Asthma Morbidity In Children Research Articles

Routinely sleeping away from home and the association with child asthma readmission.

The increased prevalence of transitions between households may have implications for child asthma morbidity. We, therefore, sought to enumerate the prevalence of regularly spending nights sleeping away from home among children admitted to the hospital for asthma and to examine the relationship of nights away to asthma-related readmission. This was a population-based, prospective cohort of 774 children, aged 1-16years, who were admitted with asthma or bronchodilator-responsive wheezing and enrolled in the Greater Cincinnati Asthma Risks Study. The study took place at Cincinnati Children's Hospital Medical Center, an urban, academic children's hospital in the Midwest. The primary exposure was regularly spending nights away from home. Selected covariates included caregiver marital status, shift work, child's race, income, psychological distress, and running out of/not having medications on hand. The primary outcome was asthma-related readmission within 12months. A total of 19% were readmitted within 12months. The 33% of children that spent ≥1 night away from home per week were significantly more likely to be readmitted than those who spent no nights away (25% vs. 16%, p=0.002). Spending nights away from home [adjusted relative risk (aRR) 1.5, 95% confidence interval (CI) 1.2-2.0] and lower income (aRR 2.6, 95% CI 1.1-6.4) were the strongest independent predictors of readmission after adjusting for child age, gender, and race, and caregiver marital status, shift work, risk of psychological distress, and running out of meds. Increased awareness of the multiple settings in which children with asthma live may help shape more comprehensive approaches to asthma care.

Possible molecular mechanisms linking air pollution and asthma in children

BackgroundAir pollution has many effects on the health of both adults and children, but children’s vulnerability is unique. The aim of this review is to discuss the possible molecular mechanisms linking air pollution and asthma in children, also taking into account their genetic and epigenetic characteristics.ResultsAir pollutants appear able to induce airway inflammation and increase asthma morbidity in children. A better definition of mechanisms related to pollution-induced airway inflammation in asthmatic children is needed in order to find new clinical and therapeutic strategies for preventing the exacerbation of asthma. Moreover, reducing pollution-induced oxidative stress and consequent lung injury could decrease children’s susceptibility to air pollution. This would be extremely useful not only for the asthmatic children who seem to have a genetic susceptibility to oxidative stress, but also for the healthy population. In addition, epigenetics seems to have a role in the lung damage induced by air pollution. Finally, a number of epidemiological studies have demonstrated that exposure to common air pollutants plays a role in the susceptibility to, and severity of respiratory infections.ConclusionsAir pollution has many negative effects on pediatric health and it is recognised as a serious health hazard. There seems to be an association of air pollution with an increased risk of asthma exacerbations and acute respiratory infections. However, further studies are needed in order to clarify the specific mechanism of action of different air pollutants, identify genetic polymorphisms that modify airway responses to pollution, and investigate the effectiveness of new preventive and/or therapeutic approaches for subjects with low antioxidant enzyme levels. Moreover, as that epigenetic changes are inheritable during cell division and may be transmitted to subsequent generations, it is very important to clarify the role of epigenetics in the relationship between air pollution and lung disease in asthmatic and healthy children.

Environmental exposures and asthma morbidity in children living in urban neighborhoods

A substantial disparity in asthma prevalence and morbidity among urban children compared with their nonurban counterparts has been recognized for more than two decades. Because of the nature of urban neighborhoods, pest allergens, such as cockroach and mouse, are present in high concentrations in US urban housing and have both repeatedly been linked to asthma morbidity in sensitized children. In addition, there is a growing body of evidence demonstrating that concentrations of many pollutants are higher indoors than outdoors in both US and European urban communities and that exposures to indoor pollutants such as particulate matter (PM) and nitrogen dioxide (NO2 ) are independently associated with symptoms in children with asthma. Although environmental interventions are challenging to implement, when they reduce relevant indoor allergen and pollutant exposures, they are associated with clear improvements in asthma. Other modifiable risk factors in urban childhood asthma that have emerged include dietary and nutritional factors. Overweight and obese children, for example, may be more susceptible to the pulmonary effects of pollutant exposure. Insufficiency of vitamin D and folate has also emerged as modifiable risk factors for asthma morbidity in children. The identification of these modifiable risk factors for urban childhood asthma morbidity offers a ripe opportunity for intervention.

Does The Sinusitis Affect Bronchial Hyperresponsiveness In Asthmatic Children ?

