Childhood Asthma Hospitalization Research Articles

Circulating miRNAs associate with historical childhood asthma hospitalization in different serum vitamin D groups

BackgroundVitamin D may help to alleviate asthma exacerbation because of its anti-inflammation effect, but the evidence is inconsistent in childhood asthma. MiRNAs are important mediators in asthma pathogenesis and also excellent non-invasive biomarkers. We hypothesized that circulating miRNAs are associated with asthma exacerbation and modified by vitamin D levels.MethodsWe sequenced baseline serum miRNAs from 461 participants in the Childhood Asthma Management Program (CAMP). Logistic regression was used to associate miRNA expression with asthma exacerbation through interaction analysis first and then stratified by vitamin D insufficient and sufficient groups. Microarray from lymphoblastoid B-cells (LCLs) treated by vitamin D or sham of 43 subjects in CAMP were used for validation in vitro. The function of miRNAs was associated with gene modules by weighted gene co-expression network analysis (WGCNA).ResultsWe identified eleven miRNAs associated with asthma exacerbation with vitamin D effect modification. Of which, five were significant in vitamin D insufficient group and nine were significant in vitamin D sufficient group. Six miRNAs, including hsa-miR-143-3p, hsa-miR-192-5p, hsa-miR-151a-5p, hsa-miR-24-3p, hsa-miR-22-3p and hsa-miR-451a were significantly associated with gene modules of immune-related functions, implying miRNAs may mediate vitamin D effect on asthma exacerbation through immune pathways. In addition, hsa-miR-143-3p and hsa-miR-451a are potential predictors of childhood asthma exacerbation at different vitamin D levels.ConclusionsmiRNAs are potential mediators of asthma exacerbation and their effects are directly impacted by vitamin D levels.

Suppressed pediatric asthma hospitalizations during the COVID-19 pandemic in Japan, from a national survey.

Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID-19 pandemic in Japan. Thirty-three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID-19 pandemic and whether or not COVID-19 caused acute asthma exacerbation were investigated. From fiscal years 2010-2019, the median number of acute asthma hospitalizations per year was 3524 (2462-4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3- to 6-year group. SARS-CoV-2 was evaluated in 2094 patients from fiscal years 2020-2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS-CoV-2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long-term control medications before admission despite the severity of bronchial asthma. SARS-CoV-2 was hardly detected in children with acute asthma hospitalization during the COVID-19 pandemic. This result indicated that SARS-CoV-2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long-term control medications is a major problem that should be addressed.

School building energy efficiency and NO2 related risk of childhood asthma in England and Wales: Modelling study

BackgroundClimate change legislation will require dramatic increases in the energy efficiency of school buildings across the UK by 2050, which has the potential to affect air quality in schools. We assessed how different strategies for improving the energy efficiency of school buildings in England and Wales may affect asthma incidence and associated healthcare utilization costs in the future. MethodsIndoor concentrations of traffic-related NO2 were modelled inside school buildings representing 13 climate regions in England and Wales using a building physics school stock model. We used a health impact assessment model to quantify the resulting burden of childhood asthma incidence by combining regional health and population data with exposure-response functions from a recent high-quality systematic review/meta-analysis. We compared the effects of four energy efficiency interventions consisting of combinations of retrofit and operational strategies aiming to improve indoor air quality and thermal comfort on asthma incidence and associated hospitalization costs. ResultsThe highest childhood asthma incidence was found in the Thames Valley region (including London), in particular in older school buildings, while the lowest concentrations and health burdens were in the newest schools in Wales. Interventions consisting of only operational improvements or combinations of retrofit and operational strategies resulted in reductions in childhood asthma incidence (547 and 676 per annum regional average, respectively) and hospital utilization costs (£52,050 and £64,310 per annum regional average, respectively. Interventions that improved energy efficiency without operational measures resulted in higher childhood asthma incidence and hospital costs. ConclusionThe effect of school energy efficiency retrofit on NO2 exposure and asthma incidence in schoolchildren depends critically on the use of appropriate building operation strategies. The findings from this study make several contributions to fill the knowledge gap about the impact of retrofitting schools on exposure to air pollutants and their effects on children's health.

Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review.

Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.

