Asthma In School-aged Children Research Articles

DNA methylation in nasal epithelium, atopy, and atopic asthma in children: a genome-wide study

Epigenetic mechanisms could alter the airway epithelial barrier and ultimately lead to atopic diseases such as asthma. We aimed to identify DNA methylation profiles that are associated with-and could accurately classify-atopy and atopic asthma in school-aged children. We did a genome-wide study of DNA methylation in nasal epithelium and atopy or atopic asthma in 483 Puerto Rican children aged 9-20 years, recruited using multistage probability sampling. Atopy was defined as at least one positive IgE (≥0·35 IU/mL) to common aeroallergens, and asthma was defined as a physician's diagnosis plus wheeze in the previous year. Significant (false discovery rate p<0·01) methylation signals were correlated with gene expression, and top CpGs were validated by pyrosequencing. We then replicated our top methylation findings in a cohort of 72 predominantly African American children, and in 432 children from a European birth cohort. Next, we tested classification models based on nasal methylation for atopy or atopic asthma in all cohorts. DNA methylation profiles were markedly different between children with (n=312) and without (n=171) atopy in the Puerto Rico discovery cohort, recruited from Feb 12, 2014, until May 8, 2017. After adjustment for covariates and multiple testing, we found 8664 differentially methylated CpGs by atopy, with false discovery rate-adjusted p values ranging from 9·58 × 10-17 to 2·18 × 10-22 for the top 30 CpGs. These CpGs were in or near genes relevant to epithelial barrier function, including CDHR3 and CDH26, and in other genes related to airway epithelial integrity and immune regulation, such as FBXL7, NTRK1, and SLC9A3. Moreover, 28 of the top 30 CpGs replicated in the same direction in both independent cohorts. Classification models of atopy based on nasal methylation performed well in the Puerto Rico cohort (area under the curve [AUC] 0·93-0·94 and accuracy 85-88%) and in both replication cohorts (AUC 0·74-0·92, accuracy 68-82%). The models also performed well for atopic asthma in the Puerto Rico cohort (AUC 0·95-1·00, accuracy 88%) and the replication cohorts (AUC 0·82-0·88, accuracy 86%). We identified specific methylation profiles in airway epithelium that are associated with atopy and atopic asthma in children, and a nasal methylation panel that could classify children by atopy or atopic asthma. Our findings support the feasibility of using the nasal methylome for future clinical applications, such as predicting the development of asthma among wheezing infants. US National Institutes of Health.

Prenatal particulate matter affects new asthma via airway hyperresponsiveness in schoolchildren.

The most relevant time of PM10 exposure to affect airway hyperresponsiveness (AHR) and new development of asthma in school-aged children is unclear. The aims of this study were to investigate the most critical time of PM10 exposure to affect AHR and new diagnosis of asthma from AHR in school-aged children. Elementary schoolchildren (n=3570) have been enrolled in a nationwide prospective 4-year follow-up survey in Korea from 2005 to 2006. Individual annual PM10 exposure was estimated by using an ordinary kriging method from the prenatal period to 7years of age. AHR at 7years was defined by a methacholine PC20 ≤8mg/mL. PM10 exposure during pregnancy and at 1year of age showed significant effects on AHR (aOR: 1.694, 95% CI: 1.298-2.209; and aOR: 1.750, 95% CI: 1.343-2.282, respectively). PM10 exposure during pregnancy was associated with the risk of a new diagnosis of asthma (aOR: 2.056, 95% CI: 1.240-3.409), with the highest risk in children with AHR at age 7 (aOR: 6.080, 95% CI: 2.150-17.195). PM10 exposure in the second trimester was associated with the highest risk of a new diagnosis of asthma in children with AHR at age 7 (aOR: 4.136, 95% CI: 1.657-10.326). Prenatal PM10 exposure in the second trimester is associated with an increased risk of a new diagnosis of asthma in school-aged children with AHR at 7years. This study suggests that PM10 exposure during a specific trimester in utero may affect the onset of childhood asthma via AHR.

