Exacerbations In Children Research Articles

Sociome Data Commons: A scalable and sustainable platform for investigating the full social context and determinants of health.

Non-clinical aspects of life, such as social, environmental, behavioral, psychological, and economic factors, what we call the sociome, play significant roles in shaping patient health and health outcomes. This paper introduces the Sociome Data Commons (SDC), a new research platform that enables large-scale data analysis for investigating such factors. This platform focuses on "hyper-local" data, i.e., at the neighborhood or point level, a geospatial scale of data not adequately considered in existing tools and projects. We enumerate key insights gained regarding data quality standards, data governance, and organizational structure for long-term project sustainability. A pilot use case investigating sociome factors associated with asthma exacerbations in children residing on the South Side of Chicago used machine learning and six SDC datasets. The pilot use case reveals one dominant spatial cluster for asthma exacerbations and important roles of housing conditions and cost, proximity to Superfund pollution sites, urban flooding, violent crime, lack of insurance, and a poverty index. The SDC has been purposefully designed to support and encourage extension of the platform into new data sets as well as the continued development, refinement, and adoption of standards for dataset quality, dataset inclusion, metadata annotation, and data access/governance. The asthma pilot has served as the first driver use case and demonstrates promise for future investigation into the sociome and clinical outcomes. Additional projects will be selected, in part for their ability to exercise and grow the capacity of the SDC to meet its ambitious goals.

Assessment and management of asthma exacerbations in an emergency department unit.

The Pediatric Respiratory Assessment Measure (PRAM) score is a useful tool for the assessment of asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in children, assessed with the PRAM score and having mild-moderate asthma exacerbation, who were treated with salbutamol delivered via a metered-dose inhaler and spacer (MDI/S). The study population consisted of children aged 3-16 years with mild-moderate asthma exacerbations. All children received 1mg/kg prednisolone p.o. (max 40 mg) and 4-6 puffs of salbutamol via MDI/S. Fifty patients participated in the study. Admission was associated positively with the initial PRAM score (OR: 18.91, CI: 2.42-123.12, P = 0.005) and negatively with the improvement in PRAM score (OR: 0.52, CI: 0.01-0.78, P = 0.032). PRAM is a reliable tool that can be used effectively to estimate the asthma exacerbation severity.

Associations between outdoor air pollutants and non-viral asthma exacerbations and airway inflammatory responses in children and adolescents living in urban areas in the USA: a retrospective secondary analysis

Asthma prevalence and severity have markedly increased with urbanisation, and children in low-income urban centres have among the greatest asthma morbidity. Outdoor air pollution has been associated with adverse respiratory effects in children with asthma. However, the mechanisms by which air pollution exposure exacerbates asthma, and how these mechanisms compare with exacerbations induced by respiratory viruses, are poorly understood. We aimed to investigate the associations between regional air pollutant concentrations, respiratory illnesses, lung function, and upper airway transcriptional signatures in children with asthma, with particular focus on asthma exacerbations occurring in the absence of respiratory virus. We performed a retrospective analysis of data from the MUPPITS1 cohort and validated our findings in the ICATA cohort. The MUPPITS1 cohort recruited 208 children aged 6-17 years living in urban areas across nine US cities with exacerbation-prone asthma between Oct 7, 2015, and Oct 18, 2016, and monitored them during reported respiratory illnesses. The last MUPPITS1 study visit occurred on Jan 6, 2017. The ICATA cohort recruited 419 participants aged 6-20 years with persistent allergic asthma living in urban sites across eight US cities between Oct 23, 2006, and March 25, 2008, and the last study visit occurred on Dec 30, 2009. We included participants from the MUPPITS1 cohort who reported a respiratory illness at some point during the follow-up and participants from the ICATA cohort who had nasal samples collected during respiratory illness or at a scheduled visit. We used air quality index values and air pollutant concentrations for PM2·5, PM10, O3, NO2, SO2, CO, and Pb from the US Environmental Protection Agency spanning the years of both cohorts, and matched values and concentrations to each illness for each participant. We investigated the associations between regional air pollutant concentrations and respiratory illnesses and asthma exacerbations, pulmonary function, and upper airway transcriptional signatures by use of a combination of generalised additive models, case crossover analyses, and generalised linear mixed-effects models. Of the 208 participants from the MUPPITS1 cohort and 419 participants from the ICATA cohort, 168 participants in the MUPPITS1 cohort (98 male participants and 70 female participants) and 189 participants in the ICATA cohort (115 male participants and 74 female participants) were included in our analysis. We identified that increased air quality index values, driven predominantly by increased PM2·5 and O3 concentrations, were significantly associated with asthma exacerbations and decreases in pulmonary function that occurred in the absence of a provoking viral infection. Moreover, individual pollutants were significantly associated with altered gene expression in coordinated inflammatory pathways, including PM2·5 with increased epithelial induction of tissue kallikreins, mucus hypersecretion, and barrier functions and O3 with increased type-2 inflammation. Our findings suggest that air pollution is an important independent risk factor for asthma exacerbations in children living in urban areas and is potentially linked to exacerbations through specific inflammatory pathways in the airway. Further investigation of these potential mechanistic pathways could inform asthma prevention and management approaches. National Institutes of Health, National Institute of Allergy and Infectious Diseases.

