Prevalence Of Current Asthma Research Articles

The Interplay Between Eczema and Breastfeeding Practices May Hide Breastfeeding’s Protective Effect on Childhood Asthma

Early allergic disease manifestations in infants may influence breastfeeding practices. In the current study, researchers sought to examine the relationship between breastfeeding duration and the development of asthma and allergic asthma phenotypes, stratified by a diagnosis of eczema during or after breastfeeding.Children who participated in the 6 year follow-up of the HealthNuts study, a population-based, longitudinal cohort study of allergic diseases in Australia.Children were enrolled between the ages of 11 and 15 months, and data regarding breastfeeding history, eczema diagnosis, environmental exposures, and family history of allergic disease were collected via questionnaire. At 6 years, information on wheeze, medication use, and parental report of physician-diagnosed asthma were obtained. Skin-prick testing to foods and aeroallergens at the age of 6 helped to stratify children with asthma into allergic and nonallergic phenotypes. From an original cohort of 5276 children, 3663 had completed questionnaires at 6 years, 3111 underwent skin testing, and 3632 had asthma data available for analysis. Children were characterized as never or ever breastfed. Of those breastfed, exclusive breastfeeding was categorized as never, <6 months, or >6 months. The overall duration of breastfeeding was treated as both a continuous (number of months) and categorical variable (<3 months, 3 to <6 months, 6 to <12 months, or >12 months).Children who did not participate in the full questionnaire at the age of 6 were more likely to be never breastfed, from a lower socioeconomic background, have one or both parents born outside of Australia, have no family history of allergic disease, and have had exposure to prenatal maternal or environmental smoking. Among children with asthma data, 96% were breastfed. At the age of 6, the prevalence of current asthma was 13%. Children with asthma were more likely to be male, have a parental history of asthma, have a family history of allergic disease, have been born preterm, have been born via cesarean delivery, and have been exposed to maternal smoking during pregnancy. Breastfeeding initiation was not associated with current asthma at the age of 6 years (adjusted odds ratio: 0.76) when compared with never breastfeeding. An increased duration of breastfeeding in children without eczema in infancy was associated with a reduced odds of asthma (per month increase; adjusted odds ratio: 0.98), which equates to a 0.86 reduced odds of asthma for a 6 month increase in breastfeeding. This association was not apparent in children who were diagnosed with eczema during breastfeeding.A longer duration of breastfeeding was associated with a reduced odds of asthma at the age pf 6 years among children without history of eczema in the first year. This association was masked before stratification of patients by history of eczema in infancy.Breastfeeding is known to be beneficial for improving many health outcomes. However, previous studies have not clearly demonstrated protective effects for breastfeeding on asthma. In the current study, a modest protective association was observed between an increased duration of breastfeeding and asthma but only among children who were not diagnosed with eczema in their first year. This association is complex because infantile eczema is a known risk factor for asthma and has also been shown to influence breastfeeding choices. Additional study is needed on the interplay between breastfeeding practices, early allergic manifestations, and the risk of subsequent allergic outcomes.

Exposure to road noise and asthma prevalence in adults.

Noise has been reported as one of the most important risk factors for asthma, but there are some disagreements. This study aimed to investigate the effect of road noise on asthma prevalence in adults. In the current study, 3172 adults were interviewed through the ECRHS standardized questionnaire in Tehran, the capital of Iran. Exposure to road noise was assessed considering distance of individual participants from the noise monitoring stations via the spatial analysis in GIS software. Logistic regression was used to assess the effect of noise on the symptoms of asthma. Findings showed a significant positive association between wheezing with dyspnea as the best marker for asthma and noise levels at daytime (OR 1.03; 0.98-1.05) and nighttime (OR 1.05; 0.84-1.09). Also, a significant positive association was obtained between daytime and nighttime noise levels and other asthma symptoms including wheezing, nocturnal chest tightness, nocturnal dyspnea, wheezing without cold, nocturnal cough, and asthma medication. Association between current asthma and noise level was not significant. There was a significant association between population age and current asthma prevalence (P = 0.001). Therefore, chronic exposure to road noise especially in the nighttime could increase asthma prevalence. So, control of noise sources can be suggested to diminish asthma in adults.

