Burden Of Asthma In Children Research Articles

The acute care burden of asthma in children was profoundly reduced during the COVID-19 pandemic: A multi-centre Canadian retrospective study.

Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces. We queried whether pandemic-related changes would impair preventive care and delay presentation to care, increasing asthma exacerbation severity. This retrospective study compared the frequency of acute care access and severity of presentation to emergency departments (ED) for acute asthma to four tertiary care children's hospitals during the COVID-19 pandemic (from March 17, 2020 to June 30, 2021) to a pre-lockdown control period (July 1, 2018 to March 16, 2020). Data was subjected to interrupted time series and Chi-square analysis. Our study included 26,316 acute asthma visits to ED. Sites experienced a 63% to 89% reduction in acute asthma visits during the pandemic, compared with pre-lockdown controls, and a 17% to 85% reduction in asthma, that is out of proportion as a fraction of all-cause ED visits. For asthma, there was no difference in severity measured by rate of ward admission or rate of Paediatric Intensive Care Unit (PICU) admission. Public health measures appear to have resulted in a specific protective association on acute asthma with reduced acute care utilization over and above the reduction in all-cause presentations, without an increase in severity upon presentation. Our study indicates an importance to antiviral public health and engineering strategies to reduce viral transmission and thereby asthma morbidity.

The Healthcare Cost Burden of Asthma in Children: A Longitudinal Population-Based Study

ObjectivesThis study aimed to investigate the extent of healthcare cost increase at population level due to childhood asthma. We aimed to investigate the cross-sectional relationship between asthma and healthcare costs among children aged 2 to 18 years and, in longitudinal analyses, whether costs increase with an increase in the duration of asthma prevalence. MethodsStudy participants are 4175 and 4482 children of birth and kindergarten cohorts from the nationally representative Longitudinal Study of Australian Children for whom the linked Medicare cost data are available. The children were followed in all waves from the year 2004 to 2018. Generalized linear models were used to estimate the excess healthcare costs associated with asthma. The sum of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme costs constitutes the total healthcare costs. ResultsTotal excess healthcare costs associated with asthma among the 2- to 18-year-old children were A$4316 per child. At the population level, the estimated total excess Medicare costs associated with current asthma treatment among 2- to 18-year-old children were, on average, A$190.6 million per year (2018 population and price). Compared with the non-asthmatic children, peers with persistent asthma morbidity and treatment requirements had excess costs up to A$20 727 for the B cohort children until 14 years of age, whereas excess costs for the K cohort children were A$19 571 until 18 years of age. ConclusionsAsthma in children imposes a significant financial burden on the public health system. Higher excess healthcare costs of all asthmatic children than the costs of nonasthmatic children provide further economic justification for promoting preventive efforts at early ages.

The Burden of Asthma in Children Aged 0-14 Years in Asia: A Systematic Analysis for the Global Burden of Disease Study 2019

The Burden of Asthma in Children Aged 0-14 Years in Asia: A Systematic Analysis for the Global Burden of Disease Study 2019

The increasing burden of asthma in South African children: A call to action

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed. Objectives. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context. Methods. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Conclusions. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.

Correlation of financial burden with severity of asthma in children

Introduction: Urbanisation is causing a rise in the financial burden of Asthma in children and it varies with the disease severity. Asthma has a low public health priority and is often under diagnosed and treated inappropriately. Objectives: Our aim was to correlate the financial burden of disease costs with Asthma classification. Methods: It was a prospective study of 38 patients attending paediatric pulmonology clinic in a tertiary care hospital. Details were entered in a predesigned proforma and institutional ethics committee approval was taken. Quantitative statistical analysis using mean, standard deviation and applying one way ANNOVA test was done. Results: Intermittent, mild and moderate persistent asthma were 8 (21.05%), 21(55.26%) and 9(23.68%) respectively. Majority of the patients;19 (50%) belonged to the upper middle class.The direct mean costs across severities ranged between INR 5700-7400 for general practitioner consultation, INR 3550-10300 for emergency visits, INR 4500-9000 for investigations and INR 7000-13700 for medications. The indirect costs ranged between INR 9000-19800 on daily wages lost, INR 2900-8700 on travel expenses (significant p value<0.014) between mild and moderate persistent asthma. Mean costs on food ranged between INR 1700-3200, tuitions INR 3000-5700 and miscellaneous expenditure being INR 2000-8300.The percentage of annual income spent was 28.76%, 40.99% and 60.64% in intermittent, mild and moderate persistent asthma respectively. Conclusion: Early referral, diligent counselling, physician and parents education along with good compliance would impart effective control and thereby reduce economic burden.