A Genome-wide Study of DNA Methylation in Nasal Epithelium and Atopy and Atopic Asthma in Children

BACKGROUND: Up to 10-12% of U.S. children and adolescents report respiratory or skin allergies. Epigenetic mechanisms may alter the airway epithelial barrier and ultimately lead to atopic diseases. Here we aim to identify DNA methylation profiles that are associated with - and accurately classify - atopy and atopic asthma in school-aged children. METHODS: We conducted an epigenome-wide study of DNA methylation in nasal epithelium and atopy or atopic asthma in 482 Puerto Rican children. Significant methylation signals were correlated with gene expression, and top CpGs were validated by pyrosequencing. We then replicated our top methylation findings in a cohort including 72 predominantly African American children, and in another cohort including 432 children of European descent. Next, we tested nasal methylation-based classification models of atopy or atopic asthma in all cohorts. FINDINGS: DNA methylation profiles were markedly different between subjects with and without atopy. After adjustment for covariates and multiple testing, we found 8,664 differentially methylated CpGs by atopy, with P-values ranging from 9·58*e-17 to 2·18*e-22 for the top 30 CpGs. These CpGs are in or near genes relevant to epithelial barrier function, including CDHR3 (cadherin-related family member 3) and CDH26 (cadherin 26), and in other biologically plausible genes like FBXL7 (F-box and leucine-rich repeat protein 7), NTRK1 (neurotrophic receptor tyrosine kinase 1), and SLC9A3 (solute carrier family 9 member A3). Moreover, 28 of the top 30 CpGs replicated in both cohorts. Nasal methylation-based classification models of atopy and atopic asthma performed well in the Puerto Rico cohort (area under the curve=0·93-0·94 and accuracy=85%-88%) and in both replication cohorts (AUC=0·74-0·92, accuracy=68%-82%). INTERPRETATION: We have identified methylation profiles in airway epithelium that are associated with atopy and atopic asthma in children, and a nasal methylation profile that classified children by atopy or atopic asthma. This panel performed well in three independent cohorts from different ethnic/racial backgrounds. Funding: This study was supported by grants HL079966, HL117191, and MD011764 (PI: Celedon JC) from the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (NIH). Dr. Forno’s contribution was supported by NIH grant HL125666. Dr. Celedon’s contribution was additionally supported by The Heinz Endowments. Research operations at the University of Puerto Rico were additionally supported by grant U54MD007587 from the National Institute on Minority Health and Health Disparities (NIMHD) and the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. NIH. PIAMA was supported by The Netherlands Organization for Health Research and Development; The Netherlands Organization for Scientific Research; The Netherlands Lung Foundation (with methylation studies supported by AF 4.1.14.001); The Netherlands Ministry of Spatial Planning, Housing, and the Environment; and The Netherlands Ministry of Health, Welfare, and Sport. Dr. Qi is supported by a grant from the China Scholarship Council. Declaration of Interest: Dr. Celedon has received research materials from Merck, GSK and Pharmavite, to provide medications free of cost to participants in NIH-funded studies, unrelated to the current work. The other authors report no conflicts of interest. Ethical Approval: The study was approved by the institutional review boards of the University of Puerto Rico (San Juan, PR) and the University of Pittsburgh (Pittsburgh, PA).

Vitamin A and D intake in pregnancy, infant supplementation, and asthma development: the Norwegian Mother and Child Cohort

