Asthma-related Hospitalizations Research Articles

Trends in US Pediatric Asthma Hospitalizations, by Race and Ethnicity, 2012-2020.

Some racial and ethnic minority communities have long faced a higher asthma burden than non-Hispanic White communities. Prior research on racial and ethnic pediatric asthma disparities found stable or increasing disparities, but more recent data allow for updated analysis of these trends. Using 2012-2020 National Inpatient Sample data, we estimated the number of pediatric asthma hospitalizations by sex, age, and race and ethnicity. We converted these estimates into rates using data from the US Census Bureau and then conducted meta-regression to assess changes over time. Because the analysis spanned a 2015 change in diagnostic coding, we performed separate analyses for periods before and after the change. We also excluded 2020 data from the regression analysis. The number of pediatric asthma hospitalizations decreased over the analysis period. Non-Hispanic Black children had the highest prevalence (range, 9.8-36.7 hospitalizations per 10,000 children), whereas prevalence was lowest among non-Hispanic White children (range, 2.2-9.4 hospitalizations per 10,000 children). Although some evidence suggests that race-specific trends varied modestly across groups, results overall were consistent with a similar rate of decrease across all groups (2012-2015, slope = -0.83 [95% CI, -1.14 to -0.52]; 2016-2019, slope = -0.35 [95% CI, -0.58 to -0.12]). Non-Hispanic Black children remain disproportionately burdened by asthma-related hospitalizations. Although the prevalence of asthma hospitalization is decreasing among all racial and ethnic groups, the rates of decline are similar across groups. Therefore, previously identified disparities persist. Interventions that consider the specific needs of members of disproportionately affected groups may reduce these disparities.

Projected Cost Savings of a Community Health Worker Model for Asthma Home Visits in the Massachusetts Pediatric Medicaid Population.

The community health worker-led asthma home visiting model (CHW model) improved asthma outcomes and reduced health care costs among Massachusetts children with asthma. We projected cost savings associated with the expansion of the CHW model among pediatric Massachusetts Medicaid (MassHealth)-eligible patients with uncontrolled asthma (≥2 asthma-related emergency department visits per year). We estimated 2019 costs associated with asthma-related hospitalizations and emergency department visits for MassHealth pediatric patients with uncontrolled asthma who also had 365 days of Medicaid eligibility in 2019. We based estimated cost savings on previously published results from a study of a comparable patient population. The projected asthma-related cost savings from expansion of the CHW model were $566.58 per patient, or $774,514.86 total, for the 1,367 MassHealth-eligible children with uncontrolled asthma in our analysis. Expansion of the CHW model is an effective way to increase asthma services and reduce Medicaid costs for MassHealth patients, a population made up disproportionately of Black and Hispanic residents with low incomes.

The temporal-spatial association of respiratory manifestations and air pollution in children referred to the Emergency Department of Akbar Children’s Hospital, Mashhad, Iran

BackgroundAir pollution causes many respiratory disorders, especially in children and the elderly. These disorders include asthma exacerbations, bronchiolitis, and pneumonia. Research on the association between air pollution and respiratory disorders helps to reevaluate environmental policies in developing countries.MethodsThis descriptive cross-sectional study was conducted on 932 children with respiratory manifestations admitted from December 2017 to December 2019 at the Emergency Department of Akbar Children’s Hospital of Mashhad University of Medical Sciences, Mashhad, Iran. Air pollution indices such as concentration of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matter (PM) smaller than 2.5 and 10 μm and other parameters, including the air quality index (AQI), air temperature, and humidity level from 2017 to 2019, were retrieved from Mashhad Environmental Pollution Monitoring Center. Demographic and clinical data of patients were collected from patients’ hospital documents. We used descriptive analytical methods such as central tendency, variability, and frequency distribution to report and analyze demographic and clinical data through tables and diagrams. The association between air pollution indices and respiratory manifestations was examined by the Spearman correlation test. The correlation between the AQI and total hospital admissions and asthma-related hospital admissions was also evaluated by the Spearman correlation test.ResultsHospital admissions due to respiratory manifestations were not associated with the AQI of each month (p-value = 0.794). The concentration of SO2 was correlated with respiratory-related hospital admissions (correlation coefficient = 0.487, p-value = 0.016) but not asthma attacks.ConclusionGenerally, our cross-sectional study showed no statistically considerable association between air pollution and hospital admissions due to respiratory manifestations and asthma attacks in children. Of the air pollution indices, only SO2 concentration was associated with respiratory-related hospital admissions but not asthma attacks.