Ambient Air Pollution and Asthma-Related Outcomes in Children of Color of the USA: a Scoping Review of Literature Published Between 2013 and 2017.

Given racial disparities in ambient air pollution (AAP) exposure and asthma risk, this review offers an overview of the literature investigating the ambient air pollution-asthma relationship in children of color between 2013 and 2017. AAP is likely a key contributor to the excess burden of asthma in children of color due to pervasive exposure before birth, at home, and in school. Recent findings suggest that psychosocial stressors may modify the relationship between AAP and asthma. The effect of AAP on asthma in children of color is likely modulated by multiple unique psychosocial stressors and gene-environment interactions. Although children of color are being included in asthma studies, more research is still needed on impacts of specific criteria pollutants throughout the life course. Additionally, future studies should consider historical factors when analyzing current exposure profiles.

Asthma across the lifespan: Time for a paradigm shift

We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and affect respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations, and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk, as well as impairment, with a goal to achieve optimal control. Based on several National Institutes of Health studies conducted over the last 10years, we now have the tools necessary to accomplish this goal. The tools include assessment of lung function over time or defining trajectories of lung growth, the Composite Asthma Severity Index score, a panel of useful biomarkers, the Seasonal Asthma Exacerbation Prediction Index score, and rapidly advancing technology that includes adherence monitoring. Future guideline revisions should consider incorporating recommendations to follow spirometry over time and defining trajectories of lung growth to assess risk for reduced lung growth and early decline, asthma burden by using biomarkers to select and monitor therapy, assessment of social determinants of health, evaluation of risk for seasonal exacerbations, and consideration of electronic adherence monitoring for difficult-to-manage asthma. Guidelines should continue to include a core dedicated to the diagnosis and treatment of intermittent and mild and moderate persistent asthma and include additional sections dedicated to the management of severe asthma.

The National Burden of Asthma in Children in the U.S.: Results from a Nationally Representative Study

The National Burden of Asthma in Children in the U.S.: Results from a Nationally Representative Study

Improved Guideline Adherence With Integrated Sickle Cell Disease and Asthma Care.

Introduction:In children with sickle cell disease (SCD), concomitant asthma is associated with increased morbidity and mortality when compared with children with SCD without asthma. Despite the well-established burden of asthma in children with SCD, no paradigm of care exists for the co-management of these two diseases.Methods:To address this gap, an integrated SCD and asthma clinic was created in a community health center that included (1) a dual respiratory therapist/asthma case manager; (2) an SCD nurse practitioner with asthma educator certification; (3) an onsite pulmonary function test laboratory; (4) a pediatric hematologist with expertise in managing SCD and asthma; and (5) application of the National Asthma Education and Prevention Program guidelines. A before (2010–2012) and after (2013–2014) study design was used to assess for improved quality of care with implementation of an integrative care model among 61 children with SCD and asthma followed from 2010 to 2014.Results:Asthma action plan utilization after initial diagnosis increased with the integrative care model (n=16, 56% before, 100% after, p=0.003), as did the use of spirometry in children aged ≥5 years (n=41, 65% before, 95% after, p<0.001) and correction of lower airway obstruction (n=10, 30% before, 80% after, p=0.03).Conclusions:Although the use of an integrative care model for SCD and asthma improved evidence-based asthma care, longer follow-up and evaluation will be needed to determine the impact on SCD-related morbidity.

Global burden of asthma among children.

About 334 million people worldwide suffer from asthma, and this figure may be an underestimation. It is the most common chronic disease in children. Asthma is among the top 20 chronic conditions for global ranking of disability-adjusted life years in children; in the mid-childhood ages 5-14 years it is among the top 10 causes. Death rates from asthma in children globally range from 0.0 to 0.7 per 100 000. There are striking global variations in the prevalence of asthma symptoms (wheeze in the past 12 months) in children, with up to 13-fold differences between countries. Although asthma symptoms are more common in many high-income countries (HICs), some low- and middle-income countries (LMICs) also have high levels of asthma symptom prevalence. The highest prevalence of symptoms of severe asthma among children with wheeze in the past 12 months is found in LMICs and not HICs. From the 1990s to the 2000s, asthma symptoms became more common in some high-prevalence centres in HICs; in many cases, the prevalence stayed the same or even decreased. At the same time, many LMICs with large populations showed increases in prevalence, suggesting that the overall world burden is increasing, and that therefore global disparities in asthma prevalence are decreasing. The costs of asthma, where they have been estimated, are relatively high. The global burden of asthma in children, including costs, needs ongoing monitoring using standardised methods.