Self-reported asthma prevalence and management in adults in France in 2018: ASTHMAPOP survey

BackgroundThere is a paucity of epidemiological data on asthma classified by disease severity in France. The ASTHMAPOP cross-sectional study aimed to review the prevalence and current management of asthma in people aged ≥18 years in France. MethodsA self-administered questionnaire was mailed to 19 676 people representative of the French population in age, gender, region, and socio-economic status. Asthma was classified by treatment steps per the 2017 Global Initiative for Asthma (GINA) report, according to prescribed treatments. Analyses were mostly descriptive. ResultsThe questionnaire return rate was 81.7% (n = 16 083), and 15 587 questionnaires were analyzed. The prevalence of lifetime asthma was 12.8% (95% confidence interval (CI):12.3−13.3%; n = 1 989) in 2018. The prevalence of current asthma (i.e., 12 months before the survey) was 6.4% (95% CI: 6.0−6.8%; n = 993); most of these respondents (95.3% [n = 946]) were receiving asthma treatment, and 49.4% (n = 491) were treated for mild asthma (GINA step 1 or 2). Of people with current asthma, 47.6% reported ≥1 asthma exacerbation in the past 12 months—defined as episodes (several days) during which symptoms (cough, sputum, and dyspnea) were worse than usual; 14.3% had ≥1 emergency visit, and 3.1% had ≥1 hospitalization due to asthma. Of those taking continuous asthma controller medications who answered all Morisky Medication Adherence Scale questions (n = 501), 46.4% were adherent (score=4) to their treatment regimen. Based on the 6-item Asthma Control Questionnaire scores, asthma was partially controlled or uncontrolled in 47.7% of 969 people. ConclusionsThe prevalence of asthma in France has remained stable since 2006, but levels of asthma control and treatment adherence continue to be relatively poor. Asthma management in France requires improvement.

Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers.

Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes.Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated.Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic.Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.

Asthma Among Adults and Children by Urban-Rural Classification Scheme, United States, 2016-2018.

Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban-rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban-rural classification in each state. We estimated current asthma prevalence among adults for urban-rural categories in the 50 states and the District of Columbia and among children for urban-rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban-rural classification scheme to define urban-rural status of counties. During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban-rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban-rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest. Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

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.

Prevalence of symptoms, severity and diagnosis of asthma in adolescents in the Province of Salamanca, Spain: Global Asthma Network (GAN) Phase I.

Asthma is the most prevalent chronic disease in childhood. However, the latest data on its prevalence in Spain are from Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC), 2004. The objective of our study was to assess the prevalence of asthma symptoms, severity and diagnosis in the paediatric population aged between 13 and 14 years in the province of Salamanca. Cross-sectional multicentre study carried out in 2017-2018 in 13-and 14-year-old school children in the province of Salamanca as a centre participating in of the Global Asthma Network (GAN) Phase I. The standardised validated written questionnaire and that directed by a video was administered; it was self-completed by the pupils. A total of 3485 questionnaires were completed, and the pupils' participation rate was 95.01%. Among the total, 25.7% indicated having had wheeze ever (20.7% in the video questionnaire); 14.7% indicated having had wheeze in the past 12 months (11.3% in the video questionnaire). The prevalence of current wheeze that limited speech was 3.9% (7.5% in the video questionnaire) and the current prevalence of severe wheeze was 6.5%. Regarding asthma diagnosis, 19.7% of the sample answered that they had had asthma ever, whilst 14.0% referred to having physician-diagnosed asthma. The agreement between the written questionnaire and that directed by video was acceptable for the questions of wheeze ever (Cohen Kappa index [k] = 0.53) and current wheeze (k = 0.42). The prevalence of current asthma (wheeze in the past 12 months) in the population aged 13 and 14 years in the province of Salamanca is higher compared with that presented in 2004 in Spain, but similar to that described at the world level (low-moderate level), according to the ISAAC Phase III studies.