The Status of Asthma in the United States.

Asthma imposes a substantial health and economic burden on patients and their families and on the health care system. An assessment of the status of asthma in the US may lead to effective strategies to improve health and quality of life among people with asthma. The objective of our study was to assess the historical trends and current state of asthma illness and death among children and adults in the US. We assessed asthma-related emergency department visits and hospitalizations among children and adults by using data from the 2010-2021 National Health Interview Survey (NHIS), the 2010-2020 Nationwide Emergency Department Sample (NEDS), the National (Nationwide) Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ). Asthma death rates were calculated by using 2010-2021 National Vital Statistics System data. Asthma prevalence increased significantly among adults from 2013 through 2021 (P = .04 for the annual percentage change [APC] slope) and decreased among children from 2010 through 2021 (P values for slopes: 2010-2017, P = .03; 2017-2021, P = .03). Prevalence of current asthma was higher among non-Hispanic Black people (children, 12.5%; adjusted prevalence ratio [APR] = 2.19; 95% CI, 1.68-2.84 and adults, 10.6%; APR = 1.25; 95% CI, 1.09-1.43) compared with non-Hispanic White people (children, 5.7%; adults, 8.2%). Prevalence of asthma attacks and use of asthma-related health care declined among adults and children. Asthma prevalence and asthma-related emergency department visits, hospitalization, and death rates differed by select characteristics. Although asthma attacks, ED visits, hospitalizations, and deaths have declined since 2010 among all ages, current asthma prevalence declined only among children, and significant disparities in health and health care use still exist.

Social and built environmental factors associated with adult asthma hospital admission in the North Central Texas

Asthma, one of the most common chronic diseases of adults and children, is an important public health concern. The cause of asthma is thought to be a combination of genetic and environmental factors, and a growing body of research has investigated the possible geographic and contextual factors that contribute to asthma prevalence. However, few studies have incorporated geographic and environmental variables into their designs, despite evidence that geography is associated with asthma exacerbation. Additionally, studies of asthma exacerbations among adults are limited. The situation regarding asthma is particularly concerning in North Central Texas (NCT) compared to the national context. In light of this, we analyzed the geographic variation of approximately 12,000 adult patients hospitalized for asthma in the North Central Texas Region, and their association with built environmental features such as land use types, dwelling characteristics, exposure to traffic parameters at the Census Block Group (CBG) level, and pollutant concentrations in the relevant counties for the year 2014. We applied the Hierarchical Linear Model (HLM), and our analysis indicates that there are significant health disparities in the region. We found that the adult asthma hospitalization rate is significantly higher in low-income, low-education neighborhoods with a significant Black population. Furthermore, factors such as increased travel distance to work and substandard dwelling conditions have been found to trigger an increase in hospital visits for asthma patients. Conversely, the presence of greenspace in the surrounding area has been found to help reduce the frequency of asthma-related hospital visits. It is worth noting that both indoor and outdoor environmental quality contribute to adult asthma hospitalizations. Overall, our study highlights the importance of considering geographic and environmental factors in understanding the prevalence and exacerbation of asthma. Our findings suggest that targeted interventions, such as improving indoor and outdoor environmental quality and increasing access to greenspace, may help reduce the burden of asthma in high-risk communities.

Asthma in the Brazilian Unified Health Care System: an epidemiological analysis from 2008 to 2021.

To analyze the number of hospitalizations, the length of hospital stay, and mortality due to asthma, as well as the costs to the Unified Health Care System in Brazil between 2008 and 2021. This was a cross-sectional epidemiological study using data from the Information Technology Department of the Brazilian Unified Health Care System. Proportional hospitalization and death rates were estimated per 100,000 population by age, microregion, and year. The number of hospitalizations and deaths due to asthma decreased from 2008 to 2021 (205,392 vs. 55,009 and 822 vs. 327, respectively). In addition, a between-sex difference was observed in asthma-related hospitalizations in 2008, and more men were hospitalized in 2021 (51.8%). Asthma mortality rates were similar for both sexes (50.0% each) in 2008, and a slight increase was observed in women's deaths in 2021 (52.9%). Even so, approximately one death/day and more than 55,000 hospitalizations were observed yearly, with a mean length of hospital stay of three days. Additionally, the Southeast region allocated more financial resources to asthma-related hospitalizations. Our results showed that the number of deaths and hospitalizations due to asthma substantially declined during the study period.

"Will anybody listen?" parents' views on childhood asthma care: a qualitative study.