Prevalence of Asthma in Urban School Children in Jaipur, India

Methods: A cross sectional study of school children 5-15 years in Jaipur city using Modified ISAAC questionnaire. After analyzing questionnaire, probable asthmatic children were subjected to detailed history and physical examination and appropriate investigations. Results: Total 3321 questionnaires were distributed of which 2263 (68.14%) were returned. Of these 2225 (98.32%) were fully filled. After analyzing 169 (7.59%) children were found to have asthma. Age distribution of asthmatic children was as follows 5-8 years 49/604 (8.11%), 9-11 years 57/745 (7.65%) and 12-15 years 63/876 (7.19 %%). Prevalence of asthma related symptoms were as follows: Wheezing ever 12.17%, wheezing in last 12 months 12.17%, Physician diagnosed asthma ever 5.3%, exercise wheeze 12.62%, night cough 9.57% and sleep disturbance in night was found in 4.94%. Conclusion: Prevalence of asthma in urban school children of Jaipur is high and increasing and many of the asthmatic children remain undiagnosed. Larger standardized research should be carried out all over India with validated questionnaire in locally understandable language to find out actual burden of asthma in children.

The burden of asthma in children: a European perspective

Asthma is the most common chronic disease in childhood, imposing a huge burden on the patient, their family and society. It is a worldwide disease with variable expression between countries and between different populations in a country. There is evidence that its prevalence has increased considerably over the last two decades and is still increasing, despite there being some indications that the increase in prevalence may have plateaued in some countries in the last few years. Better understanding of the natural course of asthma and improved asthma control can lead to a decreased burden on the patient, their family and society. The burden of asthma consists mainly of a decreased quality of life for the patient and their family, as well as high costs for society; the healthcare expenditures for asthma in developed countries are 1-2% of the total healthcare costs.

The burden of asthma in children: a Latin American perspective

Worldwide, studies on asthma prevalence have shown major rises over the last 30 years. The impact on the burden of asthma is being increasingly recognised. In some countries in Latin America, the prevalence of asthma is among the highest in the world. Asthma admissions are very common in children, leading to high costs for the health systems of those countries. Unfortunately, Latin America has limited resources to pay for appropriate treatment. The main goals of the international guidelines for asthma treatment are not being met. However, asthma programmes operating in some countries are showing promising results in reducing asthma admissions and consequently decreasing the burden of asthma. Local adaptation of international guidelines must be implemented in order to decrease costs and optimise outcomes.

The burden of asthma in children: an Australian perspective

The burden of asthma among children is high in Australia compared with many other countries. Recent data show that 14-16% of children report a diagnosis of asthma that remains a problem. Boys, children under the age of 5 years and urban indigenous children experience a greater burden of asthma than other children. More than one-third of children with asthma have sleep disturbance due to the illness and 60% have missed school and/or experienced other restrictions in their activities due to the disease. Despite this, there is continuing evidence of under-utilisation of effective treatment for the disease. Asthma is a major cause of healthcare utilisation among children. Since the early 1990s, there has been a decline in both hospitalisation rates and general practitioner consultation rates for asthma among children. It remains to be seen whether this favourable trend will continue and extend into the adult age range.

The burden of asthma in children: an Asian perspective

A worldwide increase in the prevalence of asthma has been reported in recent years. With an increase in prevalence comes an increased burden of disease in terms of morbidity, mortality and compromised quality of life. The economic burden in terms of utilisation of healthcare resources and limitation of the earning capacity of the individuals and families is an added problem. Various indicators such as disability-adjusted life years and healthy life years have been used to define the economic burden. The data from Asian countries regarding these parameters is scarce, underlining the need for systematic studies in these countries, especially those that are resource poor. The purpose of this review is to highlight the varying prevalence of asthma in Asia and to assess the likely economic burden for the future.