Daily Asthma Symptoms Research Articles

Urinary biomarkers of environmental exposures and asthma morbidity in a school inner city asthma study

BackgroundThe burden of pediatric asthma and other allergic diseases is not evenly distributed among United States populations. ObjectiveTo determine whether urinary biomarkers are associated with asthma morbidity, and if associations vary by child race, ethnicity and sex. MethodsThis study includes n = 152 children with physician-diagnosed asthma who participated in the School Inner-City Asthma Intervention Study (SICAS-2). Metabolites of phenol, paraben, polycyclic aromatic hydrocarbons, and phthalate analytes were analyzed from urine samples collected at baseline. Asthma symptom days over the past 2 weeks were dichotomized to no asthma symptom days or any asthma symptom days. Cross-sectional regression models were adjusted for age, sex, number of colds, household income, prescription control, race and ethnicity, body mass index (BMI) percentile, and smoke exposure. Weighted quantile sum regression was used to analyze each chemical class and a total mixture effect, controlling for the same covariates. Analyses were conducted with the assistance of the National Institute of Environmental Health Sciences Children's Health Exposure Analysis Resource (CHEAR). ResultsParticipants were mostly Hispanic/Latino and low income with an average age of 7.83 years and the average maximum asthma symptom days over the past two weeks of 2.13 (standard deviation: 3.56). The maximum concentrations indicate extreme values for several chemicals, including bisphenol-3, 2,5-dichlorophenol, propyl and methyl parabens, triclosan, methyl paraben and cotinine. We found a significant interaction effect and differing contributions of analytes for children with allergen sensitivity versus those that did not. For stratified analyses assessing effect modification by child race and ethnicity, weighted quantile sum interaction models showed reduced odds of asthma symptoms to a greater magnitude in children of other races and ethnicities compared to Black, Non-Hispanic children. ConclusionsPreliminary analyses of the association between environmental chemical exposure and asthma symptoms among inner-city children revealed an inverse association, which may be due to personal care and medication use and can be understood further in future analyses. Beneficial effects were detected for most of the chemicals.

Influence of residential location on asthma symptoms in children: A cross-sectional study in Shanghai, China

IntroductionRapid industrialization and environmental and lifestyle modifications in China have led to the prevalence of asthma in children showing an increasing trend. However, few studies have assessed the influence of residential geographic location on asthma symptoms in this population. We aimed to explore the influence of residential location on asthma symptoms of children in Shanghai, China. MethodsThis cross-sectional study included 114 children with physician-diagnosed asthma. The inclusion criteria included an age <18 years and reported wheezing or asthma medication use over the previous 12 months. We excluded children with other respiratory diseases (e.g., pneumonia and laryngeal edema); severe diseases, disabilities, and mental illnesses; or undiagnosed asthma (with symptoms suggestive of asthma, yet having not been diagnosed with asthma by a physician). We evaluated asthma symptoms by assessing the number of asthma exacerbations in the previous 12 months, number of maximum symptom days, spirometry outcomes, respiratory resistance at 5 Hz, and fractional exhaled nitric oxide. Spatial analysis techniques of geographic information systems were used to assess the distance from the residence to major roadways. ResultsApproximately 66.7% of children reside in close proximity to urban expressways. The number of asthma exacerbations in the past 12 months increased if the children lived close to a national highway. Asthma symptom days was high in children living in Jiading District. Residential location was not significantly associated with spirometry outcomes, total specific airway resistance, and fractional exhaled nitric oxide. ConclusionsResidential location was associated with more severe asthma symptoms. To better prevent and control asthma symptom exacerbations, the construction of physical barriers around high-risk roads and areas, avoidance of smoking exposure from neighbors in the same building, and weight control are potential strategies; older children should be seriously considered. The traffic volume and flow effects should be further explored.

