Childhood Asthma Research Articles

Maternal exercise during pregnancy is associated with reduced risk of asthma in the child: A prospective birth cohort study.

The means of primary prevention of asthma are limited. Maternal physical activity during pregnancy promotes fetal lung development and the newborn's lung function; thus, it could lower asthma risk and aid in asthma prevention. The objective of this study is to determine whether maternal physical activity during pregnancy is associated with asthma development in the child. The study population included 963 mother-infant pairs from the prospective Kuopio Birth Cohort study. Data on maternal physical activity during pregnancy, confounding factors, and children's asthma at 5 to 7 years of age were obtained from the Kuopio University Hospital birth registry and questionnaires. Maternal physical activity during pregnancy, when practiced three or more times per week, was associated with a reduced risk of asthma in the child, with an adjusted odds ratio of 0.54 (95% confidence interval 0.33-0.89; p= 0.02). The association was stable across a comprehensive set of adjustments, including length of gestation, mode of delivery, and maternal health indicators (e.g., asthma, smoking, pre-pregnancy body mass index and weight gain during pregnancy, infections, medication, healthy diet, stress), as well as various family environment variables. Maternal physical activity during pregnancy may be associated with marked protection of asthma in childhood and should be studied further as an applicable measure for asthma prevention. The study has been financially supported by grants from the Academy of Finland (no. 349427), the Emil Aaltonen Foundation, the Finnish Cultural Foundation, the Yrjö Jahnsson Foundation, the Juho Vainio Foundation (no. 202200461), the Kuopio Area Respiratory Foundation, and the Ida Montini Foundation.

196 COVID-19 Pandemic-Related Racial/Ethnic Disparities in Emergency Department Visits for Patients With Childhood Asthma in the United States

196 COVID-19 Pandemic-Related Racial/Ethnic Disparities in Emergency Department Visits for Patients With Childhood Asthma in the United States

Effects of Medication on Asthma and the Development of Caries Cavities in Children Aged 3-15 at Luz Hospital in Lisbon, Portugal.

To examine the impact of medication on asthma treatment and the occurrence of caries cavities in children aged 3 to 15 years old (Luz Hospital in Lisbon, Portugal). The frequency of caries cavities in 3 different groups was examined. In addition, the possible association of caries cavities with different asthmatic medication was also assessed. Asthma and caries cavities affect many children worldwide. Investigating the connection between asthma medication and the development of caries cavities is important for enhancing asthma treatment while reducing oral health risks. Exploring the relationship between asthma medication and caries cavities is compelling due to the limited number of conclusive studies on the subject. A descriptive observational study was conducted on children aged 3 to 15 years old, who attended the immunology-allergology and dentistry services at the Luz Hospital in Lisbon, Portugal. between January 2021 and February 2022. The sample was divided into 3 groups (medicated asthmatics, unmedicated asthmatics, and healthy children without asthma). An intraoral examination was performed to collect the DMFT index (decayed, missing, and filled teeth) to assess the presence of caries cavities. Clinical and dietary data were supplemented with a questionnaire and medical history in all groups. All variables used were qualitative and described using absolute frequencies and percentages. These results showed that anti-asthmatic medications may influence the development of caries cavities. The occurrence of caries cavities is more prominent in medicated asthmatic children when compared to unmedicated asthmatic children.

Long-term exposure to PM2.5 has significant adverse effects on childhood and adult asthma: A global meta-analysis and health impact assessment

Long-term exposure to PM2.5 has significant adverse effects on childhood and adult asthma: A global meta-analysis and health impact assessment

Impulse Oscillometry Combined to FeNO in Relation to Asthma Control Among Preschool Children.