705: NATIONAL TRENDS IN PEDIATRIC CRITICAL ASTHMA SEVERITY DURING THE COVID-19 PANDEMIC

Introduction: Asthma exacerbations in children have historically been attributed to a combination of viral infection, environmental exposures, and individual patient attributes. The COVID-19 pandemic has provided a unique opportunity to evaluate variations in asthma severity during a time of changing viral exposure patterns and patient behaviors. This study describes the trends in pediatric critical asthma severity during the COVID-19 pandemic. Methods: We performed a retrospective analysis of the Virtual Pediatric Systems (VPS) database. Inclusion criteria were: patients admitted to a pediatric intensive care unit in the United States from 2014-2021 with a discharge diagnosis of “asthma with acute exacerbation” or “asthma with status asthmaticus.” Asthma severity was determined by the maximum level of respiratory support required during the admission, from lowest to highest: 1-Heated high flow nasal cannula; 2-Non-invasive positive pressure; 3-Endotracheal intubation; 4-Inhaled anesthetics or ECMO. Patients were divided into Pre-COVID, Pandemic Era 2020, and 2021 groups based on the date of admission, with the start of the COVID-19 pandemic defined as April 1, 2020. Subgroup analysis was performed based on race/ethnic group. Results: A total of 51,746 patients were identified in the VPS database that met the stated criteria. The average number of admissions per month was 713 and 206 in the Pre-COVID and Pandemic groups, respectively. Patients categorized as “Severe” (severity levels 3 & 4) represented 3.8% and 4.7% of admissions, respectively (p< 0.05). Patients categorized as “Moderate” (severity level 2) represented 16.9% and 21.7% of admissions, respectively (p< 0.05). Asthma mortality rates were found to be 0.3% and 0.7%, respectively (p< 0.05). Subgroup analysis by race/ethnic group found that asthma severity by race/ethnicity was unchanged from the pre-COVID baseline. Conclusions: During the COVID-19 pandemic, the number of critical asthma admissions decreased while the average severity and mortality rate in those patients increased. Further study is needed to determine whether these findings are due to delayed presentation to healthcare, changes in viral exposure patterns, or other factors.

Impact of viral respiratory infections on pulmonary exacerbations in children with cystic fibrosis.

Viral respiratory infections trigger pulmonary exacerbations (PEs) in children with cystic fibrosis (CF), but their clinical impact is not well understood. A retrospective review of pediatric patients with CF who underwent nasopharyngeal respiratory viral paneltesting during hospitalization for a PE between 2011 and 2018 was conducted. Patients were dichotomized into viral-positive and viral-negative groups. The results of spirometry, respiratory cultures, duration of hospitalization, and risk for subsequent PEs were analyzed. Ninety-five patients had 210 hospitalizations for PE (viral-positive = 71/210, 34%) during the study period. Rhinovirus/enterovirus was the most common virus (52/71, 73%) identified. Viral-positive patients were younger (p < 0.001), had higher baseline forced expiratory volume in 1 s(FEV1) (p = 0.037), continued to maintain higher FEV1 at 3 and 6 months following PE (p = 0.003 and 0.002, respectively), and had a shorter duration of hospitalization (p = 0.006) compared to the viral-negative group. There was no difference between the two groups in the rate of recovery of FEV1 at 3 and 6 months following PE (p = 0.71 and 0.405, respectively), time to the next PE (hazard ratio = 1.34, p = 0.157), number of subsequent PEs in 6 months (p = 0.99), or Pseudomonas aeruginosa(PA) acquisition (p = 0.707). In this single pediatric CF center cohort, one-third of PEs requiring hospitalization were associated with a viral infection, with rhinovirus/enterovirus being the most common. Viral-positive PEs were not associated with a greater decline or delayed recovery of lung function, increased risk for PA acquisition, shortened duration to next PE, longer hospital stay, or an increase in the frequency of subsequent PEs in 6 months compared to viral-negative PEs.