Psychometric evaluation of an electronic Asthma Symptom Diary for young children

BackgroundPatient-reported outcome measures that facilitate self-report by children are needed to reduce the bias of proxy report. We previously developed an electronic Pediatric Asthma Symptom Diary (ePASD) to assess the severity of daily asthma symptoms and proximal impacts in children aged 6–11 years with mild to severe asthma. The ePASD, administered via a digital application with visuals, sounds, and text, is uniquely designed to minimize the importance of reading skills on children’s ability to self-report accurately. Here, we describe the ePASD’s psychometric properties.MethodsNinety-one children aged 6–11 years with mild to severe asthma and their caregivers participated in 2 study visits, which consisted of training on the provisioned device and completing asthma-specific clinical outcome assessment (COA) questionnaires. The children self-completed the ePASD at home twice daily for 8 consecutive days. The scoring of the ePASD was guided by factor analyses, inter-item correlations, and internal consistencies. Reliability, discriminating ability, construct validity, and responsiveness were evaluated for ePASD items and candidate scores.ResultsAll COAs included in the study—the ePASD, Asthma Control Questionnaire (ACQ), Childhood Asthma Control Test, Pediatric Asthma Quality of Life Questionnaire–Standardized (PAQLQ[S]), and global ratings—demonstrated that the children exhibited few asthma-related symptoms and impacts at all timepoints, and consequently, showed little change over time. Internal consistencies (all Cronbach’s alphas ≥ 0.52) and test-retest reliabilities (all intraclass correlation coefficients ≥ 0.60) were largely satisfactory. Patterns of convergent and divergent correlations supported the construct validity of ePASD scores. The ePASD symptom scores correlated moderately to strongly with PAQLQ(S) Symptom scores (all correlations ≥ − 0.46) and with ACQ scores (all correlations ≥ 0.42), as predicted. Evidence of the discriminating ability of ePASD items and composite scores was demonstrated by known-groups analyses.ConclusionsThe ePASD is a reliable and valid measure of asthma symptoms and proximal impacts in children aged 6–11 years with mild, moderate, or severe asthma. These results lay the psychometric groundwork for use of the ePASD in future clinical trials for the management of pediatric asthma. An ongoing pediatric asthma treatment trial is anticipated to provide evidence of the ePASD’s responsiveness to change.

Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations

Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors. Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores. Moving to a low-poverty neighborhood. Caregiver-reported asthma exacerbations and symptoms. Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations. Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

Effect of radon exposure on asthma morbidity in the School Inner-City Asthma study.

Radon may have a role in obstructive lung disease outside its known carcinogenicity. Little is known about radon's effects on asthma morbidity. To determine the effect of radon on fractional exhaled nitric oxide (FE NO), asthma symptom-days, and lung function in inner-city asthmatic school children. Two hundred ninety-nine school-aged asthmatic children enrolled in the School Inner-City Asthma Study (SICAS-1) were followed. One and two-month averaged radon was assessed using a spatiotemporal model predicting zip code-specific monthly exposures. FE NO and spirometry were measured twice during the academic year. Asthma symptoms were assessed four times during the academic year. The interaction between indoor radon exposure (Bq/m3 ) and seasonality predicting log-transformed FE NO, forced expiratory volume in 1 s (FEV1 ) % predicted, forced vital capacity (FVC) % predicted, FEV1 /FVC, and asthma symptom-days was evaluated. Participants with high radon exposure had greater change in FE NO from warm to cold periods compared to low radon exposure (interaction p = 0.0013). Participants with >50th percentile radon exposure experience significant FE NO increase from warm to cold weather ( = 0.29 [95% confidence interval [CI]: 0.04-0.54], p = 0.0240). We report a positive association between radon 1-month moving average (incidence rate ratio [IRR] = 1.01, p = 0.0273) and 2-month moving average (IRR = 1.01, p = 0.0286) with maximum asthma symptom-days (n = 299, obs = 1167). In asthmatic children, radon may be associated with increased asthma morbidity, suggesting radon may be a modifiable environmental risk factor for airway inflammation.

PCR197 Psychometric Evaluation of a New Electronic Pediatric Asthma Symptom Diary

We developed an electronic pediatric asthma symptom diary (ePASD) to assess the severity of daily asthma symptoms and proximal impacts in children with asthma. The unique design of the ePASD minimizes the importance of reading skills on children’s ability to self-report accurately and reduces the bias of proxy report. This observational, prospective study evaluated the psychometric properties of the ePASD.