We aimed to observe and analyze the differences in impulse oscillometry (IOS) and fractional expiratory nitric oxide (FeNO) in relation to asthma control among preschool children, and to explore the predictive value of IOS combined with FeNO for uncontrolled asthma. This study enrolled 171 preschool children with asthma and 30healthy preschool children between June 2022 and June 2023. We categorized the asthmatic children as having controlled asthma (n=85) and uncontrolled asthma (n=86) after a 3-month follow-up. IOS and FeNO were collected on the first visit at baseline. Differences in metrics were compared between controlled asthma, uncontrolled asthma and healthy control groups. The area under the receiver operating characteristic curve (AUROC) was utilized to explore the discriminative ability of IOS and FeNO, alone or in combination, against uncontrolled asthma. Compared to the controlled asthma group, the IOS values of R5, X5, R5-R20, and Fres were significantly higher in the uncontrolled asthma group, except for R20. R5 and R5-R20 had the highest area under the curve (AUC), which could reach 0.74 (95% CI 0.66-0.82) and 0.72 (95% CI 0.64-0.80). R20had the lowest AUC of 0.59. The AUC for FeNO alone was 0.88 (95% CI 0.84-0.93) with a cutoff value of 17.50 ppb, sensitivity and specificity of 0.73 and 0.89. The AUCs of all IOS metrics combined with FeNO were significantly higher, with the highest AUC of 0.92 (95% CI 0.87-0.96) for R5-R20+FeNO, and with a sensitivity and specificity of 0.88 and 0.84. There were significant differences in IOS and FeNO in relation to asthma control among preschooler children. FeNO might be the best predictor of asthma control, and adding any of IOS metrics increased moderately the predictive value.

Development, Validation, and Reliability Analysis of the Household-Related Air Pollution on the Childhood Bronchial Asthma Onset Checklist (HAPBAC-Checklist)

Development, Validation, and Reliability Analysis of the Household-Related Air Pollution on the Childhood Bronchial Asthma Onset Checklist (HAPBAC-Checklist)

What constitutes valid evidence of causation? Gas stoves and childhood asthma revisited

What constitutes valid evidence of causation? Gas stoves and childhood asthma revisited

Viral Determinants of Childhood Asthma Exacerbation Severity and Treatment Response

Although respiratory viruses are common triggers of asthma exacerbations, the influence of viral infection characteristics on exacerbation presentation and treatment response in the pediatric emergency department (ED) is unclear. To assess viral infection characteristics of children experiencing ED asthma exacerbations and to test their associations with severity and treatment response. This is a prospective study of children, aged 4 to 18 years, who received standard ED asthma exacerbation treatment with inhaled bronchodilators and systemic corticosteroids. Nasal swabs collected for viral metagenomic analyses determined virus presence, load, and species. Outcomes included exacerbation severity (Pediatric Asthma Severity [PAS] score, clinician impression, and vital signs) and treatment response (discharge home without needing additional asthma therapies). Of 107 children, 47% had moderate/severe exacerbations by PAS and 64% demonstrated treatment response. Viral metagenomic analysis on nasal swabs from 73 children detected virus in 86%, with 10 different species identified, primarily rhinovirus A (RV-A), RV-C, and enterovirus D68. Exacerbations involving RV-A were milder (odds ratio [OR]= 0.25; 95% confidence interval [CI]= 0.07-0.83) and tended to be more responsive to treatment than non-RV-A infections, whereas exacerbations involving enterovirus D68 were more severe (OR= 8.3; 95% CI= 1.3-164.7) and had no treatment response association. Viral load was not associated with treatment response but exhibited a strong linear relationship with heart rate (rpartial= 0.48), respiratory rate (rpartial= 0.25), and oxygen saturation (rpartial= -0.25), indicative of severity. The majority of ED asthma exacerbations are triggered by respiratory viruses. Viral species are associated with severity and treatment response, suggesting that early pathogen detection could inform ED treatment decisions. Additional studies are needed to identify differences in pathobiology underlying exacerbations triggered by different viral species, and how to effectively treat these heterogeneous exacerbations.