Asthma is the most common chronic disease in children, resulting in considerable morbidity and health care utilisation, especially in geographical areas with high deprivation. Parents play a pivotal role in children's asthma management. To explore the views of parents whose children have asthma, regarding barriers and facilitators to receiving adequate asthma care. A qualitative study conducted in an urban, multi-ethnic setting with high socioeconomic deprivation and paediatric asthma related hospital admissions. The study used a pragmatic approach underpinned by a perspective of critical realism. Parents of children with asthma were recruited through purposive and convenience sampling and data collected through semi-structured interviews. Transcripts were analysed using thematic analysis, facilitated by NVivo software. 10 parents participated in nine interviews. Six themes were identified relating to: (1) the establishment of a new life dynamic following a diagnosis of asthma; (2) the turbulent and drawn-out process of asthma diagnosis; (3) the roles and expectations of the partnership established between parents and healthcare services; (4) the importance of schools in asthma management; (5) sources and access to relevant information; and (6) the importance of social support networks. Parents frequently felt unsupported and misunderstood, particularly during the diagnostic process. Unmet parental educational and emotional needs, particularly around the time of diagnosis were identified as a key barrier to adequate asthma management. Deeper understanding of gaps in support can instruct asthma care delivery and inform co-produced interventions, thus improving asthma outcomes in children.

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents and adults: a cohort study using primary and secondary care data

BackgroundAsthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in...

Using Electronic Health Records to Identify Asthma-Related Acute Care Encounters

ObjectiveLeveraging “big data” to improve care requires that clinical concepts be operationalized using available data. Electronic health record (EHR) data can be used to evaluate asthma care, but relying solely on diagnosis codes may misclassify asthma-related encounters. We created streamlined, feasible and transparent prototype algorithms for EHR data to classify emergency department (ED) encounters and hospitalizations as “asthma-related.” MethodsAs part of an asthma program evaluation, expert clinicians conducted a multi-phase iterative chart review to evaluate 467 pediatric ED encounters and 136 hospitalizations with asthma diagnosis codes from calendar years 2017 and 2019, rating the likelihood that each encounter was actually asthma-related. Using this as a reference standard, we developed rule-based algorithms for EHR data to classify visits. Accuracy was evaluated using sensitivity, specificity, and positive and negative predictive values (PPV, NPV). ResultsClinicians categorized 38% of ED encounters as “definitely” or “probably” asthma-related; 13% as “possibly” asthma-related; and 49% as “probably not” or “definitely not” related to asthma. Based on this reference standard, we created two rule-based algorithms to identify “definitely” or “probably” asthma-related encounters, one using text and non-text EHR fields and another using non-text fields only. Sensitivity, specificity, PPV, and NPV were >95% for the algorithm using text and non-text fields and >87% for the algorithm using only non-text fields compared to the reference standard. We created a two-rule algorithm to identify asthma-related hospitalizations using only non-text fields. ConclusionsDiagnostic codes alone are insufficient to identify asthma-related visits, but EHR-based prototype algorithms that include additional methods of identification can predict clinician-identified visits with sufficient accuracy.

Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England.

There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO2) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO2. We aimed to investigate how daily NO2 estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England. We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0-14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO2 levels were predicted at the patients' place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses. For each 10 µg/m³ increase in NO2 exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO2 average (mean lag 0-4) (OR 1.08, 95% CI 1.06-1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07-1.12) and during the cold season (OR 1.10, 95% CI 1.08-1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region. Short-term exposure to NO2 was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.

Smaller Differences in the Comparative Effectiveness of Biologics in Reducing Asthma-Related Hospitalizations Compared With Overall Exacerbations