Identification by cluster analysis of patients with asthma and nasal symptoms using the MASK-air® mHealth app

BackgroundThe self-reporting of asthma frequently leads to patient misidentification in epidemiological studies. Strategies combining the triangulation of data sources may help to improve the identification of people with asthma. We aimed to combine information from the self-reporting of asthma, medication use and symptoms to identify asthma patterns in the users of an mHealth app. MethodsWe studied MASK-air® users who reported their daily asthma symptoms (assessed by a 0-100 visual analogue scale – “VAS Asthma”) at least three times (either in three different months or in any period). K-means cluster analysis methods were applied to identify asthma patterns based on: (i) whether the user self-reported asthma; (ii) whether the user reported asthma medication use and (iii) VAS asthma. Clusters were compared by the number of medications used, VAS asthma levels and Control of Asthma and Allergic Rhinitis Test (CARAT) levels. FindingsWe assessed a total of 8,075 MASK-air® users. The main clustering approach resulted in the identification of seven groups. These groups were interpreted as probable: (i) severe/uncontrolled asthma despite treatment (11.9-16.1% of MASK-air® users); (ii) treated and partly-controlled asthma (6.3-9.7%); (iii) treated and controlled asthma (4.6-5.5%); (iv) untreated uncontrolled asthma (18.2-20.5%); (v) untreated partly-controlled asthma (10.1-10.7%); (vi) untreated controlled asthma (6.7-8.5%) and (vii) no evidence of asthma (33.0-40.2%). This classification was validated in a study of 192 patients enrolled by physicians. InterpretationWe identified seven profiles based on the probability of having asthma and on its level of control. mHealth tools are hypothesis-generating and complement classical epidemiological approaches in identifying patients with asthma.

A cross-validation based approach for estimating specific gravity in elementary-school aged children using a nonlinear model

Environmental research often relies on urinary biomarkers which require dilution correction to accurately measure exposures. Specific gravity (SG) and creatinine (UCr) are commonly measured urinary dilution factors. Epidemiologic studies may assess only one of these measures, making it difficult to pool studies that may otherwise be able to be combined.Participants from the National Health and Nutrition Examination Survey 2007–2008 cycle were used to perform k-fold validation of a nonlinear model estimating SG from UCr. The final estimated model was applied to participants from the School Inner-City Asthma Intervention Study, who submitted urinary samples to the Children's Health Exposure Analysis Resource. Model performance was evaluated using calibration metrics to determine how closely the average estimated SG was to the measured SG. Additional models, with interaction terms for age, sex, body mass index, race/ethnicity, relative time of day when sample was collected, log transformed 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and asthma status were estimated and assessed for improvement. The association between monobenzyl phthalate (MBZP) and asthma symptom days, controlling for measured UCr, measured SG, and each estimated SG were compared to assess validity of the estimated SG.The model estimating SG from UCr alone, resulted in a beta estimate of 1.10 (95% CI: 1.01, 1.19), indicating agreement between model-predicted SG and measured SG. Inclusion of age and sex in the model improved estimation (β = 1.06, 95% CI: 0.98, 1.15). The full model accounting for all interaction terms with UCr resulted in the best agreement (β = 1.01, 95% CI: 0.93,1.09). Associations between MBZP and asthma symptoms days, controlling for each estimated SG, were within the range of effect estimates when controlling for measured SG and measured UCr (Rate ratios = 1.28–1.34). Our nonlinear modeling provides opportunities to estimate SG in studies that measure UCr or vice versa, enabling data pooling despite differences in urine dilution factors.

Effectiveness of eAsthmaCare on Symptoms, Childhood Asthma Control Test, and Lung Function among Asthmatic Children.

A web-based self-health management system-eAsthmaCare, was developed as an intervention for asthmatic children. A randomized controlled trial was performed. Consent was obtained for 98 children with asthma to participate in the study and the pre- and post-test data collection process. The experimental group was given access to eAsthmaCare online management, the control group was subjected to general asthma management. The experimental and control groups' asthma symptoms, Childhood Asthma Control Test (C-ACT) scores, and lung function were evaluated, and their pre- and 3-month post-test results were compared. The following records were maintained: (1) medication record (2) daily asthma symptoms log (3) monthly C-ACT and lung function records. The C-ACT results indicated a p-value of < .01 for: overall improvements to childhood asthma symptoms, time effect, group and time interaction effects, and group and time interaction effects in relation to sleeping condition on the previous day; cough symptom time effect, and group and time interaction effects; the two groups' time effect in relation to cough symptoms; the two groups' time effect in relation to monthly activity restrictions (number of days); and the two groups' time effect in relation to nasal symptoms; the two groups' time effect; and group and time interaction effects (p < .01). In terms of the predictive values for lung function (FVC, FEV1, PEFR), the improvements in both groups were not statistically significant. The implementation of the eAsthmaCare intervention might have a positive impact on pediatric patients, making it an effective management tool for monitoring asthmatic children's physical function and discomfort.