Long-term health outcomes of children born by cesarean section: A nationwide population-based retrospective cohort study in Taiwan

BackgroundTaiwan had high cesarean rate which exceeded the recommended threshold (15%), set by WHO. However, there have not a comprehensive study to discuss the long-term offspring consequences of cesarean section (CS). This study aimed to show whether allergy disorders, obesity and respiratory infection of children are associated with modes of delivery, using the National Health Insurance Research Database (NHIRD) of Taiwan. MethodsThis study used the maternal and child health database of NHIRD. We included the children who birth between 2004 and 2013 and inter-linked the database of the mother and children. The participants were followed until 2018/12/31. We performed a Cox proportional hazards model to identify the association of CS with respiratory tract infection, allergy disorder, and obesity diagnosed in childhood. ResultsCS significantly increased the risk of developed childhood asthma (adjusted hazard ratio [aHR] = 1.03; 95% confidence interval [CI]: 1.02–1.03), allergy rhinitis (aHR = 1.04; 95% CI: 1.04–1.05), atopic dermatitis (aHR = 1.05; 95% CI: 1.04–1.06), respiratory tract infection (aHR = 1.07; 95% CI: 1.06–1.07) and overweight (aHR = 1.29; 95% CI: 1.18–1.40) even after adjusting with confounding factor. Development of food allergy (aHR = 1.13; 95% CI: 0.87–1.47) was not associated with cesarean section. ConclusionThis study indicated that children delivered by CS more commonly developed respiratory tract infections, asthma, allergic rhinitis, atopic dermatitis, obesity than children delivered vaginally. Among these, obesity have a stronger association with cesarean section.

The role of school safety perceptions in childhood asthma diagnosis disparities.

Childhood racial and ethnic asthma disparities in the United States are the consequence of structural inequities such as those in socioeconomic status (SES) and exposure to violence, but little research has explored the role of the school environment in perpetuating racial and ethnic disparities. This study examines associations between perceptions of unsafe school environments (USEs) and subsequent asthma diagnosis for elementary-aged children and the extent to which USE mediates relations from SES and race/ethnicity to asthma diagnosis for Black, Latinx, and non-Latinx White children. We conducted a secondary analysis of data from the Early Childhood Longitudinal Study. Structural equation modeling was used to evaluate the association between USE and subsequent asthma diagnosis, controlling for child sex, and indirect effects of SES and race/ethnicity on asthma diagnosis via USE. For 6,532 children, USE in second grade positively predicted new asthma diagnoses in third grade and mediated the association between SES and new asthma diagnosis. SES and USE serially mediated the relationship between race/ethnicity and asthma diagnosis. Identifying as non-Latinx White was associated with a lower likelihood of subsequent asthma diagnosis via higher SES and lower USE while identifying as Black or Latinx was associated with a higher likelihood of subsequent asthma diagnosis via lower SES and higher USE. USE was associated with pediatric asthma diagnosis and mediated the relationship between SES and asthma diagnosis as well as race/ethnicity and asthma diagnosis. Findings highlight the need to consider USE as a social determinant of health for pediatric asthma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and Clinico-sociodemographic Factors of Asthmatic Children Aged 1 to 14 Years: A Prospective Descriptive Cross-sectional Study in Gandaki Province, Nepal

Introduction Pediatric asthma poses a significant public health challenge, impacting children’s health and quality of life. As asthma prevalence continues to rise globally, understanding its epidemiology is crucial for developing effective management strategies. This study aims to investigate the prevalence and associated demographic, socioeconomic, and clinical characteristics of pediatric asthma among children aged 1 to 14 years. Methods This study employed a prospective descriptive cross-sectional design. Data were collected from a diagnosed asthmatic children attending pediatric department of the GP Koirala National Respiratory Centre and Hospital, Tanahun, Ganaki, Nepal over three months from April 20, 2023 by assessing demographic factors (age, gender, residence), socioeconomic status, clinical history (family history and comorbid conditions), and asthma severity. Data were analyzed with SPSS version 23 using descriptive statistics. Results Prevalence rate of pediatric asthma was 3.08%. The demographic analysis revealed that most participants were aged 1-5 years (53%), predominantly male (64.9%), and resided in urban areas (59.6%). Socioeconomic data indicated that 59.6% came from low-income households, suggesting a potential link between socioeconomic status and asthma prevalence. Clinically, 53% had a family history of asthma, with 26.3% presenting with comorbid allergic rhinitis. Asthma severity assessments showed that 50% had mild asthma, 33.33% had moderate asthma, and 16.67% had severe asthma. Conclusion This study highlights a low prevalence of asthma in the pediatric population at GP Koirala National Respiratory Centre and Hospital, yet emphasizes the burden faced by younger children, especially those from low-income backgrounds. The correlations between asthma prevalence, socioeconomic status, and comorbid conditions underscore the need for targeted public health interventions and comprehensive management strategies. Further research is warranted to deepen understanding and enhance healthcare services for affected children.