278 Psycho Social Stresses and Asthma Morbidity In Children Dr. Ejaz Yousef, MD, FAAAI; Marshfield Clinic, Marshfield, WI; Marshfield Clinic, MARSHFIELD, WI. RATIONALE: The purpose of this review is to investigate the influence of psycho-social stress on asthma morbidity in children. METHODS: Data on 56 asthmatic children aged 5-18 years were collected. Subjects were examined for the influence of psychological stresses (AHDH, Anxiety, Depression) and social factors (parental divorce, poor school performance, chronic illness in the family and any other stress in the family). The study subjects were divided into two groups. Group A (N5 30) comprised of children without personal or family history of psychosocial stress. Subjects in Group B (N5 26) had 2 or more background psychosocial stressors. RESULTS: Group A: Average asthma related hospital admission rate for group Awas 2 ER/Urgent care visits/year. 10 subjects had >2 courses of systemic steroids/year. Average asthma related missed school days/parental job time in the group was 4 days/year. Non compliance with asthma medications/care plan was found in 11 subjects Group B: Average hospital admission rate for group B was > 1.5 /year/subject.16 Subjects had >2 ER/Urgent care visits/year. 17 subjects had >2 courses of systemic steroids /year. Average missed school /parental job time in group was 9 days/ year. 16 subjects in Group were found to be non-compliant with medication/asthma care plan. CONCLUSIONS: These data suggest that psychosocial stressors may act as risk factors for asthma morbidity. Further research is needed to characterize the relationship with stress at multiple levels to more fully understand and address asthma morbidity in children.

Perceived neighborhood safety and asthma morbidity in the School Inner‐City Asthma Study

The aim of this study was to investigate whether neighborhood safety as perceived by primary caregivers is associated with asthma morbidity outcomes among inner-city school children with asthma. School children with asthma were recruited from 25 inner-city schools between 2009 and 2012 for the School Inner-City Asthma Study (N = 219). Primary caregivers completed a baseline questionnaire detailing their perception of neighborhood safety and their children's asthma symptoms, and the children performed baseline pulmonary function tests. In this cross-sectional analysis, asthma control was compared between children whose caregivers perceived their neighborhood to be unsafe versus safe. After adjusting for potential confounders, those children whose primary caregivers perceived the neighborhood to be unsafe had twice the odds of having poorly controlled asthma (odds ratio [OR] adjusted = 2.2, 95% confidence interval [CI] = 1.2-3.9, P = 0.009), four times the odds of dyspnea and rescue medication use (OR adjusted = 4.7; 95% CI = 1.7-13.0, P = 0.003, OR adjusted = 4.0; 95% CI = 1.8-8.8, P < 0.001, respectively), three times as much limitation in activity (OR adjusted = 3.2; 95% CI = 1.4-7.7, P = 0.008), and more than twice the odds of night-time symptoms (OR adjusted = 2.2; 95% CI = 1.3-4.0, P = 0.007) compared to participants living in safe neighborhoods. There was no difference in pulmonary function test results between the two groups. Primary caregivers' perception of neighborhood safety is associated with childhood asthma morbidity among inner-city school children with asthma. Further study is needed to elucidate mechanisms behind this association, and future intervention studies to address social disadvantage may be important.

Single parent households and increased child asthma morbidity

Objectives: To characterize whether single parent households are associated with pediatric asthma-related repeat healthcare utilization and to examine family-level psychosocial variables that may explain this relationship. Methods: We analyzed a prospective cohort of 526 children aged 1–16 years hospitalized for asthma or bronchodilator-responsive wheezing whose caregivers self-reported their marital status. Those reporting being “single” were considered the at-risk category. The outcome was repeat asthma-related utilization (emergency room (ER) revisit or hospital readmission) within 12 months. We assessed, a priori, four psychosocial variables (household income, caregiver risk of psychological distress, ratio of in-home children to adults, and regular attendance at childcare or a secondary home). Results: Among all children enrolled in the cohort, 40% returned to the ER or hospital for asthma within 12 months. Of all caregivers, 59% self-identified as single. Single status was significantly associated with each psychosocial variable. Children in households with lower incomes and higher ratios of children to adults were both more likely to return to the ER or hospital than children with higher incomes and lower ratios, respectively (each p < 0.05). Patients in single parent households were significantly more likely to reutilize than those in married parent households (OR 1.44, 95% CI 1.00–2.07, p < 0.05). When adjusted for income, the relationship between single parent households and reutilization became non-significant. Conclusions: Children admitted for asthma from single parent households were more likely to have asthma-related reutilization within 12 months than children from homes with married parents. This was driven, in large part, by underlying differences in household income.