The modification of air particulate matter on the relationship between temperature and childhood asthma hospitalization: An exploration based on different interaction strategies

The influence of temperature on childhood asthma was self-evident, yet the issue of whether the relationship will be synergized by air pollution remains unclear. The study aimed to investigate whether the relationship between short-term temperature exposure and childhood asthma hospitalization was modified by particulate matter (PM). Data on childhood asthma hospitalization, meteorological factors, and air pollutants during 2013–2016 in Hefei, China, were collected. First, a basic Poisson regression model combined with a distributed lag nonlinear model was used to assess the temperature-childhood asthma hospitalization relationship. Then, two interactive strategies were applied to explore the modification effect of PM on the temperature-childhood asthma hospitalization association. We found a greater effect of cold (5th percentile of temperature) on asthma during days with higher PM2.5 (RR: 2.16, 95% CI: 1.38, 3.38) or PM10 (RR: 1.87, 95% CI:1.20, 2.91) than that during days with lower PM2.5 (RR: 1.64, 95% CI: 1.06, 2.54) or PM10 (RR: 1.52, 95% CI: 0.98, 2.36). In addition, we observed a greater modification effect of PM2.5 on the cold-asthma association than did PM10, with a per 10 μg/m3 increase in PM2.5 and PM10 associated with increases of 0.065 and 0.025 for the RR corresponding to the 5th temperature percentile, respectively. For the temperature-related AF, moderate cold showed the largest change magnitude with the PM levels rising compared with other temperature ranges. For the subgroup, Females and those aged 6–18 years were more sensitive to the modification effect of PM2.5 or PM10 on the cold-asthma association. Our findings demonstrated that particulate matter could modify the associations between temperature and childhood asthma hospitalization.

Geoclimatic risk factors for childhood asthma hospitalization in southwest of Iran.

Asthma is a chronic respiratory disease resulting from a complex interaction between genetic and environmental factors. Among environmental factors, climatic and geographical variations have an important role in increasing asthma hospitalization. The current study aimed to investigate the effect of geoclimatic factors on the occurrence of childhood asthma hospitalization in Fars province, southwest Iran. We mapped the addresses of 211 hospitalized patients with childhood asthma (2016-2019) and investigated the effects of different temperature models, mean annual rainfall and humidity, number of frosty and rainy days, evaporation, slope, and land covers on the occurrence of childhood asthma hospitalization using a geographical information system. The Kriging and Spline methods have been used for generating interpolated models. Data were analyzed using logistic regression. In the multivariate model, urban setting was recognized as the most important childhood asthma hospitalization predictor (p < 0.001, odds ration [OR] = 35.044, confidence interval [CI] = 9.096-135.018). The slope was considered the determinant of childhood asthma hospitalization when analyzed independently and its increase was associated with decreased childhood asthma hospitalization (p = 0.01, OR = 0.914, CI = 0.849-0.984). In the current study, the urban setting was the most important risk factor associated with increased childhood asthma hospitalization.

Children With Food Allergy Are at Risk of Lower Lung Function on High-Pollen Days

Grass pollen exposure is a risk factor for childhood asthma hospital attendances. However, its short-term influence on lung function, especially among those with other allergic conditions, has been less well-studied. To investigate this association in a population-based sample of children. Within the HealthNuts cohort, 641 children performed spirometry during the grass pollen season. Grass pollen concentration was considered on the day of testing (lag 0), up to 3 days before (lag 1-lag 3), and cumulatively (lag 0-3). We used linear regression to assess the relevant associations and examined potential interactions with current asthma, hay fever or eczema, and food allergy. Associations were observed only in children with allergic disease (P value for interaction ≤ 0.1). In children with food allergy, grass pollen concentration was associated with a lower ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) and lower mid-forced expiratory flows (FEF25%-75%) at all lags (eg, at lag 2, FEV1/FVC z-score= -0.50 [95% CI -0.80 to -0.20] and FEF25%--75% z-score=-0.40 [-0.60 to -0.04] per 20 grains/m3 pollen increase), and increased bronchodilator responsiveness (BDR) at lag 2 and lag 3 (eg, at lag 2, BDR= (31 [95% CI -0.005 to 62] mL). In children with current asthma, increasing grass pollen concentration was associated with lower FEF25%-75% and increased BDR, whereas children with current hay fever or eczema had increased BDR only. A proactive approach needs to be enforced to manage susceptible children, especially those with food allergy, before high-grass pollen days.