Western diets may provide excess vitamin A, which is potentially toxic and could adversely affect respiratory health and counteract benefits from vitamin D. The aim of this study was to examine child asthma at age 7 y in relation to maternal intake of vitamins A and D during pregnancy, infant supplementation with these vitamins, and their potential interaction. We studied 61,676 school-age children (born during 2002-2007) from the Norwegian Mother and Child Cohort with data on maternal total (food and supplement) nutrient intake in pregnancy (food-frequency questionnaire validated against biomarkers) and infant supplement use at age 6 mo (n = 54,142 children). Linkage with the Norwegian Prescription Database enabled near-complete follow-up (end of second quarter in 2015) for dispensed medications to classify asthma. We used log-binomial regression to calculate adjusted RRs (aRRs) for asthma with 95% CIs. Asthma increased according to maternal intake of total vitamin A [retinol activity equivalents (RAEs)] in the highest (≥2031 RAEs/d) compared with the lowest (≤779 RAEs/d) quintile (aRR: 1.21; 95% CI: 1.05, 1.40) and decreased for total vitamin D in the highest (≥13.6 µg/d) compared with the lowest (≤3.5 µg/d) quintile (aRR: 0.81; 95% CI: 0.67, 0.97) during pregnancy. No association was observed for maternal intake in the highest quintiles of both nutrients (aRR: 0.99; 95% CI: 0.83, 1.18) and infant supplementation with vitamin D or cod liver oil. Excess vitamin A (≥2.5 times the recommended intake) during pregnancy was associated with increased risk, whereas vitamin D intake close to recommendations was associated with a reduced risk of asthma in school-age children. No association for high intakes of both nutrients suggests antagonistic effects of vitamins A and D. This trial was registered at http://www.clinicaltrials.gov as NCT03197233.

Taming Asthma in School-Aged Children: A Comprehensive Review

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity as measured by school absences, emergency department visits, and hospitalizations. Multiple factors play a role in the development, treatment and prevention of childhood asthma including racial/ethnic and socioeconomic disparities, both the home and school environments, and medication use. The goals of this review are to summarize these aspects of asthma in school-aged children and to present an updated review of medications as it relates to treatment strategies that will help in the care of these children. We conclude that phenotypic heterogeneity and appropriate environmental assessments and interventions are important considerations in the management of childhood asthma.

Perinatal risk factors for asthma in children with allergic rhinitis and grass pollen sensitization.

Results of epidemiologic studies have determined several risk factors for asthma in school-age children. To examine whether parental and perinatal risk factors, along with infantile feeding patterns, were associated with asthma in children with grass pollen allergy and allergic rhinitis. We retrospectively analyzed the data of our cohort, which consisted of children with allergic rhinitis. Only children with grass pollen sensitization were enrolled. A detailed questionnaire regarding demographic features and perinatal events was given to the parents. A total of 293 children (200 boys [68.3%]; with median age, 10.2 years [interquartile range {IQR}, 7.4-13.0 years]) were included. A total of 109 children (37.2%) had accompanying asthma. The median age of onset of rhinitis symptoms was earlier (5.3 years [IQR, 4.0-8.0 years] versus 7.0 years [IQR, 5.0-10.0 years]; p = 0.001), histories of prematurity (16.7 versus 6.5%; p = 0.006), preeclampsia (5.5 versus 0%; p = 0.001), neonatal intensive care unit admission (15.1 versus 6.0%; p = 0.01), phototherapy (17.9 versus 7.1%; p = 0.004), early formula feeding (58.7 versus 41.2%; p = 0.006), and parental asthma (25.0 versus 11.4%; p = 0.002) were more frequent in children with asthma. Multivariate logistic regression analysis revealed prematurity (odds ratio [OR] 2.78 [95% confidence interval [CI],1.24-6.24]; p = 0.013), history of formula feeding (OR 1.81 [95% CI, 1.09-3.01]; p = 0.022), and parental asthma (OR 2.37 [95% CI, 1.22-4.63]; p = 0.011) were associated with asthma in school-age children with grass pollen-induced allergic rhinitis. Close monitoring of patients with these risk factors may help with an earlier diagnosis of asthma and prompt initiation of therapeutic interventions in children with allergic rhinitis and who were sensitized to grass pollen.