Investigation of childhood asthma morbidity rate and risk factors in Wuhan area

Objective To investigate the relative risk factors of childhood asthma. Methods An investigation was carried out by random sampling in Wuhan city. The investigation included questionnaire and clinic examination. The studied atients were the infants and children aged from 0 to 14 years old, and the sample size was of 4132 cases. The relative analysis between childhood asthma and other allergic diseases was carried out, and high risk factors were screened by multiple Logistic regression analysis with SPSS 17.0 software. Results There were 173 children with asthma, and the accumulation incidence rate was 4.2%, during which the rate of male children were higher than that of female children (4.8% vs 3.6%). Four years old was a key point, because the incidence rates of allergic rhinitis, eczema, drug allergy and food allergy were obviously increased after this point. The relative analysis results showed that allergic rhinitis was the first factor related to asthma (r=0.30, P<0.01), the second factor was eczema(r=0.24, P<0.01). The multiple Logistic regression analysis results showed that the risk factors of asthma were listed by risk degree as allergic rhinitis (OR=5.61, 95%CI: 3.88-8.13), repeated respiratory infection (OR=3.99, 95%CI: 2.78-5.74), eczema (OR=3.38, 95%CI: 2.35-4.87), drug allergy (OR=2.20, 95%CI: 1.44-3.36), asthma history of the first degree relative (OR=3.14, 95%CI: 1.60-6.13) and asthma history of the second degree relative (OR=1.92, 95%CI: 1.13-3.28). Conclusions Allergic rhinitis and repeated respiratory infection are the first and the second important risk factors of asthma. It is necessary to enhance the health management of the related children to prevent them from developing asthma. Key words: Asthma; Risk factor; Allergic rhinitis; Respiratory tract infection; Asthma history; Child

A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity

Objectives: Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. Methods: A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Results: Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker’s ability to manage the child’s asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. Conclusions: This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.

Influenza vaccination in children at high risk of respiratory disease.

Chronic respiratory diseases (CRDs) are a heterogeneous group of diseases that can affect the pediatric population and health authorities throughout the world recommend influenza vaccination because of the significant risk of influenza-related complications. However, despite this recommendation, vaccine coverage is generally unsatisfactory. The aim of this review is to analyze the impact of influenza on children at high risk of respiratory disease, and the immunogenicity, safety and efficacy of influenza vaccination in such children. The results show that there is a significant risk of influenza-related complications in preterm neonates and infants, in whom influenza vaccines are immunogenic and safe (although their efficacy has not been specifically studied). There are conflicting data concerning the effect of influenza infection on asthma morbidity in children, and whether or not influenza vaccination helps to prevent asthma exacerbations. Recent data provide no evidence that influenza is more frequent in patients with cystic fibrosis than in healthy subjects, or that it is responsible for increased lower respiratory tract morbidity. The lack of any clear correlate of protection suggests that future studies should also consider the efficacy of the different influenza vaccines and not only evaluate them in terms of immunogenicity. Furthermore, there is a need for clinical studies to assess the effectiveness of the available vaccines in patients with other rare CRDs and other chronic underlying diseases with possibly severe respiratory involvement. It is also important to determine whether children with recurrent respiratory tract infections should be included in the list of those for whom influenza vaccination is recommended. In the meantime, given the increasing evidence of the burden of influenza on the population as a whole and the benefits associated with vaccination, annual influenza vaccinations should be recommended for all children at high risk of respiratory disease and the members of their households.

Mouse Allergen Exposure in Urban Schools and Its Effect On Childhood Asthma Morbidity

S U N D A Y 502 Most House Dust Mite Aeroallergen Exposure Occurs During the Day, Not in Bed Euan Tovey, PhD, Christiana Willenborg, BSc, Daniel Crisafulli, MSc, Janet Rimmer, MD, Jason Sercombe, MSc, Guy Marks, PhD, MD; Woolcock Institute of Medical Research, Sydney, Australia, University of Sydney, Australia, Prince of Wales Hospital, Sydney, Australia. RATIONALE: The bed is frequently regarded as the main site of house dust mite (HDM) exposure, despite a lack of explicit data. We measured people’s patterns of personal airborne HDM exposure and activity over 24 hour periods. METHODS: 12 adult subjects each collected nine (8x2 hrs + 1x8 hrs) samples of inhalable aeroallergen over 24 hours using a shoulder-mounted IOM filter and 2L/minute air pump carried in a back-pack. HDM allergen Der p 1 was measured using amplified ELISA. Location and activity were recorded by diary and automated still and video camera. Particle counts were also made in the breathing zone overnight. Fourteen distinct activities were identified. Differences in exposure between these activities were estimated by mixed model regression in which subjects were assigned random intercepts. RESULTS: Compared to the 24 hour geometricmean, exposurewas lower in bed overnight (relative ratio (RR) 5 0.17, 95% CIs 0.07 to 0.45, p 0.01). Most of the aeroallergen exposure occurred during the day and was associated with being active in domestic and crowded public situations. Overnight exposure to>5mmparticles was only transiently high around the time of bed entry, with additional small peaks associated with sporadic movement during sleep. CONCLUSIONS: Contrary to conventional belief, the bed may not be the main site or source of HDM allergen exposure. Future interventions should address other sources of exposure, and measure exposure in ways other than sampling bed reservoirs.