The Effect of Outdoor Aeroallergens on Asthma Hospitalizations in Children in North-Western Tuscany, Italy.

Few data are currently available on the effects of aeroallergens in triggering respiratory symptoms in children. To evaluate the potential effects of daily outdoor aeroallergens loads on childhood admissions, in this case-crossover study, we analyzed data from 85 children hospitalized at the University Hospital of Pisa, Italy, for asthma or asthma-like symptoms without respiratory infection, between 2010 and 2019. Data were linked to outdoor allergens, temperature, nitrogen dioxide, and relative humidity observed during the same period. A 10-grains/m3 increase in the total aeroallergen concentration was associated with an increased risk of admission at lag 0 (OR = 1.054, 95% CI: 1.011–1.098), with a smaller effect at lag 1 (OR = 1.037, 95% CI: 1.008–1.067) and lag 2 (OR = 1.021, 95% CI: 1.003–1.039). Trends to larger effects were observed in children with sensitization to one or more aeroallergens (OR = 1.085, 95% CI: 1.004–1.173 at lag 0), in males (OR = 1.069, 95% CI: 1.009–1.132 at lag 0) and in older children (OR = 1.065, 95% CI: 1.007–1.127 at lag 0). Our study shows an association between increased outdoor allergens loads and asthma or asthma-like symptoms in children up to at least two days prior to hospitalization, suggesting that tracking aeroallergen counts may be useful to improve the management of respiratory allergic diseases.

Air Quality Index and Emergency Department Visits and Hospitalizations for Childhood Asthma.

Rationale: Outdoor air pollution causes emergency department visits and hospitalizations for childhood asthma. In the United States, the Air Quality Index (AQI) alerts the public to air quality and provides behavioral recommendations to reduce exposure and harm, yet little is known about the relationship between the AQI and childhood asthma exacerbations. Objectives: To test for association between the AQI and childhood asthma exacerbations resulting in emergency department visits and hospitalizations. Methods: This was a retrospective time-stratified case-crossover study, conducted using medical records data from 2010 through 2018 for children aged 6-17 years with a primary diagnosis of an asthma exacerbation (defined as an emergency department visit or hospitalization for asthma) at UPMC Children's Hospital of Pittsburgh. Daily AQI data was obtained for Allegheny County, Pennsylvania from the Environmental Protection Agency. Conditional logistic regression was used for analyses of the AQI (as both a continuous and categorical variable) and asthma exacerbations. Stratified analyses were conducted to explore modification of the AQI effects on asthma exacerbations by race and other covariates. Results: There were 6,573 events. Particulate matter <2.5μm (PM2.5) was the primary pollutant responsible for the AQI, followed by ozone (62% and 29% of days with events, respectively). The overall AQI was associated with asthma exacerbations (e.g., as continuous, per 10-unit increase, LagDay2: odds ratio [OR], 1.014; 95% confidence interval [CI],1.003-1.025; Lag Day 3: OR, 1.012; 95% CI, 1.001-1.023). By pollutant-specific AQI, the association was strongest for PM2.5. In stratified analyses, the AQI was associated with exacerbations in Black and younger children (6-11 yr) on LagDay 4. Conclusions: The AQI is associated with asthma exacerbations among children in Allegheny County. This is driven primarily by PM2.5, with Black and younger children particularly affected. Healthcare providers should discuss the AQI in asthma management.

Emergency Department Visit Count: A Practical Tool to Predict Asthma Hospitalization in Children