Neighborhood Characteristics and Childhood Asthma: Evidence from the National Survey of Children’s Health, 2016-2017

BACKGROUND AND AIM: Although several asthma-related risk factors have been identified, there is a paucity of information on the effects of neighborhood characteristics on childhood asthma in the U.S. We examined the association between asthma and neighborhood characteristics in the U.S. using the National Survey of Children’s Health (NSCH) data. METHODS: We used aggregated data from children aged 0 to 17 years (N = 66,037) which were obtained from the 2016-2017 NSCH cycle. We computed weighted descriptive statistics and multivariable logistic regression to determine the association between current asthma status and the presence of: 1) neighborhood detractors (litter or garbage, poorly kept or rundown housing, and vandalism) and 2) neighborhood amenities (sidewalks or walking paths, parks or playground, recreation center and library or bookmobile). All analyses were performed using SAS. RESULTS:About 7.93% current asthma prevalence was reported and boys had higher odds of asthma (AOR= 1.32, 95% CI= 1.16 – 1.51) compared to girls. Children who lived in neighborhoods with at least one amenity had lower odds of asthma (AOR= 0.86, 95% CI= 0.75 – 0.99) compared to those who lived in neighborhoods with no amenities. Those who lived in neighborhoods with any detractors had higher odds of asthma (AOR= 1.20, 95% CI= 1.04 – 1.40) compared to those that lived in neighborhoods without any of these elements. CONCLUSIONS:Our findings illustrate that the neighborhood characteristics are important risk factors for asthma. Childhood asthma should be studied using environmental justice and system analysis frameworks to identify environmental risk factors that could be modified to alleviate current asthma rates in children. KEYWORDS: asthma, neighborhood detractors, neighborhood amenities, neighborhood characteristics

A comparison of asthma prevalence in adolescents living in urban and semi-urban areas in northwestern Iran

The global morbidity and mortality associated with asthma have been dramatically raised. We aimed to determine the prevalence of asthma symptoms in northwestern Iran and identify the potential risk factors. A cross-sectional survey was performed from November 2019 to February 2020 among 1,459 adolescents residing in areas representing urban and semi-urban communities. International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify the participants with asthma defined based on meeting the criteria of physician diagnosis or self-report of wheezing episodes previously. Multivariable logistic regression was applied for data analysis. The prevalence of current asthma, asthma ever in life, and severe asthma were 12.2, 4.9, and 5.7%, respectively, which varied with urbanization. Overall, asthma prevalence in urban area was 13.4%, whereas in the semi-urban area was 8.3%. The related risk factors for asthma were having a pet at home [OR: 1.75 (1.11, 2.74)], current smoking [OR: 1.91 (1.21, 3.02)], artificial ventilation at home [OR: 2.67 (1.02, 7.03)], intake of fast-foods [OR: 4.51 (1.19, 17.04)], and history of allergy [OR: 1.99 (1.36, 2.92)]. However, physical activity [OR: 0.37 (0.16, 0.90)] and fruit consumption [OR: 0.11 (0.02, 0.77)] were associated with lower odds of asthma. We found that the prevalence of asthma was more common in people living in urban area compared to those living in semi-urban area.

Prévalence de l’asthme chez l’adulte en France, données de la cohorte Constances

The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals. We estimated the prevalence of current asthma (asthma attack in the past 12months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis. Using data from 34,100participants in the cohort (men: 47.7%; mean age: 44.6years), the prevalence of current asthma was estimated to be 5.8% (5.1% in men, 6.4% in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women. The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences.

Asthma prevalence and associated factors among lebanese adults: the first national survey

BackgroundNo national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above.MethodsA cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors.ResultsThe prevalence of physician-diagnosed asthma was 6.7% (95% CI 5–8.7%), and that of current asthma was 5% (95% CI 3.6–6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma.ConclusionsThe prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

Exposures in the Indoor Environment and Prevalence of Allergic Conditions in the United States of America.