Evidence on the comparative effectiveness of respiratory biologics remains sparse. We sought to evaluate the comparative effectiveness of omalizumab, mepolizumab, benralizumab, and dupilumab in a matched retrospective cohort of patients with asthma. We identified patients with asthma aged ≥18 years who were incident users of these biologics between November 1, 2018, and June 30, 2023, in administrative claims data from the FDA's Sentinel System and Merative™ MarketScan® Commercial Database. We compared asthma-related exacerbations and hospitalizations in the 12-months since biologic prescription in pairwise comparisons of propensity score-matched cohorts. Covariates used in matching included age, sex, allergic comorbidities, baseline asthma medications use, and the Charlson Comorbidity Index. Incidence rate ratios (IRR) and 95% CIs were estimated using negative binomial regression models. Eight hundred and ninety-three mepolizumab users, 1300 benralizumab, 1170 omalizumab, and 1863 dupilumab patients were identified. The average age was 55 years and two-thirds of the participants were female. At baseline, over 80% of these individuals had an active prescription for an inhaled corticosteroid. Almost half of patients on dupilumab had concomitant nasal polyposis compared to 6-13% of patients on the other biologics. Covariates were balanced after matching. In matched analyses, dupilumab was associated with the lowest incidence of exacerbations over the follow-up period (vs dupilumab): mepolizumab (IRR: 1.36; 95% CI: 1.12-1.64), omalizumab (IRR: 1.33; 95% CI: 1.13-1.58), benralizumab (IRR: 1.19; 95% CI: 1.00-1.41). For exacerbations leading to hospitalizations, benralizumab and mepolizumab were associated with the lowest incidence of hospitalizations and the greatest difference was between mepolizumab vs dupilumab (IRR 0.76; 0.56 - 1.03). Dupilumab was associated with the lowest incidence of overall exacerbations and mepolizumab with the lowest incidence of asthma hospitalizations in this administrative claims-based cohort of individuals with asthma. Despite matching propensity scores, residual confounding, such as baseline eosinophil count, may explain some of these findings.

Comparative Impact of Asthma Biologics: A Nationwide US Claim-Based Analysis

BackgroundBiologic modifiers targeting type-2 (T2) airway inflammation are effective in reducing asthma exacerbation, however real-world and comparative effectiveness studies remain limited.Objective: to examine and compare the real-world impact of anti-T2 asthma biologics MethodsIn this retrospective new user cohort study, we used the MarketScan, a Commercial Claims and Encounters Database, to identify adult patients with asthma who were started on an anti-T2 biologic agent (anti-IL-5s, dupilumab or omalizumab). We examined the influence of the biologic class on asthma exacerbation by comparing the average number of asthma exacerbation 1-year pre- and post-biologic initiation. We conducted multivariable regression analyses to compare the effectiveness of these asthma biologics on reducing the incidence of asthma exacerbations within 18-month of initial administration of biologics while controlling for demographic variables, comorbidities, and asthma severity. ResultsWe identified 5,538 asthma patients who were initiated on an anti-T2 biologic [mean age (±SD); 45.6 (12.78) years; % females, 65.8%). Asthma biologics reduced asthma exacerbation by 11-47%, particularly among patients with 2+ asthma exacerbations in the year preceding biologic initiation (31-65% reduction). Biologics were especially effective in reducing asthma-related hospitalizations (44.6-60%). After adjusting for baseline demographics, asthma medication, and co-morbidities, dupilumab was associated with a lower estimated mean number of asthma exacerbation per year and lower adjusted OR for developing asthma exacerbation relative to other biologics (50-80% less likely). ConclusionAnti-T2 asthma biologics reduced asthma exacerbation in real-word settings. Evidence supports growing literature that dupilumab might have a more favorable impact on asthma exacerbation relative to other asthma biologics.

Medicaid Expansion and Health Care Use Among Adults With Asthma and Low Incomes: The Adult Asthma Call-Back Survey.

Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics. We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used t tests to compare weighted percentages and 95% CIs, then performed adjusted difference-in-differences analyses. Secondary analyses stratified data by race, ethnicity, and sex. Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; P = .13). Use of asthma controller medication increased significantly among non-Hispanic Other participants in the nonexpansion group (2011-2013: 16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01). Asthma-related hospitalizations decreased significantly among women in the expansion group: 2011-2013 (7.8%; 95% CI, 5.3%-11.3%) and 2015-2019 (3.5%; 95% CI, 2.5%-4.9%) (P = .009). Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

Mepolizumab in children and adolescents with severe eosinophilic asthma not eligible for omalizumab: a single Center experience