To evaluate whether the frequency of asthma-related emergency department (ED) visits could predict future asthma hospitalization in the pediatric population.The study included 2669 children between the ages of 2 and 16.99 years with asthma visits to the ED at the Children’s Hospital of Eastern Ontario between September 2012 to August 2015.This was a retrospective cohort study in which health administrative data were used to identify all pediatric asthma visits to the ED from 2012 to 2015. The first asthma ED visit within the 3-year inclusion period was defined as index ED visit. The primary exposure was the number of asthma ED visits in the preceding 12 months. Each patient was managed for 12 months after the index ED visit to identify the number of asthma-related hospitalizations and subsequent ED visits. The severity of asthma symptoms at each visit was assessed by using the Canadian Triage and Acuity Scale.The number of asthma ED visits in the preceding year was associated with an increased risk of hospitalization in the subsequent 12 months in a dose-dependent manner. The risk of hospitalization was 2.9 (95% confidence interval: 1.6 to 5) times higher in children with 1 previous ED visit and 4.4 (95% confidence interval: 1.9 to 10.4) times higher in children with ≥2 previous ED visits, compared with that of children with no ED visits. Asthma severity on the basis of Canadian Triage and Acuity Scale level was also a risk factor for future asthma hospitalization. The number of previous asthma ED visits was associated with an increased risk of repeat asthma ED visits in the following year.The number of asthma ED visits was identified as an independent marker of future asthma-related hospitalizations and repeat ED visits in pediatric patients.A major goal of asthma management is to reduce the risk of exacerbations leading to ED visits and hospitalization. Poor asthma control leads to school absenteeism and increased health care use. Identification of a reliable marker to predict future asthma risk could help health care providers target interventions to children at high risk. In this study, the authors identified ED visit count as a predictor of future asthma-related hospitalization in pediatric patients.

123 Reduction of asthma hospitalizations in children in a tertiary care center in Quebec during the early confinement period of the COVID-19 pandemic

Primary Subject areaRespirologyBackgroundAsthma in children and adolescents is a major cause of urgent visits and hospitalizations. In preschoolers, viral infections remain the main cause of these exacerbations, although environmental factors may also play a role. In older children and adolescents, many other risk factors are present including respiratory allergies, exercise, strong emotions, active and passive smoking and poor adherence to recommended treatments. In the context of the COVID-19 pandemic, clinicians have been concerned about the possibility of a significant increase in urgent consultations for asthma in children. However, due to the confinement imposed on a large part of the population from March 2020, we have suspected a reduction in the number of viral infections leading to urgent visits and hospitalizations in pediatric patients.ObjectivesOur hypothesis was that the number of children hospitalized with asthma exacerbations during the pandemic lockdown declined significantly. Our objective was to determine if the number and severity of hospitalizations at the CME of the CHU de Québec for asthma exacerbations in children aged 1 to 17 had significantly decreased during the confinement period from April 1 to July 1, 2020 and to what extent, according to various clinical features.Design/MethodsRetrospective study reviewing episodes of care in medical records in children aged 1 to 17 and hospitalized on all wards at the CME-CHU de Québec. All patients with primary diagnosis of asthmatic exacerbation according to the summary sheets between April 1 to July 1, 2020 for the study group and from April 1 to July 1, 2019 for the control group were included. We aimed to determine the number of hospitalizations for this diagnosis for each period and determine the length of stay on the various pediatric wards for each episode of care according to the established criteria. We have determined the presence of risk factors (asthma diagnosis, underlying condition, regular asthma medication, allergies, and other factors relevant to asthma).We have further determined the presence of gravity markers during the course of hospitalization (need for: IV corticosteroids, Mg sulfate, IV bronchodilators, non-invasive ventilation, intubation, ICU stay and radiological pneumonia) for each episode of care. The data was denominated and collated in an encoded file, and shareable only between the investigators.ResultsAfter exclusions, a total of 97 charts were analyzed. Between April 1 and July 1 2019, a total of 89 patients were admitted with a diagnosis of asthma exacerbation while only eight patients were admitted during the same period in 2020. The median age of patients admitted in 2020 was higher than in 2019 (53 vs 25 months). In 2019, 40 children (48%) had a previous diagnosis of asthma, of whom 28 used regular controller medications compared to 2 children (25%) in 2020, both taking regular controller medications. More patients had an associated diagnosis of upper respiratory tract infection in 2019 than in 2020 (92% vs 63%). Nine patients required intensive care in 2019 compared to none in 2020.ConclusionCompared to 2019, hospital admissions for asthma exacerbations in our tertiary care centre in Quebec City were significantly lower during the early phase of the 2020 pandemic. More research is required to determine the exact causes of this significant reduction.

Seasonal characteristics of temperature variability impacts on childhood asthma hospitalization in Hefei, China: Does PM2.5 modify the association?