Childhood asthma and household exposures to nitrogen dioxide and fine particles: a triple-crossover randomized intervention trial

Objective Triple-crossover randomized controlled intervention trial to test whether reduced exposure to household NO2 or fine particles results in reduced symptoms among children with persistent asthma. Methods Children (n = 126) aged 5–11 years with persistent asthma living in homes with gas stoves and levels of NO2 15 ppb or greater recruited in Connecticut and Massachusetts (2015–2019) participated in an intervention involving three air cleaners configured for: (1) NO2 reduction: sham particle filtration and real NO2 scrubbing; (2) particle filtration: HEPA filter and sham NO2 scrubbing; (3) control: sham particle filtration and sham NO2 scrubbing. Air cleaners were randomly assigned for 5-week treatment periods using a three-arm crossover design. Outcome was number of asthma symptom-days during final 14 days of treatment. Treatment effects were assessed using repeated measures, linear mixed models. Results Measured NO2 was lower (by 4 ppb, p < .0001) for NO2-reducing compared to control or particle-reducing treatments. NO2-reducing treatment did not reduce asthma morbidity compared to control. In analysis controlling for measured NO2, there were 1.8 (95% CI −0.3 to 3.9, p = .10) fewer symptom days out of 14 in the particle-reducing treatment compared to control. Conclusions It remains unknown if using an air cleaner alone can achieve levels of NO2 reduction large enough to observe reductions in asthma symptoms. We observed that in small, urban homes with gas stoves, modest reductions in asthma symptoms occurred using air cleaners that remove fine particles. An intervention targeting exposures to both NO2 and fine particles is complicated and further research is warranted. Registration Number NCT02258893.

Effects of daily peer problems on sleep and the severity of pediatric asthma symptoms.

Although psychosocial stressors in the home environment place children at risk for physical health problems, less is known about whether or how peer stressors contribute to health problems in youth. The current study investigated associations between daily peer problems and asthma symptoms among adolescents with asthma. The possible mediating role of nightly sleep disturbance and the moderating role of adolescent mental health were also examined. Adolescents (N = 297) with asthma reported on peer problems, nighttime awakenings, sleep quality, and asthma symptoms over 4 days. Youth also self-administered daily peak expiratory flow rate (PEFR) assessments, and parents reported on their children's anxious-depressive symptoms. Adolescents encountering more daily peer problems experienced more severe asthma symptoms, but not lower PEFR. Mediation analyses demonstrated that associations between daily peer problems and subjective asthma symptoms were partially explained by more nighttime awakenings and lower sleep quality, even after accounting for potentially confounding demographic factors and adolescents' daily experiences of familial stress. However, these indirect pathways did not vary depending on youth anxious-depressive symptoms. The findings provide novel evidence for everyday peer stress as a developmentally relevant health risk factor among adolescents with asthma. Insofar as daily peer problems were associated with elevated asthma symptoms via impaired sleep, psychosocial interventions focusing on the peer context may help mitigate maladaptive health behaviors and asthma morbidity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personalized targeted therapy of moderate and severe atopic asthma in Russia