Use of Omalizumab for Pediatric Asthma After US Food and Drug Administration Expanded Indications.

Research and regulatory approval for pediatric uses of prescription drugs often lag years after adult approvals, during which time substantial off-label use of medications in children can occur. We evaluated whether US Food and Drug Administration (FDA) regulatory actions affected the pediatric use of omalizumab, a biologic drug used to treat asthma. In this serial cross-sectional study, we identified quarterly cohorts of children (0-18 years) with moderate-to-severe asthma within two large national claims databases of those with commercial insurance and Medicaid from 2003 to 2019. Using an interrupted time-series analysis, we fit segmented linear regression models to identify changes in the incidence of omalizumab use in 6-11-year-old children compared with 12-18-year-olds after two time points: (1) 2009Q3 when an FDA advisory committee voted against use for 6-11-year-old children and (2) 2016Q2 when FDA expanded omalizumab's labeling to include 6-11-year-old children. We identified 9298 new pediatric omalizumab users (84% Medicaid). Among 6-11-year-old children, the incidence of omalizumab use did not change following the FDA's initial review of evidence in 2009 and increased after 2016 Q2 FDA approval for this age group in both Medicaid (58 per 100 000 children with asthma, 95% confidence interval [CI] 27-89, p < 0.001) and commercial insurance (57 per 100 000, 95% CI 21-94, p = 0.003) compared with 12-18-year-old children. The use of omalizumab among asthmatic children aged 6-11 years remained steady after FDA advisory committee concerns in 2009 and increased after FDA expanded the indication to include this population in 2016. Additional market incentives may help to ensure the timely generation of evidence and regulatory approval of medications for children.

Interleukin-17 Genotypes in Egyptian Asthmatic Children at Zagazig University Hospitals.

Bronchial asthma (BA) is increasing among Egyptian children. It is affected by multiple factors including genetic ones. In the current study, we assessedthe relationship between interleukin-17 (IL-17) genotypes and the occurrence of BA among Egyptian children. This case-control study included 100 participants. Group I (the control group) comprised 50 healthy subjects. Group II (the asthmatic group) comprised 50 subjects diagnosed with atopic asthma according tothe Global Initiative for Asthma. Measurement of serum Ig E and eosinophilic count was performed. Detection of single nucleotide polymorphism rs2275913 of IL-17 gene by restriction fragment length polymorphism-polymerase chain reaction was conducted. GA and AA genotypes were more frequent in the asthmatic group compared tothe control group (P = 0.03 and 0.01, respectively). Subjects carrying GA and AA genotypes were more susceptibleto have asthma [odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.14-9.94, P = 0.03; OR = 7.78, 95% CI = 1.59-38.3, P = 0.01, respectively]. The A allele was higher in the asthmatic group (33%) compared tothe control group (10%). A allele carriers were more susceptibleto have asthma (OR = 4.43, 95% CI = 2.04-9.82 and P < 0.001). Immunoglobulin E (IgE) levels and eosinophil percentages were higher among the carriers of GA and AA genotypes when compared with the GG genotype. All pulmonary function tests were significantly lower among carriers of AA genotype compared with GG genotype. An A allele carrier, AA genotype, increased IgE level, and eosinophil level were significant predictors for occurrence of asthma (P = 0.01, 0.02, 0.004, and 0.01). In conclusion, AA genotype carriers and A allele carriers of the IL-17 gene are more likely to have asthma compared with controls.