Sleep-disordered breathing and childhood asthma

Asthma morbidity in children remains high despite comprehensive evidence-based guidelines for evaluation and treatment. The objective of this review is to examine the evidence that obstructive sleep-disordered breathing often co-exists with asthma and is associated with asthma severity, and to discuss the clinical implications of this relationship, focusing particularly on studies published within the past year. Obstructive sleep-disordered breathing is highly prevalent in children with severe or poorly controlled asthma. Data from an observational study suggest that adenotonsillectomy markedly improves asthma outcomes in children with poorly controlled asthma and comorbid obstructive sleep apnea. Clinicians should consider evaluating and treating obstructive sleep-disordered breathing in children with severe or difficult-to-control asthma. Further controlled studies are needed to confirm that treatment of obstructive sleep apnea improves pediatric asthma outcomes, and to extend our understanding of how asthma and sleep-disordered breathing interact.

Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) study.

Background: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma.Objectives: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina.Methods: Children (4–12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre–post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions.Results: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001).Conclusions: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.

Reasons for inadequate asthma control in children: an important contribution from the “French 6 Cities Study”

Reasons for inadequate asthma control in children: an important contribution from the “French 6 Cities Study”

Household mold and dust allergens: Exposure, sensitization and childhood asthma morbidity

BackgroundFew studies address concurrent exposures to common household allergens, specific allergen sensitization and childhood asthma morbidity. ObjectiveTo identify levels of allergen exposures that trigger asthma exacerbations in sensitized individuals. MethodsWe sampled homes for common indoor allergens (fungi, dust mites (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1) and cockroach (Bla g 1)) for levels associated with respiratory responses among school-aged children with asthma (N=1233) in a month-long study. Blood samples for allergy testing and samples of airborne fungi and settled dust were collected at enrollment. Symptoms and medication use were recorded on calendars. Combined effects of specific allergen sensitization and level of exposure on wheeze, persistent cough, rescue medication use and a 5-level asthma severity score were examined using ordered logistic regression. ResultsChildren sensitized and exposed to any Penicillium experienced increased risk of wheeze (odds ratio [OR] 2.12 95% confidence interval [CI] 1.12, 4.04), persistent cough (OR 2.01 95% CI 1.05, 3.85) and higher asthma severity score (OR 1.99 95% CI 1.06, 3.72) compared to those not sensitized or sensitized but unexposed. Children sensitized and exposed to pet allergen were at significantly increased risk of wheeze (by 39% and 53% for Fel d 1>0.12μg/g and Can f 1>1.2μg/g, respectively). Increased rescue medication use was significantly associated with sensitization and exposure to Der p 1>0.10μg/g (by 47%) and Fel d 1>0.12μg/g (by 32%). ConclusionAsthmatic children sensitized and exposed to low levels of common household allergens Penicillium, Der p 1, Fel d 1 and Can f 1 are at significant risk for increased morbidity.

Paternal Heredity and Housing Characteristics Affect Childhood Asthma and Allergy Morbidity

ABSTRACT A birth cohort was initiated when each pregnant woman was asked for her own and her husband's history of asthma and allergic diseases at the time of recruitment. They were further inquired to verify their housing conditions, and current health status of children 3 to 5 years old at the time of interview. Paternal history was the most significant risk factor associated with reporting childhood morbidities at age of 3 to 5 years. Housing characteristics became meaningful variables only if the fathers were asthmatic or atopic. A 9-fold increase of risk was found if children with paternal history and also exposed to incense burning and water damage at home. This is the first epidemiological evidence of East Asia suggesting paternal heredity, with concurrent indoor hazardous exposures, as a predominant risk on developing childhood asthma and allergy.