CME Exam: Taming Asthma in School-Aged Children: A Comprehensive Review

CME Exam: Taming Asthma in School-Aged Children: A Comprehensive Review

Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

This study aimed to construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary. Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%. Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

Maternal Depressive Symptoms, Maternal Asthma, and Asthma in School-Aged Children

BH Medsker, BK Brew, E Forno. Ann Allergy Asthma Immunol. 2017;118(1):55–60 To determine if maternal asthma with depression increases the risk for asthma in children compared with maternal asthma without depression. Two cross-sectional studies of 6- to 14-year-old children in Puerto Rico (PR) ( n = 655) and Sweden (SW) ( n = 6887). In the PR cohort, children were randomly selected based on 2009–2010 US census data. A screening questionnaire assessed for self-reported maternal asthma, physician-diagnosed asthma, and wheeze in …

Combined effects of multiple risk factors on asthma in school-aged children.

Little is known about synergistic effects of several risk factors on asthma. We developed a risk score in Puerto Rican children, and then used this score to estimate the combined effects of multiple risk factors on asthma at school age in Puerto Rican and Swedish children. Case-control study in 609 Puerto Rican children (aged 6-14 years) and longitudinal birth cohort study of 2290 Swedish children followed up to age 12 years (The Children, Allergy, Milieu, Stockholm, Epidemiological Survey [BAMSE] Study). In both cohorts, there was data on parental asthma, sex, obesity, allergic rhinitis, and early-life second-hand smoke (SHS); data on diet and (in children ≥9 years) lifetime exposure to gun violence were also available in the Puerto Rico study. Asthma was defined as physician-diagnosed asthma and ≥1 episode of wheeze in the previous year. In a multivariable analysis in Puerto Rican children, male sex, parental asthma, allergic rhinitis, early-life SHS, an unhealthy diet and (in children ≥9 years) gun violence were each significantly associated with asthma. We next created a risk score using these variables (range, 0 to 5-6 in Puerto Rico and 0 to 4 in BAMSE). Compared with Puerto Rican children without any risk factors (i.e. a score of 0), Puerto Rican children with 2, 3, and at least 4 risk factors had 3.6 times (95% CI=1.4-9.2), 10.4 times (95% CI=4.0-27.0), and 21.6 times (95% CI=7.2-64.9) significantly higher odds of asthma, respectively. In BAMSE, the presence of 2, 3, and at least 4 risk factors was significantly associated with 4.1 times (95% CI=2.3-7.4), 6.3 times (95% CI=3.0-13.3), and 17.2 times (95% CI=4.1-73.2) increased odds of asthma at age 12 years. Our findings emphasize the multifactorial etiology of asthma, and suggest that concurrent eradication or reduction of several modifiable risk factors may better prevent or reduce the burden of childhood asthma.

A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma

BackgroundEarly-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent.ObjectiveWe examined the associations of early-life respiratory tract infections...

Duration and exclusiveness of breastfeeding and school-age lung function and asthma

BackgroundBreastfeeding reduces the risk of asthma in early childhood, but it is not clear whether its effect on respiratory morbidity is still present in later childhood. ObjectiveTo examine the associations of any breastfeeding, breastfeeding duration, and breastfeeding exclusiveness with lung function and asthma in school-aged children and whether associations were influenced by respiratory tract infections and maternal or child's atopic status. MethodsThis study of 4,464 children was embedded in a population-based prospective cohort study. Information on breastfeeding was obtained by multiple questionnaires from birth until 1 year of age. At 10 years of age, lung function was measured by spirometry, and information on asthma was obtained by questionnaire. Adjusted linear and logistic regression models were used to examine the associations. ResultsShorter duration of breastfeeding was associated with a lower forced expiratory volume in 1 second (FEV1) only (z score change, −0.01; 95% confidence interval [CI], −0.02 to −0.00) per month shorter breastfeeding, but not asthma. When categorized, breastfeeding for 2 to 4 months was associated with a lower forced vital capacity (FVC) (z score change, −0.11; 95% CI, −0.20 to −0.03) compared with breastfeeding for 6 months or longer. Nonexclusive breastfeeding for 4 months was associated with a lower FVC (z score change, −0.08; 95% CI, −0.16 to −0.01) compared with exclusive breastfeeding for 4 months. Results did not materially change after additional adjustment for lower respiratory tract infections and were not modified by maternal history of asthma or atopy, child's eczema, or inhalant allergic sensitization. ConclusionShorter duration and nonexclusivity of breastfeeding were associated with a lower FEV1 and FVC but not asthma at school-age.