Association between Cough and Ambient Polycyclic Aromatic Hydrocarbons in Patients with Chronic Cough: An Observational Study in Two Regions of Japan

Ambient polycyclic aromatic hydrocarbons’ (PAHs) specific components are likely involved in respiratory disease development and exacerbation in children and adults. Airborne PAH exposure’s effects on cough symptoms in children and adults with chronic coughs in Kanazawa and Fukuoka, Japan, were investigated in this longitudinal study. A total of 98 patients with chronic coughs were enrolled and followed up between 1 April and 31 May 2020. The enrolled patients were non-smoking adults and children aged 3–83 years. Cough diaries were used to record and collect daily cough symptoms. High-performance liquid chromatography coupled with a fluorescence detector was used to determine the particulate PAH content in daily total suspended particles collected on quartz fiber filters. Ambient concentrations of fine particulate matter, nitrogen dioxide, and sulfur dioxide were obtained from local monitoring sites. Generalized estimated equations were used to estimate the association between daily PAHs and cough symptoms. Among nine PAHs measured, benz[a]anthracene (BaA) was significantly associated with cough symptoms for both lag4 and lag5 PAH exposure. These findings suggest that airborne specific PAHs, especially BaA, affect cough symptoms in children and adults with chronic cough. Further studies are needed to develop effective measures to prevent respiratory diseases against specific PAHs.

Immunomodulators Containing Epicor, Colostrum, Vitamin D, Zinc, Lactobacilli and Bifidobacterium Reduce Respiratory Exacerbations in Children and Adults with Chronic Pulmonary Diseases

(1) Background: A number of studies have demonstrated the connection between developing or exacerbating chronic respiratory diseases in adults and children. However, still, few studies focus on reducing exacerbations via immunomodulation. (2) Methods: In this pilot study, a total of 25 pediatric and adult patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)/persistent bacterial bronchitis (PBB) were included, administered over-the-counter (OTC) immunomodulators and followed up for 6 or 12 months. (3) Results: We observed a decrease in the frequency of exacerbations with slight improvements in functional respiratory indicators in adults on their second and third visits and a reduced number of exacerbations and improved spirometry indices in children with BA, although exacerbations requiring hospital admission remained at a similar rate. (4) Conclusions: We confirmed that the number of exacerbations of underlying chronic respiratory disease in adults and children could be reduced after the administration of OTC immunomodulators, probably by optimizing the immune resistance to common viral infections.

Pulse oximetry and peak expiratory flow rate correlations in acute asthma exacerbation in children.

The relationship between oxygen saturation (SpO2) and peak expiratory flow rate (PEFR) in patients with acute asthma is variable. This study aims to assess the predictive value and correlation of this relationship in identifying children with mild symptoms of asthma exacerbation and defining their role in guiding early intervention decision-making. This was a retrospective review of the register of children with asthma seen at the respiratory clinic of a tertiary center in Nigeria from April 2014 to February 2020. Information on their biodata, medical history, clinical status, baseline SPO2, and %predicted PEFR was retrieved and analyzed. The mean values for participants with no symptoms and those with mild symptoms of asthma exacerbation were respectively: SpO2 was 97 ± 1.6% and 96 ± 2.6% (MD: 1.2; 95% CI; 0.7-1.7, P < 0.001); %predicted PEFR: 77.8 ± 17.8 and 64.1 ± 23 (MD; 13.68; 95% CI; 7.3 to 20.0, P < 0.001). Among those with uncontrolled asthma who were having mild symptom exacerbation of their asthma, the correlation between SpO2 and %predicted PEFR was significantly moderate (r = 0.44, P = 0.04). Children with SpO2 between the range of 92%-95% were significantly more likely to have mild symptoms of asthma exacerbation (OR: 2.52,95% CI: 1.22, 5.2, P = 0.01) compared to those with SpO2 >95%. Children with SpO2 of <95% are more likely to have an acute asthma exacerbation. While SpO2 and PEFR have more role in identifying children without acute asthma exacerbation and a limited role in identifying children with mild symptoms of asthma due to their exacerbation due to their moderate to poor correlation.