Background Mepolizumab is an anti-interleukin-5 monoclonal antibody shown to reduce asthma exacerbations in adults and adolescents with severe eosinophilic asthma. Aim To assess the impact of mepolizumab on children and adolescents over 12 months by examining steroid usage, asthma-related hospitalizations, Asthma Control Test (ACT) scores, fractional exhaled nitric oxide concentration (FeNO), forced expiratory volume in 1 s (FEV1), mid expiratory flow (FEF25–75%), and blood eosinophil count. Methods Retrospective analysis performed between October 2015 and December 2022. Data was reviewed 12 months before and after commencing mepolizumab. Mepolizumab was offered if the patient had severe eosinophilic asthma and were unresponsive to or ineligible for omalizumab. Results Sixteen participants (age 7–17, 8 males, 8 females) received subcutaneous mepolizumab monthly with no serious adverse reactions. Incidence of hospital admissions fell significantly (IRR 0.33, p = 0.007). Among the 11 patients receiving daily oral corticosteroids, 3 were weaned off daily oral steroids and 3 patients’ daily dose was significantly reduced (mean Δ-0.095 ± 0.071 mg/kg, p = 0.0012). Eosinophil count was decreased (mean Δ-0.85 x 109/L, p < 0.001). There was no significant change in mean overall steroid burden per patient (mean Δ-1445.63 ± 1603.18 mg, p = 0.10), ACT scores (mean Δ2.88 ± 6.71, p = 0.17), FEV1 z-scores (mean Δ-0.99 ± 1.88, p = 0.053), FEF25–75% z-scores (mean Δ-0.65 ± 1.61, p = 0.13), FeNO (mean Δ-20.09 ± 80.86, p = 0.34), or number of courses of oral steroids given for asthma attacks (IRR 0.71, p = 0.09). Conclusion Among children and adolescents with severe eosinophilic asthma ineligible for or not responsive to omalizumab, mepolizumab therapy exhibited significant reduction in rate of asthma-related hospitalizations and significant decrease in daily steroid dosage.

Asthma Control and Associated Factors Among Children with Current Asthma - Findings from the 2019 Child Behavioral Risk Factor Surveillance System - Asthma Call-Back Survey.

This study aimed to determine the prevalence and correlates of uncontrolled asthma among children with current asthma in four US states. We also determined the rates and correlates of asthma-related hospitalization, urgent care center (UCC), or emergency department (ED) visits. We analyzed the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS) datasets. Asthma control status was classified as well-controlled or uncontrolled asthma based on day- and night-time asthma symptoms, activity limitation or use of rescue medications. Multivariable logistic regression models were used to identify the correlates of uncontrolled asthma and asthma-related hospitalization or UCC/ED visits. Among 249 children with current asthma, 55.1% had uncontrolled asthma while 40% reported asthma-related hospitalization or UCC/ED visits in the past year. Non-Hispanic ethnicity, ages of 0-9 and 15-17 years, household income <$25,000, and not having a flu vaccination had higher odds of uncontrolled asthma. Conversely, asthma self-management education and households with two children compared to one were positively associated with uncontrolled asthma. For healthcare utilization, male and non-Hispanic children, along with those from households earning <$25,000 exhibited higher odds of asthma-related hospitalization and UCC/ED visits. Uncontrolled asthma and asthma-related visits to UCC/ED and hospitalization are common among children with current asthma. These outcomes are influenced by low household income and male sex, among other factors which call for multi-faceted interventions by healthcare providers and policymakers. Targeted strategies to effectively manage asthma and reduce the need for emergency healthcare services are recommended.

Impact of traffic congestion on asthma-related hospital visits in major Texas cities.

Asthma is one of the most prevalent chronic conditions in the United States and is particularly sensitive to environmental changes in urban areas. While it is known that traffic congestion contributes to increased vehicle emissions and poorer air quality, its direct association with asthma incidence has not been thoroughly explored. This study aimed to address this void by analyzing 148 city-level observations from 2016 to 2020 in Texas, using data from the Texas A&M Transportation Institute and Definitive Healthcare. We investigated the association between traffic congestion, measured by the travel time index, and annual city-level asthma hospital discharges, while adjusting for refinery productivity, minority groups, and education levels through multivariate regression. Our findings revealed a significant positive correlation between the travel time index and asthma visits, indicating that higher traffic congestion is associated with increased hospital visits for asthma. This finding remains consistent across different models, regardless of whether control variables are included. For the control variables, we found that higher refinery productivity was linked to elevated risks of asthma-related hospitalizations, aligning with previous research findings. Although correlations with Black or African American and Hispanic or Latino populations, as well as those with less than a high school education, were not statistically significant, a positive trend was observed. These results emphasize the impact of traffic congestion on asthma prevalence and the necessity for targeted public health interventions and urban planning strategies.

Allergy/Atopic March and United Airway Disease: What We Know and What We Need to Know?