Introduction. Taking into account the prevalence of asthma and especially severe atopic asthma which requires carefully selected and expensive therapy, the appearance of the domestic biosimilar omalizumab among biological therapy drugs makes the choice of treatment for this category more affordable. The article presents the results of an observational open prospective clinical trial of the omalizumab biosimilar in severe athopic asthma patients.The purposeof this study was to evaluate the efficacy and safety of the domestic production biosimilar in the real clinical practice.Materials and methods. The study involved 10 adult patients aged 19 to 55 years with a diagnosis of moderate to severe uncontrolled persistent asthma treated with mediun to high dose ICS and second&amp;more controller (ACQ-5 ≥ 1,5, FEV1 &lt; 80% of the predicted normal value). For 26 weeks all patients received the omalizumab. The evaluation of the efficacy was provided taking into account asthma symptoms improvement the results of ACQ-5, FEV1, PEF, asthma exacerbations and the use of health resources. Results. According to the results of data analysis due to omalizumab all patients demonstrated reducing daily asthma symptoms, nocturnal awakening and night time symptom, shortness of breath and SABA using. An asthma control improvement was observed after 1 month treatment (Δ ACQ-5 1.6 [1.2; 2.4], p = 0.0002 compared to the baseline data) with a continued tendency to further increase during 6 months of the study. A statistically significant increase in FEV1 was noted (initially, FEV1 56.7% [51.25; 61.8] of the predicted; after 1 month, FEV1 67.5% [63.45; 70.6] of the predicted, p = 0.00003; after 6 months, FEV1 80.6% [80.55; 84.05] of the predicted, p &gt;&lt; 0.001). Omalizumab biosimilar used allowed to reduce the background asthma therapy. No asthma exacerbation was registered due to 26 weeks omalizumab treatment. Conclusions. Based on the results of the study, it was shown that the administration of the omalizumab biosimilar to patients with severe atopic asthma improves control over the symptoms, lung function and reduces the amount of asthma exacerbations, and has a good safety&gt;&lt; 80% of the predicted normal value). For 26 weeks all patients received the omalizumab. The evaluation of the efficacy was provided taking into account asthma symptoms improvement the results of ACQ-5, FEV1, PEF, asthma exacerbations and the use of health resources.Results. According to the results of data analysis due to omalizumab all patients demonstrated reducing daily asthma symptoms, nocturnal awakening and night time symptom, shortness of breath and SABA using. An asthma control improvement was observed after 1 month treatment (Δ ACQ-5 1.6 [1.2; 2.4], p = 0.0002 compared to the baseline data) with a continued tendency to further increase during 6 months of the study. A statistically significant increase in FEV1 was noted (initially, FEV1 56.7% [51.25; 61.8] of the predicted; after 1 month, FEV1 67.5% [63.45; 70.6] of the predicted, p = 0.00003; after 6 months, FEV1 80.6% [80.55; 84.05] of the predicted, p &lt; 0.001). Omalizumab biosimilar used allowed to reduce the background asthma therapy. No asthma exacerbation was registered due to 26 weeks omalizumab treatment.Conclusions.Based on the results of the study, it was shown that the administration of the omalizumab biosimilar to patients with severe atopic asthma improves control over the symptoms, lung function and reduces the amount of asthma exacerbations, and has a good safety.

Impact of Air Pollution on Daily Asthma Symptoms.

The impact of air pollution on respiratory diseases, particularly in asthma, has been the subject of several studies. The impact of pollution on the daily symptoms of patients with asthma has been less studied. The aim of this study is to assess the association between the intensity of asthma symptoms and the variation of pollution levels. Patients with a diagnosis of asthma were instructed to record the intensity of their respiratory symptoms daily, expressed on a scale from 0 to 5, in the months of March and April 2018. The website of the Portuguese Environment Agency was consulted in order to obtain the daily levels of pollutants measured by the two local monitoring stations during the same period of time. Data was analyzed using a temporal causal model to study the association between pollutant levels - particulate matter, ozone, nitrogen dioxide and carbon monoxide - and the intensity of respiratory symptoms. From the 135 schedules delivered, 35 were correctly filled out and returned. The patient median age was 47.0 years, 18 being females. The best statistical model obtained identified ozone as the most relevant 'Granger cause' of asthma symptoms. Particulate matter, carbon monoxide and nitrogen also appeared as lower impact factors. The quality of the model was expressed by an R2 of 0.92. The correlation between ozone values and asthma symptoms was more significant after five days. For the other identified factors there was a lag of four to five days. Our results support the existence of a daily variation of asthma symptoms that is associated with the pollution levels, even if these are within acceptable limits according to national and international standards. Regretfully, the small number of participants was a limitation in term of the conclusions that could be drawn and did not allow the analysis of clinical or other factors that are potentially involved. In the place and period studied the air pollutants behaved as factors of variation in the intensity of asthma symptoms. The ozone level was the best predictive factor of symptom variation. Levels of particulate matter, carbon monoxide and nitrogen were identified as secondary markers. The time lag between the variables with the best correlation suggests there could be a delayed effect of pollutants on respiratory symptoms.