Maternal depressive symptoms, maternal asthma, and asthma in school-aged children

BackgroundLittle is known about the joint effects of maternal asthma and maternal depression on childhood asthma. ObjectiveTo examine whether maternal depression and maternal asthma lead to greater risk of childhood asthma than maternal asthma alone. MethodsCross-sectional studies of children (6–14 years old) in San Juan, Puerto Rico (n = 655) and Sweden (n = 6,887) were conducted. In Puerto Rico, maternal depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire. In Sweden, maternal physician-diagnosed depression was derived from national registries, and maternal depressive symptoms were defined using an abbreviated CES-D questionnaire. Childhood asthma was defined as physician-diagnosed asthma plus current wheeze (in Puerto Rico) or plus medication use (in Sweden). Logistic regression was used for multivariable analysis. ResultsCompared with Puerto Rican children whose mothers had neither asthma nor depressive symptoms, those whose mothers had asthma but no depressive symptoms had 3.2 times increased odds of asthma (95% confidence interval [CI] = 2.1–4.8) and those whose mothers had asthma and depressive symptoms had 6.5 times increased odds of asthma (95% CI = 3.3–13.0). Similar results were obtained for maternal depression and maternal asthma in the Swedish cohort (odds ratio for maternal asthma without maternal depression = 2.8, 95% CI = 2.1–3.7; odds ratio for maternal asthma and maternal depression = 4.0, 95% CI = 1.7–9.6). Although the estimated effect of maternal asthma on childhood asthma was increased when maternal depressive symptoms (Puerto Rico) or maternal depression (Sweden) was present, there were no statistically significant additive interactions. ConclusionMaternal depression can further increase the risk of asthma in children whose mothers have a history of asthma.

PLEASANT: Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term - a cluster randomised controlled trial and economic evaluation.

Asthma episodes and deaths are known to be seasonal. A number of reports have shown peaks in asthma episodes in school-aged children associated with the return to school following the summer vacation. A fall in prescription collection in the month of August has been observed, and was associated with an increase in the number of unscheduled contacts after the return to school in September. The primary objective of the study was to assess whether or not a NHS-delivered public health intervention reduces the September peak in unscheduled medical contacts. Cluster randomised trial, with the unit of randomisation being 142 NHS general practices, and trial-based economic evaluation. Primary care. A letter sent (n = 70 practices) in July from their general practitioner (GP) to parents/carers of school-aged children with asthma to remind them of the importance of taking their medication, and to ensure that they have sufficient medication prior to the start of the new school year in September. The control group received usual care. The primary outcome measure was the proportion of children aged 5-16 years who had an unscheduled medical contact in September 2013. Supporting end points included the proportion of children who collected prescriptions in August 2013 and unscheduled contacts through the following 12 months. Economic end points were quality-adjusted life-years (QALYs) gained and costs from an NHS and Personal Social Services perspective. There is no evidence of effect in terms of unscheduled contacts in September. Among children aged 5-16 years, the odds ratio (OR) was 1.09 [95% confidence interval (CI) 0.96 to 1.25] against the intervention. The intervention did increase the proportion of children collecting a prescription in August (OR 1.43, 95% CI 1.24 to 1.64) as well as scheduled contacts in the same month (OR 1.13, 95% CI 0.84 to 1.52). For the wider time intervals (September-December 2013 and September-August 2014), there is weak evidence of the intervention reducing unscheduled contacts. The intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children collecting prescriptions in August as well as having scheduled contacts in the same month. These unscheduled contacts in September could be a result of the intervention, as GPs may have wanted to see patients before issuing a prescription. The economic analysis estimated a high probability that the intervention was cost-saving, for baseline-adjusted costs, across both base-case and sensitivity analyses. There was no increase in QALYs. The use of routine data led to uncertainty in the coding of medical contacts. The uncertainty was mitigated by advice from a GP adjudication panel. The intervention did not reduce unscheduled care in September, although it succeeded in increasing the proportion of children both collecting prescriptions and having scheduled contacts in August. After September there is weak evidence in favour of the intervention. The intervention had a favourable impact on costs but did not demonstrate any impact on QALYs. The results of the trial indicate that further work is required on assessing and understanding adherence, both in terms of using routine data to make quantitative assessments, and through additional qualitative interviews with key stakeholders such as practice nurses, GPs and a wider group of children with asthma. Current Controlled Trials ISRCTN03000938. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 93. See the HTA programme website for further project information.