Phthalate Exposure and Pediatric Asthma: A Case Control Study Among Egyptian Children

Background: Phthalates, which are diesters of phthalic acid, are commonly used as plasticizers and additives in various consumer products. Several phthalates have been identified as substances of high concern. Exposure to phthalate esters (PAEs) has been linked to asthma in children, but the specific impacts of PAEs on asthmatic children were not well understood. Objective: The objective of this study was to compare urinary phthalate concentrations in asthmatic and non-asthmatic children and to identify potential sources of exposure as risk factors for asthma. Methods: A case control study was conducted for 100 Egyptian children aged 8-16 years (50 asthmatics and 50 healthy controls). Asthma was identified using GINA guidelines. Socio-demographic and probable risk factors were assessed, in addition to measuring phthalate levels in urine samples using high-performance liquid chromatography. Results and conclusion: Mean urinary Mono-methyl as well as Mono-benzyl levels were highly significant in asthmatic children compared to control group (895.26ng/ mL vs 548.55 ng/mL and 13.5 ng/mL vs 2.07 ng/mL respectively) (p= 0.001). The number of asthmatic children living in houses painted with non-plastic paint was significantly lower (P&lt;0.05) than children living in houses painted with other paints. No association between floor type and asthma was reported. The frequent use of personal care products and plastic painting of walls were identified by multiple logistic regression analysis as the highly significant predictors of asthma in the studied subjects. The declared higher levels of urinary phthalate metabolites (Mono-methyl and Mono-benzyl) in Egyptian asthmatic children may reveal the probable risk of phthalate exposure in triggering bronchial asthma.

Perinatal maternal depression and the risk of childhood asthma in offspring: A meta-analysis.

Previous studies have yielded conflicting results regarding the link between maternal perinatal depression and asthma in children. To provide a clearer understanding of this relationship, a comprehensive meta-analysis was carried out to evaluate the association mentioned above. A comprehensive review of observational studies was conducted by searching electronic databases including Medline, Embase, and Web of Science. The data were combined using a randomized-effects model taking into account potential variations. Subgroup analyses were performed to evaluate the possible impact of study characteristics on outcomes. Ten cohort studies, which included 833,230 mother-child pairs, were examined in the analysis. Maternal depressive symptoms during the perinatal period were associated with an increased risk of asthma in offspring (risk ratio [RR]: 1.24, 95% confidence interval [CI]: 1.19 to 1.30, p < 0.001; I2 = 0%). Further sensitivity analyses restricted to multivariate studies (RR: 1.24, 95% CI: 1.19 to 1.30, p < 0.001; I2 = 0%) or studies where asthma was diagnosed in children aged three years or older (RR: 1.24, 95% CI: 1.19 to 1.30, p < 0.001; I2 = 0%) revealed consistent outcomes. Subgroup analyses according to study design, methods for the diagnosis of maternal depression, timing for the evaluation of maternal depression, methods for the validation of asthma in offspring, adjustment of maternal smoking during pregnancy and of maternal asthma, or study quality score showed similar results (p for subgroup difference all > 0.05). Maternal perinatal depression appears to be significantly linked to a higher occurrence of childhood asthma in children.

Recurrent wheezing and asthma-Epidemiology and environmental determinants.

Wheeze is the musical continuous sound produced by oscillations in any critically narrowed airways, and heard mostly on expiration. It is common in preschool age, about half of all children will experience an episode of wheezing by their sixth birthday. Asthma is usually characterized by cough, wheeze, chest tightness and fast breathing. It is a significant global health issue and affects both children and adults. The prevalence is on the increase, especially in LMIC. Studies from different populations have revealed the key role influencing the progression from preschool wheezing to childhood asthma. Recurrent wheezing is four or more episodes in the preceding year and has a spectrum of phenotypes and with heterogeneous features. Phenotypes of wheezing were proposed to facilitate the identification of young children who are at risk of subsequent development of asthma. The epidemiology and environmental determinants of recurrent wheezing and asthma are discussed.