The Utility of Forced Expiratory Flow between 25% and 75% of Vital Capacity in Predicting Childhood Asthma Morbidity and Severity

Objectives. The forced expiratory volume in 1 second (FEV1) felt to be an objective measure of airway obstruction is often normal in asthmatic children. The forced expiratory flow between 25% and 75% of vital capacity (FEF25–75) reflects small airway patency and has been found to be reduced in children with asthma. The aim of this study was to determine whether FEF25–75 is associated with increased childhood asthma severity and morbidity in the setting of a normal FEV1, and to determine whether bronchodilator responsiveness (BDR) as defined by FEF25–75 identifies more childhood asthmatics than does BDR defined by FEV1. Methods. The Boston Children’s Hospital Pulmonary Function Test database was queried and the most recent spirometry result was retrieved for 744 children diagnosed with asthma between 10 and 18 years of age between October 2000 and October 2010. Electronic medical records in the 1 year prior and the 1 year following the date of spirometry were examined for asthma severity (mild, moderate, or severe) and morbidity outcomes for the three age, race, and gender-matched subgroups: Group A (n = 35) had a normal FEV1, FEV1/forced vital capacity (FVC), and FEF25–75; Group B (n = 36) had solely a diminished FEV1/FVC; and Group C (n = 37) had a normal FEV1, low FEV1/FVC, and low FEF25–75. Morbidity outcomes analyzed included the presence of hospitalization, emergency department visit, intensive care unit admission, asthma exacerbation, and systemic steroid use. Results. Subjects with a low FEF25–75 (Group C) had nearly 3 times the odds ratio (OR) (OR = 2.8, p < .01) of systemic corticosteroid use and 6 times the OR of asthma exacerbations (OR = 6.3, p > .01) compared with those who had normal spirometry (Group A). Using FEF25–75 to define BDR identified 53% more subjects with asthma than did using a definition based on FEV1. Conclusions. A low FEF25–75 in the setting of a normal FEV1 is associated with increased asthma severity, systemic steroid use, and asthma exacerbations in children. In addition, using the percent change in FEF25–75 from baseline may be helpful in identifying BDR in asthmatic children with a normal FEV1.

Health Disparities in Asthma

Health Disparities in Asthma

The School Inner-City Asthma Study: Design, Methods, and Lessons Learned

Background. Children spend a significant amount of time in school. Little is known about the role of allergen exposure in school environments and asthma morbidity. Objectives. The School Inner-City Asthma Study (SICAS) is a National Institutes of Health (NIH)-funded prospective study evaluating the school/classroom-specific risk factors and asthma morbidity among urban children. Methods/results. This article describes the design, methods, and important lessons learned from this extensive investigation. A single center is recruiting 500 elementary school-aged children, all of whom attend inner-city metropolitan schools. The primary hypothesis is that exposure to common indoor allergens in the classroom will increase the risk of asthma morbidity in children with asthma, even after controlling for home allergen exposures. The protocol includes screening surveys of entire schools and baseline eligibility assessments obtained in the spring prior to the academic year. Extensive baseline clinical visits are being conducted among eligible children with asthma during the summer prior to the academic school year. Environmental classroom/school assessments including settled dust and air sampling for allergen, mold, air pollution, and inspection data are collected twice during the academic school year and one home dust sample linked to the enrolled student. Clinical outcomes are measured every 3 months during the academic school year. Conclusion. The overall goal of SICAS is to complete the first study of its kind to better understand school-specific urban environmental factors on childhood asthma morbidity. We also discuss the unique challenges related to school-based urban research and lessons being learned from recruiting such a cohort.

Cockroach Exposure Independent of Sensitization Status and Association With Hospitalization for Asthma in Inner-City Children

FA Rabito, J Carlson, EW Holt, S Iqbal, MA James. Ann Allergy Asthma Immunol. 2011;106(2):103–109 To examine the relationship between house dust mite, cockroach exposures and sensitization, and asthma morbidity in children in an inner-city environment. The subjects were patients from an allergy clinic ( n = 86, mostly black, aged 4–17 years) with physician-diagnosed asthma and positive skin-test results to an indoor allergen and living in urban New Orleans, Louisiana. Most of the children were taking daily asthma medications, more than half had had an emergency department visit, almost 75% had …

Indoor Particulate Matter Increases Asthma Morbidity in Children With Non-Atopic and Atopic Asthma

MC McCormack, PN Breysse, EC Matsui; Center for Childhood Asthma in the Urban Environment. Ann Allergy Asthma Immunol. 2011;106(4):308–315 Environmental control is an accepted component of asthma management in children with atopic asthma, but it is not usually a part of management in nonatopic asthma. Air pollutants, particularly particulate matter, might have a stronger effect on nonatopic asthma and might have significant indoor sources. This study examined the effect of indoor particulate matter in children with asthma. Studied were 150 predominantly black children from the east Baltimore, Maryland, area aged 2 to 6 years with physician-diagnosed asthma and symptoms or medication use …