P120 Burden of severe or poorly-controlled asthma in school-age children: healthcare use and allergic co-morbidities

P120 Burden of severe or poorly-controlled asthma in school-age children: healthcare use and allergic co-morbidities

Variability in anesthesiologists’ approach to the preoperative management of asthmatic children

ObjectiveNo consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue. DesignA questionnaire survey was conducted. SettingNational survey. SubjectsCertified Israeli pediatric anesthesiologists from all 24 general hospitals in Israel. MeasurementTwenty-one questions regarding the approach to preoperative management of asthmatic children including 6 case scenarios with a variety of clinical situations and treatments of asthmatic children. The results were compared with the attitude of pediatric pulmonologists recently published using a similar methodology. Main resultsForty-four pediatric anesthesiologists from all 24 general hospitals in Israel responded. Twenty-five percent of pediatric anesthesiologists answered that, in addition to pediatric anesthesiologists, the primary pediatrician should be consulted, and 70% believed that a pediatric pulmonologists should also be consulted. Overall, results showed a wide variability between responders especially for preschool children and unstable school-aged asthmatic children for both disciplines. The variability referred to the use of any treatment, bronchodilators, inhaled corticosteroids and their combination, addition of systemic corticosteroids, and the length of preoperative treatment. Compared with pediatric pulmonologists, a better within-discipline agreement was observed by the pediatric anesthesiologists for stable school-aged asthmatic children with a lower inclination to augment preoperative treatment (P< .001). No difference was observed for the preschool children with asthma and for the unstable school-aged asthmatic child. ConclusionsA wide variability exists in pediatric anesthesiologists’ approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.

Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide, and asthma at school-age

Obesity and asthma often coexist. We hypothesized that detailed body fat distribution measures might be more strongly associated than body mass index (BMI) with childhood asthma. We examined the associations of total body and abdominal fat measures with respiratory resistance (Rint), fractional exhaled nitric oxide (Feno), and risks of wheezing and asthma in school-aged children. In a population-based prospective cohort study among 6178 children aged 6years, we measured BMI, fat mass index, android/gynoid ratio, and preperitoneal and subcutaneous fat mass by physical examinations, dual-energy x-ray absorptiometry, and ultrasound, respectively. We performed Rint and Feno measurements, and assessed physician-diagnosed wheezing and asthma by questionnaires. A higher BMI was associated with a higher Rint (Zscore [95% CI], 0.06 [0.01-0.12]) and increased risk of wheezing (odds ratio [95% CI], 1.07 [1.00-1.14], per Z score BMI increase), but not with Feno or asthma. Ahigh fat mass index was associated with a higher Rint (Z score [95% CI], 0.40 [0.13-0.68]). Ahigh android/gynoid fat mass ratio was associated with a lower Feno (Sym% [95% CI], -9.8 [-16.3 to -3.4]), whereas a high preperitoneal fat mass was associated with a higher Feno (Sym% [95% CI], 6.5 [0.1-12.9]). Subcutaneous fat mass was not associated with any respiratory outcome. Studying detailed body fat distribution measures might provide better insight into the obesity-asthma paradigm.