Mepolizumab improves work productivity, activity limitation, symptoms, and rescue medication use in severe eosinophilic asthma.

Patients with severe eosinophilic asthma experience daily activity limitations and reduced productivity at work. Using anonymized individual patient‐level data from two previously conducted randomized, double‐blind, placebo‐controlled studies (MENSA [GSK ID:115588/NCT01691521]; MUSCA [GSK ID:200862/NCT02281318]), we investigated the effect of mepolizumab on work productivity, activity limitation, symptoms, and rescue medication use. Patient‐reported outcomes including Work Productivity and Activity Impairment–General Health (WPAI‐GH) scores (impairment percentages, 0%–100%), global activity limitation (scale 1–4), and perceived change in activity limitation (Likert scale 1–7) since the start of the study were analyzed. WPAI‐GH scores from MENSA were analyzed post hoc for employed patients using mixed model repeated measures; global activity limitation and perceived change in activity limitation from MUSCA were analyzed by ordinal logistic regression. Mean changes from baseline in daily asthma symptom scores (scale 0–5) and rescue medication use (occasions/day) were also assessed, via a post hoc meta‐analysis of MENSA and MUSCA. At study end, WPAI‐GH scores indicative of overall work impairment, impairment while working, and activity impairment consistently improved with mepolizumab versus placebo. Overall, 76% versus 54% of patients rated their activity as “much better,” “better,” or “slightly better” since the start of the study with mepolizumab versus placebo. Mepolizumab was associated with numerically larger improvements from baseline in asthma symptoms (treatment difference 0.21–0.29 points) and rescue medication use (treatment difference −0.08 to −0.22 occasions/day) versus placebo. Our results indicate that patients with severe eosinophilic asthma may experience improved activity limitation, work productivity, symptoms, and rescue medication use with mepolizumab.

Obesity May Enhance the Adverse Effects of NO2 Exposure in Urban Schools on Asthma Symptoms in Children

To evaluate relationships between inner-city classroom NO2 exposure and asthma symptoms and morbidity by BMI category.Children aged 4 to 13 (n = 271) years from 37 inner-city schools who had physician-diagnosed asthma for at least 1 year and were using daily preventive asthma medication, had wheezing within the last year, and/or had at least 1 unscheduled health care visit for asthma within the past year.This was a single-center prospective study conducted within the School Inner-City Asthma Study. Before the start of the academic year, baseline demographics, environmental factors, and asthma symptoms and medication use were obtained by questionnaire. Baseline evaluations included skin testing to common seasonal and perennial aeroallergens or by assessment serum-specific IgE to the same allergens, spirometry, and fractional exhaled nitric oxide (FeNO) measurement. BMI percentile was calculated and categorized by using CDC classifications. Classroom NO2 was measured twice during the school year, ∼6 months apart. The primary outcome was the number of days with asthma symptoms within the previous 14 days. The secondary outcomes assessed in the previous 2 weeks were the number of exacerbations (hospitalizations or unscheduled health care visits for asthma), the number of days caretakers had to change plans because of the child’s asthma symptoms, FeNO level, and pulmonary function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]).Participants were predominantly African American and Hispanic (35% each) and impoverished (49% had an annual household income <$25 000). A total of 50% had normal BMI (fifth percentile to <85th percentile), 15% were overweight (85th percentile to <95% percentile), and 35% were obese (≥95th percentile). Most (69%) were atopic, with specific immunoglobulin E to at least 1 aeroallergen. Obese students with asthma had statistically (but likely not clinically relevant) lower pulmonary function (FEV1 and FVC but not FEV1/FVC ratio), more positive skin test results, and lower FeNO than students with normal weight. The BMI category did not affect asthma symptom days, asthma symptoms, medication use, health care use for asthma, or missed school days. Caretakers of children with normal weight changed their plans more often than those of students who were overweight or obese. For children with normal weight or those who were overweight, NO2 levels were not associated with any of the measured outcomes. However, among children who were obese, for every 10-fold increase in NO2 level there were increased odds of asthma symptom days (1.9-fold), acute asthma-related health care use (2.4-fold), a missed school day because of asthma (3.1-fold), and care takers’ plans being changed because of the child’s asthma (4.2-fold). As compared with children with normal weight, in students who were obese, every 10 parts per billion increase in classroom NO2 level increased the likelihood of an asthma symptom day (odds ratio: 1.86; 95% confidence interval: 1.15 to 3.02) and of care takers changing their plans (odds ratio: 4.24; 95% confidence interval: 2.33 to 7.70). NO2 levels did not affect other outcomes, lung function, or FeNO across BMI categories.Obesity in inner-city students with asthma appears to increase susceptibility to the adverse effects of classroom NO2.NO2 is formed by combustion of liquid or solid fossil fuels. Indoor sources include gas stoves, heaters, and poorly ventilated furnaces and fireplaces. Furthermore, outdoor levels are elevated in heavily trafficked urban areas. The Environmental Protection Agency’s standard for safe outdoor level of NO2 is ∼50 parts per billion over a 1-year averaging time and 100 parts per billion over a 1 hour averaging time. Although the authors of this study do not specifically report classroom NO2 levels, it is clear from the 2 figures in the article that levels did not exceed 30 parts per billion, hence they were nowhere near the level up to which the Environmental Protection Agency considers safe. This is a warning that “safe” might not be safe enough. I think we all recognize the multiple and varied effects that both pollution and obesity have on health. With this study, the authors suggest synergy between 2 health risk factors and indicate that, as physicians, we must address all known risk factors for disease as we provide the best preventive and prospective care we can.