ObjectivesEvidence of childhood asthma hospitalizations associated with temperature variability (TV) and the attributable risk are limited in China. We aim to use a comprehensive index that reflected both intra- and inter-day TV to assess the TV-childhood asthma relationship and disease burden, further to identify seasonality vulnerable populations, and to explore the effect modification of PM2.5. MethodsA quasi-distributed lagged nonlinear model (DLNM) combined with a linear threshold function was applied to estimate the association between TV and childhood asthma hospitalizations during 2013–2016 in Hefei, China. Subgroup analysis was conducted by age and sex. Disease burden is reflected by the attributable fraction and attributable number. Besides, modifications of PM2.5 were tested by introducing the cross-basis of TV and binary PM2.5 as an interaction term. ResultsThe risk estimates peaked at TV0-3 and TV0-4 in the cool and the warm season separately, with RR of 1.051 (95%CI: 1.021–1.081) and 1.072 (95%CI: 1.008–1.125), and the effects lasted longer in the cool season. The school-age children in the warm season and all subgroups except pre-school children in the cool season were vulnerable to TV. It is estimated that the disease burden related to TV account for 6.2% (95% CI: 2.7%–9.4%) and 4% (95% CI: 0.6%–7.1%) during the cool and warm seasons in TV0-3. In addition, the risks of TV were higher under the high PM2.5 level compared with the low PM2.5 level in the cool season, although no significant differences between them. ConclusionsTV exposure significantly increases the risk and disease burden of childhood asthma hospitalizations, especially in the cool season. More medical resources should be allocated to school-age children. Giving priority to pay attention to TV in the cool season in practice could obtain the greatest public health benefits and those days with high TV and high PM2.5 need more attention.

Asthma Surveillance - United States, 2006-2018.

ProblemAsthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications.Reporting Period2006–2018.Description of SystemThe National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016–2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006–2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016–2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016–2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center.ResultsCurrent asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence of asthma attacks differed by MSA category in four states. The prevalence of ED/UCC visits was higher in the South than the Northeast and the Midwest and was also higher in large central metropolitan areas than in micropolitan and noncore areas. The asthma mortality rate was highest in non-MSAs, specifically noncore areas. The asthma mortality rate was also higher in the Northeast, Midwest, and West than in the South. Within large MSAs, asthma deaths were higher in the Northeast and Midwest than the South and West.InterpretationDespite some improvements in asthma outcomes over time, the findings from this report indicate that disparities in asthma indicators persist by demographic characteristics, poverty level, and geographic location.Public Health ActionDisparities in asthma outcomes and health care use in rural and urban populations identified from NHIS and NVSS can aid public health programs in directing resources and interventions to improve asthma outcomes. These data also can be used to develop strategic goals and achieve CDC’s Controlling Childhood Asthma and Reducing Emergencies (CCARE) initiative to reduce childhood asthma hospitalizations and ED visits and prevent 500,000 asthma-related hospitalizations and ED visits by 2024.

Potential health benefits of sustained air quality improvements in New York City: A simulation based on air pollution levels during the COVID-19 shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020)—albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown were sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits.We focused on fine particulate matter (PM2.5) and modeled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality.We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015–2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021–2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, has provided a hypothetical clean air scenario that can be considered aspirational—one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.

Potentially avoidable hospitalization for asthma in children and adolescents by migrant status: results from the Italian Network for Longitudinal Metropolitan Studies

BackgroundGlobal migration toward Europe is increasing. Providing health assistance to migrants is challenging because numerous barriers limit their accessibility to health services. Migrants may be at a greater risk of developing asthma and receiving lower quality healthcare assistance than non-migrants. We aim to investigate whether immigrants as children and adolescents have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians.MethodsWe performed a retrospective longitudinal study using six cohorts of 2–17-year-old residents in North and Central Italy from 01/01/2001 to 31/12/2014 (N = 1,256,826). We linked asthma hospital discharges to individuals using anonymized keys. We estimated cohort-specific age and calendar-year-adjusted asthma PAH rate ratios (HRRs) and 95% confidence intervals (95%CIs) among immigrants compared to Italians. We applied a two-stage random effect model to estimate asthma PAH meta-analytic rate ratios (MHRRs). We analyzed data by gender and geographical area of origin countries.ResultsThree thousand three hundred four and 471 discharges for asthma PAH occurred among Italians and immigrants, respectively. Compared to Italians, the asthma PAH cohort-specific rate was higher for immigrant males in Bologna (HRR:2.42; 95%CI:1.53–3.81) and Roma (1.22; 1.02–1.45), and for females in Torino (1.56; 1.10–2.20) and Roma (1.82; 1.50–2.20). Asthma PAH MHRRs were higher only among immigrant females (MHRRs:1.48; 95%CI:1.18–1.87). MHRRs by area of origin were 63 to 113% higher among immigrants, except for Central-Eastern Europeans (0.80; 0.65–0.98).ConclusionThe asthma PAH meta-analytic rate was higher among female children and adolescent immigrants compared to Italians, with heterogeneity among cohorts showing higher cohort-specific PAH also among males, with some differences by origin country. Access to primary care for children and adolescent immigrants should be improved and immigrants should be considered at risk of severe asthma outcomes and consequently targeted by clinicians.