Long-term effects of vitamin D on exacerbation rate, health care utilization and lung function in children with asthma.

Asthma exacerbations lead to unplanned health care utilization and reduced lung function in children. Sufficient vitamin D level has been found to have a short-term protective effect against asthma exacerbation in children. However, it is unclear whether this effect remains in the long term. We evaluated the long-term effects of vitamin D levels on the occurrence of asthma exacerbations, emergency department visits or hospitalizations, and lung function among children with asthma, and further investigated the temporal trends of the effects. In this retrospective cohort study, children with asthma who were admitted to the Children's Hospital of Chongqing Medical University from 2017 to 2021 were enrolled. Negative binomial, Poisson, or logistic regression model was used for the multivariable analysis, adjusting for age, sex, body mass index z-score, and severity of asthma exacerbation. Of the 370 children with asthma, 87.8% had vitamin D level less than or equal to 30 ng/mL. After adjustment for confounding factors, higher baseline vitamin D levels in asthma children were significantly associated with reduced occurrence of asthma exacerbations during the first [odds ratio 0.842, 95% confidence interval (CI): 0.805-0.881; P<0.001], second (odds ratio 0.848, 95% CI: 0.793-0.907; P<0.001) and third years (odds ratio 0.865, 95% CI: 0.811-0.922; P<0.001) of follow-up. Higher vitamin D levels in asthmatic children were also strongly associated with a reduced number of emergency department visits or hospitalizations during the first (odds ratio 0.880, 95% CI: 0.842-0.920; P<0.001), second (odds ratio 0.885, 95% CI: 0.832-0.941; P<0.001), and third years (odds ratio 0.922, 95% CI: 0.851-0.998; P=0.044) of follow-up. In addition, the vitamin D levels in asthmatic children were found to be negatively associated with the odds of large airway dysfunction (odds ratio 0.865, 95% CI: 0.771-0.970; P=0.013) and small airway dysfunction (odds ratio 0.922, 95% CI: 0.855-0.996; P=0.038) during the first year of follow-up. Sufficient vitamin D level is associated with lower risk of asthma exacerbations and health care utilization over a 3-year period, and improved lung function over 1 year. The protective effects of vitamin D on asthmatic children decreased over time.

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.

Vitamin D Supplementation and Allergic Diseases during Childhood: A Systematic Review and Meta-Analysis.

We performed a systematic review and meta-analysis to investigate the effects of vitamin D (VitD) supplementation on children with allergic diseases. MEDLINE, Embase, Web of Science, the Cochrane library, and three Chinese databases were searched up to 15 August 2022. Randomized controlled trials (RCTs) comparing a VitD supplementation versus a placebo for children with allergic diseases were included. Thirty-two RCTs with 2347 participants were included. VitD supplementation did not reduce the risk of asthma exacerbations in children compared with placebo overall (risk ratio (RR) = 0.84, 95% confidence interval (CI): 0.65 to 1.08, p = 0.18), but reduced the risk of asthma exacerbation in children with baseline serum 25(OH)D of <10 ng/mL compared with placebo (RR = 0.48, 95% CI: 0.28 to 0.83, p = 0.009). VitD supplementation significantly reduced Scoring Atopic Dermatitis or the Eczema Area and Severity Index scores in children with atopic dermatitis compared with placebo (standard mean difference = −0.5, 95% CI: −0.87 to −0.12, p = 0.009). VitD supplementation also reduced the symptom-medication score in children with allergic rhinitis compared with placebo (mean (standard deviation): 43.7 (3.3) vs. 57.8 (4.4), p = 0.001). In conclusion, VitD supplementation did not reduce asthma exacerbation risk in children overall but may reduce asthma exacerbation risk in children with serum 25(OH)D concentration < 10 ng/mL. VitD supplementation reduces the severity of atopic dermatitis and symptoms of allergic rhinitis in children.