Comparison of the prevalence of bronchial asthma in school-aged children and adolescents on Roatán Island and in other coastal communities in Honduras

BackgroundThe rise in consultations for asthma or wheezing in primary and hospital care in recent years suggests a progressive increase in the prevalence of this disease, causing morbidity and considerable medical expenses. However, in Honduras no information about the prevalence of asthma and its trends is available. The aim was to determine the prevalence of asthma in the school-aged and adolescent population in several coastal communities in Honduras. MethodsWe performed a multi-centre, observational, cross-sectional study, for which we took a random sample of 805 school-aged children and adolescents between the ages of 6 and 17 years residing in the coastal communities of Coxen Hole, French Harbour, Los Fuertes, Sandy Bay, Punta Gorda, Travesía and Bajamar. The prevalence and severity of asthma were determined using the validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire answered by the child's parents. Point and cumulative prevalence were estimated, stratified by ethnic group, community, sex, and family history of asthma. ResultsWe found an overall prevalence of wheezing in the past of 40.5% (95% CI 37.1, 43.9); of wheezing in the last 12 months of 28.0% (95% CI 24.9, 31.1); and have or have had asthma of 31.7% (95% CI 28.5, 34.9). The community with the highest prevalence was Bajamar with 51.0% (95% CI 44.0, 58.0), and in general, the Garifuna ethnic group with 36.5% (95% CI 31.0, 41.9). ConclusionThe prevalence of asthma was higher than in other Latin American regions, with the most cases in participants of African descent, and those with a family history of asthma. The results will provide important data on asthma in Honduras and will contribute to the identification of risk groups.

Moving towards precision care for childhood asthma.

Asthma guidelines recognize the presence of different asthma endotypes and phenotypes but treatment recommendations are limited to age groups rather than phenotypes, as the phenotype literature is regarded as emerging evidence. This review will examine the current evidence regarding the management of asthma in school age children (5-18 years old) by endotype and phenotype. A number of studies have examined the effect of endotypes and phenotypes on response to conventional asthma therapy, omalizumab and specific allergen immunotherapy, and response in children with severe asthma. Emerging therapies, namely biologics and immunomodulators, have attracted considerable attention and appear to have favorable effects in adults with asthma, but additional pediatric studies are needed. The optimal treatment strategy for children with asthma is not yet defined and likely dependent on many patient and disease characteristics. Much of the phenotypic response literature presented in this review was constrained by a limited number of pediatric and adult studies available and as such should be regarded as preliminary. Better definition of asthma phenotypes and better targeting of therapy based on individual patient phenotypes are likely to improve asthma treatment in the future.

Association of wider neck circumference and asthma in obese children

BackgroundObesity is a well-established risk factor for asthma. Previous studies have reported that central obesity is associated with asthma. ObjectiveTo investigate the association between fat distribution, which is determined by anthropometric measures, including neck circumference (NC), and asthma in school-aged children. MethodsChildren diagnosed as having asthma were enrolled along with controls who were admitted to our outpatient department with allergic symptoms, such as rhinitis, urticaria and atopic dermatitis. Anthropometric measures, including height, weight, NC, waist circumference, and hip circumference, were obtained. Skin prick tests, blood eosinophil counts, and serum total IgE level measurements were performed. ResultsA total of 196 children (92 male [46.9%]) were included. Asthma was present in 102 patients (52.1%). Ninety-one of the patients (46.4%) were overweight, and 45 patients (22.9%) were obese. The NC of children with asthma was significantly higher than that of children in the control group. Grades defined according to NC percentiles were also significantly different between groups. In children with asthma, the prevalence of children with an NC higher than the 90th percentile (grade 6) was more frequent when compared with controls. The median NC of obese-overweight children with asthma was significantly higher compared with obese-overweight controls without asthma. Results of multivariable logistic regression analysis revealed that the presence of an NC in the greater than 90th percentile was associated with asthma in obese-overweight children. ConclusionThis study found that NC, which is a simple anthropometric measure, is associated with asthma in obese children.