Our study examines the association of the presence of mildew, cockroaches, and pets in homes as well as household dust allergens with the prevalence and/or severity of allergic diseases. No study has concurrently assessed home environment exposures in relation to allergic conditions in the general US population. Data from 5409 participants from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) living in their current homes for ≥one year were analyzed. Multivariate logistic regression analyses between home exposures and allergic diseases prevalence and severity were performed. In adjusted analyses, mildew was associated with higher current asthma, allergies, and allergic rhinitis prevalence; endotoxin, with higher current asthma prevalence; and dust Canis familiaris (Can f) 1, with higher allergic rhinitis prevalence. However, presence of cockroaches and dust Dermatophagoides farinae (Der f) 1 were associated, respectively, with lower current asthma and allergies prevalence. Presence of mildew, dust Der f1, Dermatophagoides pteronyssinus (Der p) 1, Felis domesticus (Fel d) 1, and endotoxin were all associated with asthma and/or wheeze severity. Non-atopic asthma was more frequent with mildew and/or musty smell dust and higher dust Fel d1 concentration, while atopic asthma was more prevalent with higher Can f1 and endotoxin concentrations in dust. This study confirms previous relationships and reports novel associations, generating hypotheses for future research.

Decreasing ten-year (2008–2018) trends of the prevalence of childhood asthma and air pollution in Southern Taiwan

BackgroundAsthma is a common pediatric chronic respiratory disease worldwide. Previous studies showed the prevalence of childhood asthma increased in developed countries as well as in Taiwan in the late 20th century. Recently, several reports from different parts of the world showed a reversed trend in this epidemic of childhood asthma prevalence. This study investigated the trend of childhood asthma through serial cross-section questionnaire surveys in the southern part of Taiwan, and identified associated factors related to this trend in elementary school children. MethodsWe used the Chinese version of the International Study of Asthma and Allergies in Childhood (ISAAC)29 questionnaire to assess the asthma status of elementary school students aged 6–12 years in Tainan city in 3 independent study periods, namely, 2008–2009, 2010–2012, and 2017–2018. We assessed the trend of “asthma” and “related respiratory symptoms” across 3 study periods. ResultsOf the 19,633 respondents, 17,545 (89.4%) completed the questionnaires. After adjustment for covariates, the prevalence of asthma and related respiratory symptoms was significantly lower in 2017–2018 than in the 2 earlier periods. Among the protective factors, the increasing rate of breastfeeding might be partly responsible for the observed reduced prevalence of current asthma and exercise-induced wheeze, but not physician-diagnosed asthma. The presence of pets in the house was the risk factor that correlated with the prevalence of nocturnal cough. Pearson correlation analysis showed a significant correlation of the prevalence of physician-diagnosed asthma, current asthma, and exercise-induced wheezing with the concentrations of air pollutant particles with aerodynamic diameter ≤10 μM (PM10) (r = 0.84, 0.77 and 0.81, respectively). ConclusionThe prevalence of asthma and related respiratory symptoms has declined in elementary school-age children in southern Taiwan. The increased prevalence of breastfeeding, decreased rate of the presence of pets in the house, and improvement in outdoor air pollution seem to be related to this decreasing trend of asthma in school children. Our findings will provide the scientific base to empower prevention policy to reverse the trend of childhood asthma prevalence. Trial registrationN/A

Creation and validation of a citywide pediatric asthma registry for the District of Columbia

Objective To create and validate a citywide pediatric Asthma Registry to improve the care and outcomes of children and adolescents in Washington, DC through data-driven quality improvement (QI). Methods All available electronic health record data from inpatient and outpatient domains of Children’s National Hospital were aggregated from an existing enterprise data warehouse. Inclusion criteria included asthma relevant ICD-10 codes over the prior 24 months. Available Asthma Registry measures include patient demographics, ambulatory visits, hospital admissions, persistent asthma diagnoses, and prescription of controller medications. Data capture was validated using US Census data and current asthma prevalence estimate of the Behavioral Risk Factor Surveillance System (BRFSS). Results The registry identified 15,991 DC children and adolescents with asthma aged 0–17 years, inclusive, at the end of 2020. This was 14.2% higher than the estimate of 14,001 children derived from BRFSS. Characteristics of those in the registry included: mean age of 9.5 (1.4) years, 57.9% male, 72.3% Black, and 66.7% publicly insured. Over the prior 24 months, 30.3% had ≥1 emergency department visit, and 10.5% had ≥1 hospital admission. Controller medications were prescribed for 59.6% of children with persistent asthma. Rates varied by sampled primary care practice sites. Conclusions A population-level pediatric asthma registry captures more children and adolescents with asthma in DC then a BRFSS-derived estimate, and provides city-wide measures of asthma-related utilization. The registry allows for stratification by primary care practice locations and asthma characteristics, supporting the design, implementation, and evaluation of QI projects at the practice, health system, and population levels. Supplemental data for this article can be accessed at publisher’s website.