Estimate the effects of environmental determining factors on childhood asthma hospital admissions in Lisbon, Portugal: a time series modelling study

Several epidemiological studies have shown the relationship between hospital admissions associated with asthma, meteorological variables, and exposure to outdoor air pollution. In this study, we propose to evaluate the effects of environmental variables on asthma admissions in the Lisbon Metropolitan Area, Portugal. A quasi-Poisson generalized additive model combined with a distributed lag non-linear model (DLNM) was applied to estimate the delayed effects of environmental variables on childhood asthma admissions from 2009 to 2015. Subgroup analyses by sex and age were performed. We found that an increase of 1 μg/m3 of PM10 was associated with an increased risk of asthma-related hospital admission, on the order of 2% (RR = 1.02; CI 95% 1.01–1.03). There was an increase of 4% associated with a rainfall (PP) increase of 1 mm (RR = 1.04; 95% CI 1.02–1.11). Among male children, the increase of PM10 concentration is associated with a 2% increase in the risk of hospital admission, while PP is associated with a 5% increase. PM10, Tmean, and Tmax are significantly associated at lags 0–3 months, for age group 5–9 years, with a cumulative effect of RR = 1.03; 95% CI (1.01–1.05); RR = 1.54; 95% CI (1.19–1.99); and RR = 0.67; 95% CI (0.54–0.84) at lag 0, respectively. For age group 10–14 years, only relative humidity (RH) was significantly associated with hospital admissions; an increased risk was with higher relative humidity and short term (lag 0). Our results provide evidence of the adverse effects of PM10, PP, and RH on childhood asthma. These variables are good predictors of asthma. The risk of hospital admission with a primary diagnosis of asthma is more frequent during the autumn, when the school year begins. These findings will be important for health authorities as they provide epidemiological evidence for developing prevention strategies to reduce the risk of childhood asthma hospitalizations.

Analysis of the trend of hospitalizations for asthma in children and adolescents in Brazil

ObjectiveTo analyze the trend of hospitalizations for asthma in children and adolescents by region and age group in Brazil, from 2008 to 2017. MethodThis is a time-series study with secondary data regarding hospitalizations for asthma in children and adolescents, according to age, region, and gender. Descriptive statistics procedures were used with measures of central tendency to calculate the variation between the periods of 2008 and 2017. Rates of hospitalizations were calculated specifically by age group and region. Time trend analysis was performed by simple linear regression, considered as stationary (p>0.05), declining (p<0.05 and negative regression coefficient), or ascending (p<0.05) and positive regression coefficient). ResultsThe present study identified a higher proportion of hospitalizations for asthma in Brazil in children aged 5–9 years. Regarding gender, there were more hospitalizations in boys. The region that presented the highest proportion of hospitalizations, in all age groups investigated, was the Northeast. As for the trend analysis, this article showed that, in Brazil, there was a trend toward a reduction in hospitalization rates for asthma. ConclusionIn Brazil, there was a tendency to reduce hospitalizations for all investigated age groups. The Northeast was the only region that showed a decline in all age groups.