Viral Infection and Airway Epithelial Immunity in Asthma.

Viral respiratory tract infections are associated with asthma development and exacerbation in children and adults. In the course of immune responses to viruses, airway epithelial cells are the initial platform of innate immunity against viral invasion. Patients with severe asthma are more vulnerable than those with mild to moderate asthma to viral infections. Furthermore, in most cases, asthmatic patients tend to produce lower levels of antiviral cytokines than healthy subjects, such as interferons produced from immune effector cells and airway epithelial cells. The epithelial inflammasome appears to contribute to asthma exacerbation through overactivation, leading to self-damage, despite its naturally protective role against infectious pathogens. Given the mixed and complex immune responses in viral-infection-induced asthma exacerbation, this review examines the diverse roles of airway epithelial immunity and related potential therapeutic targets and discusses the mechanisms underlying the heterogeneous manifestations of asthma exacerbations.

Protective effect of inhaled corticosteroid on children with asthma with Mycoplasma pneumoniae pneumonia

BackgroundThe aim of this study was to determine the differences in the characteristics of Mycoplasma pneumoniae pneumonia (MPP) in children with and without asthma and in children with asthma with and without inhaled corticosteroid (ICS) therapy in order to determine the risk factors for asthma exacerbation and the effect of regular ICS therapy on children with asthma with MPP.Materials and methodsChildren with MPP were divided into two groups according to whether they had a history of asthma. Children with asthma were further divided into an ICS therapy group and a group without ICS therapy. The clinical characteristics, laboratory test results, and pulmonary images were compared between the children with and without asthma. Differences in the severity of acute exacerbation were compared between the children with asthma in the ICS therapy and without ICS therapy groups. Multivariable logistic regression was used to determine the risk factors for exacerbation of MPP in children with asthma.ResultsIn children with MPP, the differences in the eosinophil counts; total immunoglobulin E (IgE), C-reactive protein, procalcitonin (PCT), and lactate dehydrogenase (LDH) levels; and fever duration, wheezing, extrapulmonary complications, oxygen saturation < 92%, severe pneumonia, pleural effusion, co-infection with other pathogens, and lobar pneumonia between children with and without asthma were statistically significant. Among children with asthma with MPP, those in the ICS therapy group were less likely to experience an exacerbation, and exacerbations were less severe than those in the without ICS therapy group. The multivariable logistic regression analysis showed that the ICS therapy was an independent protective factor against exacerbation.ConclusionAmong children with MPP, the chance of wheezing was higher in children with asthma than in children without asthma. The ICS therapy was a protective factor against exacerbation in children with asthma with MPP.

Association between early chronic methicillin-susceptible Staphylococcus aureus colonization and lung function in children with cystic fibrosis.

Our aim was to determine whether early chronic methicillin-susceptible Staphylococcus aureus (MSSA) colonization in children with cystic fibrosis (CF) is associated at 8 years of age with poorer lung function, poorer nutritional status, and increased exacerbation frequency. In this retrospective cohort study, a total of 52 children with chronic MSSA colonization were included. Of them, 26 were chronically colonized with MSSA before the age of 4 years (early onset), and 26 were chronically colonized from 4 years to 6 years of age (late-onset). At the age of 8 years, lung function, body mass index (BMI) as an indicator of nutritional status and frequency of pulmonary exacerbations were compared between two groups. At 8 years of age, BMI was similar between the early-onset and late-onset groups (15.0 [min-max: 12.9-26.8] vs. 15.7 (min-max: 13.0-24.9), p = 0.327]. Percentage of forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) in 8-year-old children were significantly lower in the early onset group compared to the late-onset group (98 [min-max: 44-139] vs. 106.5 [min-max: 82-131], p = 0.047; 84.9 ± 25.5 vs. -102.3 ± 26.3, respectively; p = 0.019], although the percentage of forced vital capacity did not differ significantly between two groups (93.5 [min-max: 45-131] vs. 103 [min-max: 84-119], respectively; p = 0.092). Exacerbation frequency between the ages of 6 and 8 years in the early onset group was higher compared to the late-onset group according to the Poisson regression model [1 (min-max:0-10) vs 0 (min-max:0-4), respectively; p = 0.044]. Early chronic MSSA colonization is associated with poorer lung function and frequent exacerbations in children with CF. However, further studies are needed to reveal the cause-and-effect relationship between early chronic MSSA colonization and pulmonary outcome.

