache. Of those, 207 (5.4%) patients were diagnosed with migraine. The frequency of migraine was significantly higher in patients with asthma than those without asthma (OR = 1.84 (95% CI 1.62-2.05), P <0.001). Conclusion: The risk of migraine is significantly increased in school age children with asthma. This study is very important in that it is one of the largest pediatric studies performed so far in our country.

Angle β combined with FeNO and FEV1/FVC% for the detection of asthma in school-aged children

Objective: The diagnostic value of angle β in school-aged children with asthma is unknown. We speculate that angle β may reflect diversification of the forced expiratory flow (FEF) to some extent. The objective of this study was to assess the diagnostic accuracy of angle β, FeNO, pulmonary function parameters and their combinations for asthma in school-aged children. Methods: In total, 248 children participated in this study (140 children with asthma and 108 healthy children). The diagnostic performance of angle β, FeNO and pulmonary function parameters was determined using receiver operating characteristic (ROC) curves. In the ROC analysis, we used the hold out cross-validation method to avoid overfitting. This study was performed in China and followed the Guidelines for the diagnosis and optimal management of asthma in children (China). Results: 1) In the asthma group, the mean angle β value was significantly smaller than that in the control group (P < 0.001), but the mean FeNO value was significantly higher than that in the control group (P < 0.001). 2) More acute exacerbation or greater severity corresponded to a smaller angle β. 3) Among the single indices, the area under the ROC curve of angle β was the largest (except for FEV1/FVC%). For combined indicators, after cross-verification, the combination of angle β, FEV1/FVC% and FeNO showed the highest diagnostic accuracy. Conclusion: Angle β combined with FeNO and FEV1/FVC% can improve the diagnostic accuracy for asthma in school-aged children.