Detecting asthma control level using feature-based time series classification

Asthma symptom control is the best method for asthma treatment. Early detection of asthma control status can provide the time required for presenting preventive treatment programs to reduce the future risk of asthma exacerbation and episodes of poor asthma control. Accordingly, the current study aims to outline a novel model for classifying asthma control status using a time series/time sequence-based classification approach. Few researchers have addressed the problem of classifying asthma control level in the context of the time series/time sequences dynamics-based approach. It is a significant defect in chronic disease management such as asthma that requires continuous monitoring of symptoms. As a result, it is needed to examine the effect of the time-series/time-sequences of the stimuli affecting asthma status in classifying the control level of this disease. We have designed a daily asthma self-monitoring form and collected a total of 2870 daily assessments of asthma control on 96 asthmatics patients older than five years for 9 months. Using a 7-day window of time, we created the asthma control dataset with clinical variables, the patient’s medical history, and environmental parameters, to detect asthma control level using a time series/time sequence-based classification model. Our best model yielded a recall of 87%, a specificity of 94%, a precision of 89%, a negative predictive value of 93%, an accuracy of 92%, an F-measure of 88%, and an AUC of 87%. Our study indicated that time series classification models among data mining techniques have great potential in creating a prognostic model for chronic diseases such as asthma. Furthermore, the time-series/time sequences of daily asthma symptoms also play a significant role in classifying asthma control levels.

Associations of Snoring and Asthma Morbidity in the School Inner-City Asthma Study

Inner-city children are disproportionately affected by asthma and sleep-disordered breathing (SDB). However, little is known about the association of SDB symptoms with asthma morbidity in this vulnerable population. Assess the relationship between snoring frequency and asthma morbidity. This study was part of the School Inner-City Asthma Study, a longitudinal prospective cohort study of children with persistent asthma who attended schools in the Northeast United States from 2008 to 2013. Participants had baseline assessments of asthma symptoms, snoring, and allergy status. Caregivers completed quarterly surveys for 12 months on symptoms of asthma, snoring, and health care outcomes. Snoring frequency (non-, rare-, sometimes-, habitual-snoring) and its relationship with asthma symptoms and asthma morbidity were assessed by mixed-effects models. There were 1186 observations from 339 subjects. Mean age was 7.9 years; roughly half were male, and most were of minority race. Half were overweight or obese, and 65.5% had atopy. At initial snoring assessment, 24.8% reported habitual snoring, but report of snoring frequency varied over the study period. Multivariate analyses revealed increased odds of maximum asthma symptom days for habitual snoring compared with nonsnoring (1.58; 95% CI, 1.19-2.10; P < .002) and all other snoring categories. Habitual snoring was associated with greater odds of health care utilization (incidence rate ratio, 1.72; 95% CI, 1.10-2.69; P= .02) and worse asthma control (odds ratio, 1.49; 95% CI, 1.05-2.11; P= .03) compared with nonsnoring. Snoring is common among inner-city school-age children with asthma, and habitual snoring is associated with increased asthma symptom burden and health care utilization.