Household mold, pesticide use, and childhood asthma: A nationwide study in the U.S.

To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S. Nationally representative data were drawn from the cross-sectional 2017 and 2018 National Surveys of Children's Health. Household mold and pesticide exposures during the past 12 months and physician-diagnosed childhood asthma were assessed by standard questionnaires administered to primary caregivers. Multivariable logistic regression models were used to calculate adjusted odds ratios (aOR) for current asthma, adjusting for child, caregiver, and household covariates. We also examined potential effect modification by child's sex. Sampling weights accounted for the complex survey design. Among 41,423 U.S. children in 2017-2018, the weighted prevalence of current asthma was 10.8% in household mold-exposed children, compared with 7.2% in non-exposed children (P<0.001). After adjusting for covariates including child's obesity, children with household mold exposure compared to those with no household mold exposure had a 1.41-fold (95% CI: 1.07, 1.87) higher odds of current asthma. Associations between household mold and current asthma were pronounced among boys (aOR 1.57; 95% CI: 1.03-2.38) but not girls (aOR 1.28; 0.90-1.83; P for interaction <0.001). No significant associations were observed between household pesticide use and current asthma, after adjusting for covariates. Our findings suggest that household mold is associated with current asthma among children, independent of other major risk factors including child's obesity status. Our findings may inform strategies targeting mitigation of household mold as an important indoor environment factor to address childhood asthma.

Asthma Prevalence and Mold Levels in US Northeastern Schools

Asthma is among the most common chronic diseases of children in the United States (US). Mold exposures have been linked to asthma development and exacerbation. In homes, mold exposures have been quantified using the Environmental Relative Moldiness Index (ERMI) and higher home ERMI values have been linked to occupant asthma. In this analysis of the School Inner-City Asthma Study 2 (SICAS 2), we aimed to evaluate the ERMI’s applicability to measuring mold in schools compared to homes, to assess the relationship between the prevalence of asthma in schools and mold levels, and to examine the prevalence of asthma in relationship to students’ demographics and the physical characteristics of school-buildings. Northeastern US schools (n=32) and homes (n=33) were selected and the 36-ERMI molds were quantified in a dust sample from each classroom or home. School building characteristics, student demographics and asthma prevalence data were collected from the SICAS 2 study or obtained from government websites. Linear regression and mixed models were fit to assess the association of current asthma prevalence and physical characteristics of the school, make-up of the student body and the ERMI metric. Levels of outdoor Group 2 molds were significantly (p<0.01) greater in schools compared to homes and higher Group 2 levels in schools were linked to higher asthma prevalence for their students. The presence of AC in school buildings correlated significantly (p=0.02) with lower asthma prevalence. Higher mold levels in northeastern US schools were associated with an increase in students’ asthma.

Current Asthma Prevalence Using Methacholine Challenge Test in Korean Children from 2010 to 2014.

BackgroundMost epidemiological studies depend on the subjects' response to asthma symptom questionnaires. Questionnaire-based study for childhood asthma prevalence may overestimate the true prevalence. The aim of this study was to investigate the prevalence of “Current asthma” using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and methacholine challenge test in Korean children.MethodsOur survey on allergic disease included 4,791 children (age 7–12 years) from 2010 to 2014 in Korean elementary schools. Bronchial hyperresponsiveness (BHR) was defined as provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) ≤ 16 mg/mL. “Current asthma symptoms” was defined as positive response to “Wheezing, current,” “Treatment, current,” or “Exercise, current.” “Current asthma” was defined when the subjects with “Current asthma symptoms” showed BHR on the methacholine challenge test or had less than 70% of predicted FEV1 value.ResultsThe prevalence of “Wheezing, ever,” “Wheezing, current,” “Diagnosis, ever,” “Treatment, current,” “Exercise, current,” and “Current asthma symptoms” was 19.6%, 6.9%, 10.0%, 3.3%, 3.5%, and 9.6%, respectively, in our cross-sectional study of Korean elementary school students. The prevalence of BHR in elementary school students was 14.5%. The prevalence of BHR in children with “Wheezing, ever,” “Wheezing, current,” “Diagnosis, ever,” “Treatment, current,” and “Exercise, current” was 22.3%, 30.5%, 22.4%, 28.8%, and 29.9%, respectively. BHR was 26.1% in those with “Current asthma symptoms.” The prevalence of “Current asthma” was 2.7%.ConclusionsOur large-scale study provides 2.7% prevalence of current asthma in Korean elementary school children. Since approximately one third of the children who have “Current asthma symptoms” present BHR, both subjective and objective methods are required to accurately predict asthma in subjects with asthma symptoms.