C-CBL/LCK/c-JUN/ETS1/CD28 axis restrains childhood asthma by suppressing Th2 differentiation

BackgroundAsthma is a common immune disease with high morbidity in children. Type 2 inflammation is the center of asthma development, and mainly mediated by a subset of CD4 + T cells, T helper 2 (Th2) cells. Excess Th2 differentiation was generally associated with asthmatic attack. Casitas B-lineage lymphoma (c-CBL) was reported to involved in T cell development and databank showed its decreased expression in CD4 + T cells from peripheral blood of asthmatic children. This study aims to investigate the role of c-CBL in childhood asthma and Th2 differentiation, and explore the underlying mechanism.MethodsWe collected peripheral blood samples from clinical childhood asthma cases and healthy controls, and determined c-CBL expression in CD4 + T cells. Asthma was induced in neonatal mice by ovalbumin (OVA) intraperitoneal injection and aerosol inhalation, and c-CBL expression in CD4 + T cells from peripheral blood and spleen was measured. Gain-of-function experiments was performed to confirm the effects of c-CBL on Th2 differentiation in vitro. Finally, c-CBL was delivered into asthmatic mice via lentivirus infection to verify its effects on experimental asthma.Resultsc-CBL was lowly expressed in CD4 + T cells from asthmatic children than those of healthy controls. Similarly, it was downregulated in CD4 + T cells from peripheral blood and spleen of asthma mice. Overexpression of c-CBL restrained lung pathological injury and type 2 inflammation in experimental asthmatic mice. Gain-of-function experiments demonstrated that c-CBL inhibited Th2 differentiation of CD4 + T cells from healthy children, and mediated the ubiquitination of lymphocyte cell-specific protein-tyrosine kinase (LCK). LCK acted as a kinase to phosphorylate and activate c-JUN, which was predicted to bind promoter sequence of CD28 by bioinformatic analysis. Dual-luciferase reporter assay verified that c-JUN and ETS1 synergically enhanced transcription of CD28, and this transcription activation was aggravated by LCK overexpression.Conclusionc-CBL alleviated asthma and suppressed Th2 differentiation by facilitating LCK ubiquitination, interrupting c-JUN activation and CD28 expression in vivo and in vitro. c-CBL/LCK/c-JUN/ETS1/CD28 axis was partially involved in childhood asthma, and may provide novel insights for clinical treatment for asthma.

Prevalence, symptomatology and factors associated with asthma in adolescents aged 13–14 years from rural Sri Lanka: an analytical cross-sectional study

BackgroundAsthma is the most common chronic disease affecting children. However, the epidemiology of asthma in adolescents from rural geographies is lacking.MethodsAn analytical cross-sectional study was conducted in secondary schools located...

The Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) pilot study

Objective To evaluate the feasibility of a novel intervention of health literacy-informed, telemedicine-enhanced asthma education and home management support for hospitalized children and caregivers, and assess caregiver perspectives of the intervention. Methods We conducted a pilot randomized trial of the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention vs. standardized care (SC) for children (5–13 yrs) hospitalized with asthma. Participants in TEACHH received health literacy-informed teaching prior to discharge, including pictorial materials (e.g. flipchart, action plan), color- and shape-coded medication labels, and medication demonstration. Two Zoom-based follow-up teaching visits were completed within 1-month of discharge. Feasibility was assessed by tracking visit completion, and we measured preliminary outcomes using health records (i.e. total asthma-related acute healthcare visits) and blinded surveys of caregivers 2-, 4-, and 6-months post-discharge (i.e. symptom-free days, quality of life). We interviewed caregivers about their perceptions of TEACHH. Transcripts were coded inductively. Results We enrolled 26 children and interviewed 14 caregivers (9 TEACHH, 5 SC). All inpatient sessions were completed, as were 77% of virtual visits. Both groups experienced improved symptoms and quality of life over time. Caregivers valued the teaching, involvement of children, visual tools, and color-coded information of TEACHH. They described child-specific benefits, greater support after discharge, and improved asthma-related communication, and indicated that other families would benefit from similar teaching. Conclusions A novel program of patient-centered asthma education was feasible in both hospital and home settings and well received by caregivers. A larger study is needed to assess the impact of TEACHH on childhood asthma morbidity. Clinicaltrials.gov identifier NCT04995692 (Registration date 8/9/2021)

Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma

AimsSpirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the...