Antibiotics and outcomes of CF pulmonary exacerbations in children infected with MRSA and Pseudomonas aeruginosa

Limited data exist to inform antibiotic selection among people with cystic fibrosis (CF) with airway infection by multiple CF-related microorganisms. This study aimed to determine among children with CF co-infected with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (Pa) if the addition of anti-MRSA antibiotics to antipseudomonal antibiotic treatment for pulmonary exacerbations (PEx) would be associated with improved clinical outcomes compared with antipseudomonal antibiotics alone. Retrospective cohort study using data from the CF Foundation Patient Registry-Pediatric Health Information System linked dataset. The odds of returning to baseline lung function and having a subsequent PEx requiring intravenous antibiotics were compared between PEx treated with anti-MRSA and antipseudomonal antibiotics and those treated with antipseudomonal antibiotics alone, adjusting for confounding by indication using inverse probability of treatment weighting. 943 children with CF co-infected with MRSA and Pa contributed 2,989 PEx for analysis. Of these, 2,331 (78%) PEx were treated with both anti-MRSA and antipseudomonal antibiotics and 658 (22%) PEx were treated with antipseudomonal antibiotics alone. Compared with PEx treated with antipseudomonal antibiotics alone, the addition of anti-MRSA antibiotics to antipseudomonal antibiotic therapy was not associated with a higher odds of returning to ≥90% or ≥100% of baseline lung function or a lower odds of future PEx requiring intravenous antibiotics. Children with CF co-infected with MRSA and Pa may not benefit from the addition of anti-MRSA antibiotics for PEx treatment. Prospective studies evaluating optimal antibiotic selection strategies for PEx treatment are needed to optimize clinical outcomes following PEx treatment.

Past asthma exacerbation in children predicting future exacerbation: a systematic review.

Acute exacerbations are common in children and potentially preventable. Currently, a past exacerbation is the best predictor of a future exacerbation. We undertook a systematic review of the literature describing the relationship between past and future exacerbations. Our analysis considered whether the odds ratios for one exacerbation to predict a recurrence were different across different categories of exacerbation. Four databases were searched systematically (MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health and PsycInfo). Exacerbations were categorised by severity as: presentation to emergency department (ED); hospital admission; paediatric intensive care unit (PICU) admission; and "unspecified severity" (i.e. no distinction between severity categories was made). Meta-analysis was performed for studies where sufficient data were provided for inclusion. There were 26 eligible articles from 9185 identified. There was significant heterogeneity in duration of follow-up, healthcare system and exacerbation definition between studies. For the unspecified severity definition, the odds ratio for an exacerbation after a previous exacerbation was 9.87 (95% CI 5.02-19.39; six studies, 162 583 individuals). PICU admission was also associated with increased risk of future admission (OR 5.87, 95% CI 2.96-11.64; two studies, 730 individuals). Meta-analysis was not possible for ED visits or hospitalisation. The median odds ratio (range) for past ED visit predicting future ED visit was 6.27 (3.3-8.26) and for past hospitalisation predicting future hospitalisation was 3.37 (1.89-5.36). The odds for a second asthma exacerbation do not necessarily increase with increasing severity of an initial exacerbation.