Second-hand smoke and NFE2L2 genotype interaction increases paediatric asthma risk and severity.

Second-hand smoke (SHS) exposure is associated with paediatric asthma, and oxidative stress is believed to play a role in mediating this association. The nuclear factor (erythroid-derived 2)-like 2 (NFE2L2) is important for the defence against oxidative stress. To explore interactions between NFE2L2 genotype and SHS exposure in paediatric asthma risk. We used a genotyped subset of patients of European ancestry (N=669, median age at enrolment=6.8years) enrolled in the clinical cohort Greater Cincinnati Pediatric Clinic Repository as the study population, and a population-based paediatric cohort (N=791) to replicate our findings. History of asthma diagnosis was obtained from medical records, and SHS exposure was obtained from questionnaires. Four NFE2L2 tagging SNPs were included in the analysis, and interactions between SHS and NFE2L2 genotype were evaluated using logistic regression. Three of the analysed SNPs, rs10183914, rs1806649 and rs2886161, interacted significantly with SHS exposure to increase asthma risk (p≤.02). The interaction was replicated in an independent cohort for rs10183914 (p=.04). Interactions between SHS exposure and NFE2L2 genotype were also associated with an increased risk of hospitalization (p=.016). In stratified analyses, NFE2L2 genotype was associated with daily asthma symptoms in children with SHS exposure (OR=3.1; p=.048). No association was found in children without SHS exposure. Examination of publicly available chromatin immunoprecipitation followed by sequencing (ChIP-seq) data sets confirmed the presence of active histone marks and binding sites for particular transcription factors overlapping the coordinates for the significantly associated SNPs. Our study provides evidence that NFE2L2 genotype interacts with SHS exposure to affect both asthma risk and severity in children and identifies a population of children at increased risk of asthma development.

Association Between Fungal Spore Exposure in Inner-City Schools and Asthma Morbidity

SN Baxi, WJ Sheehan, JE Sordillo. Ann Allergy Asthma Immunol . 2019;122(6):610–615.e1 To evaluate the association of school-based fungal spore exposures on asthma symptom days in children with asthma. Children 4–13 years of age with persistent asthma attending an elementary school in the Northeast US from 2008–2013, where environmental sampling was obtained. Children had to have physician diagnosed asthma with symptoms in the prior 12 months, daily controller medication usage, or unscheduled medical visits for asthma in the past year. Children were recruited from participating schools …

A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes

Objective The objective of this study was to evaluate the effects of using Community Health Workers (CHWs) to deliver the home-based Wee Wheezers asthma education program on asthma symptoms among children with persistent asthma. Methods In this randomized controlled trial of 151 children aged 2–9 years with persistent asthma, we assigned 75 to the intervention and 76 to the control. The primary outcome was caregiver-reported asthma symptom days. Secondary outcomes included asthma-related healthcare utilization, caregivers’ asthma knowledge, illness perception and management behaviors, MDI-spacer administration technique, and home environmental triggers. Outcomes were collected at baseline, 3, 6, 9 and 12 months. A repeated measurements analytic approach with generalized estimating equations was used. To account for missing data, multiple imputation methods were employed. Results At 3 and 6 months, improvement in symptom days was not significantly different between groups. However, at 9 and 12 months, the reduction in asthma symptom days was 2.15 and 2.31 days more respectively for those in the intervention group compared to the control. Improvements in MDI-spacer technique, knowledge and attitudes were significant throughout follow-up. Improvement in habits regarding MDI use was significant at 3 and 6 months, and asthma routines were improved at 3 months. However, there was no change in asthma-related healthcare utilization or home environmental triggers. Conclusion Using CHWs to deliver a home-based asthma education program to caregivers of children with persistent asthma led to improvements in symptom days and several secondary outcomes. Expanding the use of CHWs to provide home-based interventions can help reduce disparities in children’s health outcomes.