IgE mediated food allergy in Turkey: different spectrum, similar outcome.

Food allergies (FAs) potentially differ across cultures. All medical records of 534 children and adolescents with IgE-mediated FA over a 5-year period were reviewed to document the regional characteristics with regard to spectrum and outcome. According to their last visit, the most common FAs were tree nuts (TNs) (52.4%), cow`s milk (27.3%), seeds (24.7%), egg white (23.2%) and peanuts (14.9%). Hazelnut and Anacardia nuts were the most common etiologies for TN allergies, whereas lentils and chickpeas for legumes and sesame and pumpkin seed for seeds were most common, respectively. TN allergy was in first place in school-age children (55.3%) and adolescents (57.1%) while in the second place in preschoolers (57.7%) after egg white (60%). Of these 534 children, 59.2% had at least one resolved FA (mainly egg white, cow`s milk) and 21% had no residual FA during the study period. Emerging FAs (fish, shellfish, fruit, TN and seed) after the age of 3 years was reported in 94 children. The prevalence of current asthma (22.3%, 38.2%, 40%) and allergic rhinitis (11.6%, 45.2%, 60%) increased, while current atopic dermatitis (17.5%, 8.6%, 8,6%) decreased in preschoolers, school age children and adolescents, respectively. The FA spectrum of Turkish children and adolescents differs from many regions of the world with high rates of TN (hazelnut, Anacardia nuts), seed (sesame, pumpkin seed) and lentils, and low rates of soy, peanut and seafood allergies. However, resolution, emergence and persistence of allergies and comorbidities are similar, which points to the limited role of the environment in the outcome.

Asthma

Asthma is one of the most common diseases in developed nations. A pathognomonic feature of asthma is episodic aggravations of the disease; these exacerbations can be life-threatening and contribute to a significant proportion of the public health burden of asthma. In the emergency department, successful management of asthma exacerbations requires early recognition and intervention before they become severe and potentially fatal. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for asthma. Figures show the management of asthma exacerbations in the emergency department and hospital, pooled odds ratio comparing inhaled corticosteroids and oral corticosteroids with oral corticosteroids alone following emergency department discharge, and an asthma discharge plan at the emergency department. Tables list current asthma prevalence among selected demographic groups in the United States, risk factors for fatal asthma exacerbations, differential diagnosis of asthma exacerbations, and dosages of drugs for asthma exacerbations. This review contains 3 figures, 16 tables, and 88 references. Key Words: Asthma, allergic bronchopulmonary aspergillosis, gastroesophageal reflux disease, sinus disease, breathlessness, shortness of breath

Asthma

Asthma is one of the most common diseases in developed nations. A pathognomonic feature of asthma is episodic aggravations of the disease; these exacerbations can be life-threatening and contribute to a significant proportion of the public health burden of asthma. In the emergency department, successful management of asthma exacerbations requires early recognition and intervention before they become severe and potentially fatal. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for asthma. Figures show the management of asthma exacerbations in the emergency department and hospital, pooled odds ratio comparing inhaled corticosteroids and oral corticosteroids with oral corticosteroids alone following emergency department discharge, and an asthma discharge plan at the emergency department. Tables list current asthma prevalence among selected demographic groups in the United States, risk factors for fatal asthma exacerbations, differential diagnosis of asthma exacerbations, and dosages of drugs for asthma exacerbations. This review contains 3 figures, 16 tables, and 88 references. Key Words: Asthma, allergic bronchopulmonary aspergillosis, gastroesophageal reflux disease, sinus disease, breathlessness, shortness of breath