Interactions between climate factors and air quality index for improved childhood asthma self-management

BackgroundDaily air quality index (AQI) forecast can provide early warning information, and it is not clear whether it is appropriate for childhood asthma hospitalizations (CAHs). Furthermore, little is known about the effects of AQI on CAHs, as well as the interactions between temperature, humidity and AQI. MethodsWe collected 32,238 cases in Hefei from 2013 to 2016 and estimated the association between daily CAHs and AQI by combining the Poisson Generalized Linear Models (PGLMs) with the Distributed Lag Nonlinear Models (DLNMs). The interaction between AQI and temperature was tested by stratifying AQI and temperature, as well as humidity. ResultsAQI was associated with an increased risk of hospitalizations for childhood asthma. The adverse effect first appeared on the 3rd day, with the RR of 1.011 (95%CI: 1.000–1.023) and continued until the 19th day of lag (RR = 1.010, 95%CI: 1.001–1.020). In the subgroup analysis, the male and pre-school children were more sensitive to AQI, and there are seasonal differences in the effects of AQI on CAHs. Besides, in a stratified analysis with an AQI of 150, we found synergies between temperature, humidity and AQI. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for the interaction between temperature and AQI were 1.157 (95%CI: 1.029–1.306) and 0.122 (95%CI: 0.022–0.223) respectively. For the humidity, the IRR and RERI were 1.090 (95%CI: 1.056–1.206) and 0.083 (95%CI: 0.083–0.143) respectively. Exploring different subgroups in the interaction analyses, it was worth noting that female and pre-school children were more sensitive to the interaction between AQI and temperature, while school-age children were more sensitive to the interaction between AQI and humidity. ConclusionsThe study found that not only AQI can significantly increase the risk of CAHs, but also that under the context of climate change, temperature and humidity have a synergistic effect on AQI, suggesting that considering only the warning information of air pollution is not enough to strengthen the prevention of childhood asthma hospitalization.

Decline in hospitalization for childhood asthma in different air pollution regions in Taiwan, 2001–2012

ABSTRACT This study aimed to investigate the trends in childhood asthma hospitalization in regions with differing levels of air pollution in Taiwan, 2001–2012. Joinpoint regression was used to identify significant trend changes. The hospitalization rate varied according to gender, geographic region, and age. The incidence of childhood asthma hospitalization decreased from 127.99 to 76.67 (/100,000 population), with an average annual percentage change of around −4.1%; in the Yilan region, the average air pollution concentrations were 19.92 μg/m3, 39.47 μg/m3, 25.99 ppb, 2.19 ppb, and 11.23 ppb for PM2.5, PM10, O3, SO2, and NO2, respectively, which were lower than Taiwan’s average values; however, the childhood asthma hospitalization rate was the highest (179.75/100,000 population). The national trend in childhood asthma hospitalization exhibited a significant decrease. The effects of air pollution on childhood asthma were greater in the higher-level air pollution regions, while less association was observed in the lower-level air pollution regions.

Health Benefits of Sustained Air Quality Improvements in New York City: A Simulation Based on Air Pollution Levels During the COVID-19 Shutdown

New York City (NYC) experienced a sharp decline in air pollution during the COVID-19 shutdown period (March 15, 2020 to May 15, 2020) — albeit at high social and economic costs. It provided a unique opportunity to simulate a scenario in which the city-wide air quality improvement during the shutdown was sustained over the five-year period, 2021 through 2025, allowing us to estimate the potential public health benefits to children and adults and their associated economic benefits. We focused on fine particulate matter (PM2.5) and modelled potential future health benefits to children and adults. The analysis considered outcomes in children that have not generally been accounted for in clean air benefits assessments, including preterm birth, term low birthweight, infant mortality, child asthma incidence, child asthma hospital admissions and emergency department visits, autism spectrum disorder, as well as adult mortality. We estimated a city-wide 23% improvement in PM2.5 levels during the COVID-19 shutdown months compared to the average level for those months in 2015-2018 (the business as usual period). Based on the data for 2020, we extrapolated the ambient levels of PM2.5 for the following five-year period. The estimated cumulative benefits for 2021-2025 included thousands of avoided cases of illness and death, with associated economic benefits from $31.8 billion to $77 billion.This “natural experiment,” tragic though the cause, resulted in a clean air scenario that can be considered aspirational — one that could be achieved through transportation, climate, and environmental policies that support robust economic recovery with similarly reduced emissions.Funding Statement: This study was supported by the Environmental Protection Agency (EPA) RD83615401 and National Institute of Environmental Health Sciences (NIEHS) P50ES09600, The John Merck Fund (JMF), and New York Community Trust (NYCT).Declaration of Interests: The authors declare no competing interests.