The Nutritional Status of Children with Asthma and Its Relationship with Acute Exacerbations

Background: Asthma is a chronic inflammatory disease of the airways. There is increasing international interests in the role of nutrition in asthma control. Objectives: This study was carried out to determine the nutritional status of children with asthma using the World Health Organization (WHO) growth reference charts for height, weight, and body mass index (BMI) for age and to determine the relationship if any between nutritional status and frequency of acute asthmatic exacerbations. Materials and Methods: It was a descriptive cross-sectional study of children aged 6–17 years with asthma attending the pediatric respiratory clinic of a tertiary hospital from October 2017 to March 2019. All the values obtained were interpreted using the WHO reference growth charts z-scores. Results: A total of 71 children participated in the study. The study showed that 94% of the children with asthma were of normal height with 2.6% stunted and 2.6% severely stunted. There was no significant association between the height and the frequency of acute exacerbation. About 65% of the children had normal BMI. Those that were wasted/severely wasted were 19.7%, whereas 15.5% were overweight/at risk of overweight. There was no significant association between the BMI and the frequency of acute exacerbations (P &gt; 0.05). The odds of having more frequent exacerbations in children with either above normal or below normal BMI were 1.05 (0.11–10.44) and 0.81 (0.08–7.88), respectively. Conclusion: Majority of the children with asthma were of normal height. Despite the fact that there were more children who were wasted/severely wasted than overweight/risk of overweight, these findings were not significantly associated with more frequent acute exacerbations.

Ozone Pollution, Perceived Support at Home, and Asthma Symptom Severity in the Adolescent Sample of the California Health Interview Survey

BackgroundOutdoor air pollution, including ozone (O3) pollution, and childhood family environments may interact and impact asthma exacerbations in children. Previous epidemiology studies have primarily focused on stress in the home, rather than support, and whether psychosocial factors modify the association between pollution and health outcomes, rather than whether pollution exposure modifies associations between psychosocial factors and health outcomes.MethodsData from the cross-sectional 2003 representative, population-based California Health Interview Survey were linked with air quality monitoring data on O3 pollution from the California Air Resources Board. Adolescents (N = 209) ages 12–17 who reported an asthma diagnosis and lived within 5 mi of the nearest air monitoring station had linked O3 data for a 12-month period preceding the survey interview date. Adolescents reported perceived available support from an adult at home and frequency of asthma symptoms.ResultsIn unadjusted models, for adolescents living in high O3 pollution regions, greater perceived support was related to lower asthma symptom frequency. Follow-up analyses suggested that the most plausible interpretation of the interaction was that O3 exposure modified the association between perceived support and symptom frequency. O3 × perceived support interactions were not statistically significant after adjusting for covariates.ConclusionsThese data provide preliminary evidence that the association between the lack of support in the home environment and worse asthma symptoms may be stronger in areas with higher O3 exposure. Future work may benefit from incorporating personal pollution exposure assessments, comprehensive family environment assessments, and longitudinal follow-up of asthma exacerbations over time.

Value of the acute asthma intensity research score (AAIRS) for asthma exacerbations in children

Background: Correct severity assessment of asthma exacerbations helps in appropriate management. The purpose of the study was to investigate the value of the Acute Asthma Intensity Research Score (AAIRS) in assessing the severity of asthma exacerbations in children. Methods: A cross-sectional descriptive study was conducted in 226 children aged 1-15 years admitted with asthma exacerbations from April 2018 to June 2020. Results: The majority of children were admitted with severe asthma exacerbations (44.2% in children aged 1-5 years and 85.5% in children aged 6-15 years). The prevalence of mild, moderate, and severe AAIRS were 31.0%, 56.6%, and 12.4%, respectively. In children 5 years and younger, AAIRS ≥ 9 had a sensitivity of 73.81% and a specificity of 83.02% in the classification of severe asthma exacerbations according to the guidelines of Vietnam Ministry of Health (AUC = 0.833) with Cohen’s kappa coefficient k = 0.17. In children aged 6-15 years, AAIRS ≥ 6 had a sensitivity of 89.29% and a specificity of 100% in the classification of severe asthma exacerbations according to the GINA guidelines (AUC = 0.951) with Cohen’s kappa coefficient k = 0.56. Conclusion: The AAIRS was not a substitute for current guidelines for assessing asthma exacerbation severity, especially in children aged 1-5 years. Key words: asthma exacerbations, AAIRS, children

Risk factors of asthma exacerbations in children and its effect on their school absence and performance

Risk factors of asthma exacerbations in children and its effect on their school absence and performance