Abstract “Allergy/atopic march” refers to a typical sequence in which the allergic or atopic features appear at a certain age, and may or may not persist thereafter. In general, atopic dermatitis or atopic eczema occurs first, which progresses to immunoglobulin-E-mediated food allergy, asthma, and then allergic rhinitis (AR). However, this sequence may not be conspicuous in many cases. AR is an independent risk factor for asthma; in fact, AR often precedes that of asthma. United airway disease (allergic rhino-bronchitis) means the coexistence of AR and asthma. This has been shown in clinical and experimental studies, which suggest a similar immune pathology between the upper and lower airways in allergic subjects. In children with asthma, coexistent AR leads to an increased risk of asthma exacerbation leading to hospitalization and/or emergency visits as well as increased health-care cost. Treatment of AR in asthmatic children results in a lowered risk of asthma-related hospitalizations and emergency visits, and improved quality of life. In this article, we have discussed the current evidence for the clinically relevant effects that allergic conditions (from food allergies to atopic march, united airways disease, and AR) can have on children with asthma along with the future of allergic diagnosis (precision allergy molecular diagnosis) and allergen immunotherapy.

Asthma exacerbations and eosinophilia in the UK Biobank: a genome-wide association study.

Asthma exacerbations reflect disease severity, affect morbidity and mortality, and may lead to declining lung function. Inflammatory endotypes (e.g. T2-high (eosinophilic)) may play a key role in asthma exacerbations. We aimed to assess whether genetic susceptibility underlies asthma exacerbation risk and additionally tested for an interaction between genetic variants and eosinophilia on exacerbation risk. UK Biobank data were used to perform a genome-wide association study of individuals with asthma and at least one exacerbation compared to individuals with asthma and no history of exacerbations. Individuals with asthma were identified using self-reported data, hospitalisation data and general practitioner records. Exacerbations were identified as either asthma-related hospitalisation, general practitioner record of asthma exacerbation or an oral corticosteroid burst prescription. A logistic regression model adjusted for age, sex, smoking status and genetic ancestry via principal components was used to assess the association between genetic variants and asthma exacerbations. We sought replication for suggestive associations (p<5×10-6) in the GERA cohort. In the UK Biobank, we identified 11 604 cases and 37 890 controls. While no variants reached genome-wide significance (p<5×10-8) in the primary analysis, 116 signals were suggestively significant (p<5×10-6). In GERA, two single nucleotide polymorphisms (rs34643691 and rs149721630) replicated (p<0.05), representing signals near the NTRK3 and ABCA13 genes. Our study has identified reproducible associations with asthma exacerbations in the UK Biobank and GERA cohorts. Confirmation of these findings in different asthma subphenotypes in diverse ancestries and functional investigation will be required to understand their mechanisms of action and potentially inform therapeutic development.

The increasing burden of asthma acute care in Singapore: an update on 15-year population-level evidence

BackgroundIn Singapore, there is currently scarce population-based research informing the recent trends of asthma-related healthcare burdens. In this study, we investigated the past 25-year trends of asthma-related hospitalisations, emergency department (ED) visits and deaths in Singapore and projected the future burdens from 2023 to 2040.MethodsWe acquired annually-measured data from the Singapore Ministry of Health Clinical and National Disease Registry, containing 25-year asthma-related hospitalisation and death rates as well as 15-year ED visit rates. We conducted change-point analysis and generalised linear modelling to identify time intervals with stable trends and estimate asthma-related healthcare utilisation and mortality rates. To project future asthma-related burdens, we developed a probabilistic model which combined projections of future population size with the estimated rate outcomes from the last stable period.ResultsOur results show that the asthma hospitalisation rate in Singapore had remained at approximately 80 episodes per 100,000 from 2003 to 2019 and are likely to grow by 1.7% each year (95% CI: 0.7, 5.0%), leading to a total of 163,633 episodes from 2023 to 2040 which corresponds to an estimated $103,075,820 based on 2022 USD. Besides, Singapore’s asthma-related ED visit rate was 390 per 100,000 in 2019 and is expected to decline by 3.4% each year (95% CI: − 5.8, 0.0%), leading to a total of 208,145 episodes from 2023 to 2040 which corresponds to USD$15,053,795. In contrast, the 2019 asthma-related mortality rate in Singapore was approximately 0.57 per 100,000 and is likely to stay stably low (change per year: -1.3, 95% CI: − 11.0, 4.3%). Between 2023 and 2040, Singapore’s estimated total number of asthma-related deaths is 638 episodes.ConclusionsCurrently, the burden of asthma acute care in Singapore is high; Singapore’s asthma-related hospitalisation and ED visit rates are relatively higher than those of other developed economies, and its asthma admission rate is expected to increase significantly over time, possibly indicating excess resource use for asthma. The established national asthma programme in Singapore, together with recent efforts in reinforcing primary care at the national level, provides opportunities to reduce avoidable asthma admissions.