Exacerbations In Children Research Articles

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

P213 The 3-minute step test as a predictor of exacerbations in children and adolescents with cystic fibrosis

P213 The 3-minute step test as a predictor of exacerbations in children and adolescents with cystic fibrosis

Association of vitamin D levels and asthma exacerbations in children and adolescents: Experience from a tertiary care center.

The role of vitamin D as an immunosuppressant and anti-inflammatory has been studied previously for different pathologies in different populations globally. Relationships between serum vitamin D levels and its effect on asthma exacerbations in the adolescent asthma population are not well studied in this region. Therefore, this study was conducted to determine the vitamin D status in pediatric and adolescent asthma patients, and its association with asthma exacerbations. A retrospective study was conducted at The Aga Khan University Hospital from 2016 to 2020. Children and adolescents who were diagnosed and admitted with acute asthma exacerbations and who had at least one measurement of 25 hydroxy-vitamin D (25 OHD) were included in the study. Serum vitamin D levels were documented for enrolled patients and their past 2-year data was analyzed for asthma exacerbations, mean length of stay per admission, and admission plus length of stay at High Dependency Unit. 114 patients were included in the study. 41 patients (35.96%) were found to be vitamin D deficient, 38 patients (33.3%) were vitamin D insufficient, and 35 patients (30.7%) were labeled as vitamin D sufficient. The average number of exacerbations per year was significantly high in vitamin D deficient group (2.82±1.11) in comparison with insufficient (2.05±0.92) and sufficient groups (1.37±0.59) (p<0.001). Vitamin D deficiency is related to an increased number of annual asthma exacerbations, length of stay per admission, and admission into High Dependency Unit (HDU).

Volatile Organic Compounds in Exhaled Breath as Biomarkers of Pulmonary Exacerbations in Children with Cystic Fibrosis

Background/Objective: Cystic Fibrosis (CF) is the most common lethal genetic disease in Caucasians, but CF affects all races and ethnicities. A characteristic manifestation of CF is the pulmonary exacerbation (PEx), which involves an increase in pulmonary symptoms, decrease in pulmonary function, energy loss, weight loss, and changes to clinical findings, and correlates with lung disease progression and lower quality of life. However, in children with CF, PExs have a subtle presentation, similar to that of the cold or flu, and there is a need for a test that can identify PExs. For this project, our objective was to establish a proof of concept for the use of volatile organic compounds (VOCs) in exhaled breath as PEx biomarkers.&#x0D; &#x0D; Methods: This project enrolled 19 participants with a diagnosis of CF between the ages of 8 and 18, at Riley Cystic Fibrosis Center in Indianapolis. From each participant, exhaled breath was collected in a Tedlar Bag, in addition to lung function data and PEx status. Exhaled breath was analyzed for VOCs using Solid Phase Microextraction coupled to Gas Chromatography-Mass Spectrometry.&#x0D; &#x0D; Results: There were 13 VOCs that exhibited statistically significant differences in concentration between exhaled breath at baseline and during a PEx. These VOCs could be used in a Principal Component Analysis to differentiate baseline and PEx conditions. Finally, using Linear Regression, this project identified 22 VOCs with a significant correlation to lung function, an important potential confounder. Limitations include: (1) comparisons of multiple VOCs increase the likelihood of a false positive result and (2) small sample size.&#x0D; &#x0D; Conclusions: VOCs in exhaled breath are promising candidates as biomarkers to diagnose the presence and severity of PExs. In future experiments, we aim to expand the number of participants and track more clinical details to provide further evidence and applications for this proof of concept.

Evaluating FEV1 decline in diagnosis and management of pulmonary exacerbations in children with cystic fibrosis.

RationaleForced expiratory volume in 1 s (FEV1) decline (ΔFEV1) is associated with pulmonary exacerbation (PEx) diagnosis in cystic fibrosis (CF). Spirometry may not be available during telehealth visits and could impair clinician ability to diagnose PEx. This study aims to (1) identify the associations between degrees of ΔFEV1 (decrease of <5% predicted vs. 5%−9% predicted vs. ≥10% predicted from baseline), clinical symptoms, and clinician‐diagnosed PEx and (2) evaluate the correlation between respiratory symptoms, ΔFEV1, and antibiotic treatment.MethodsRetrospective, descriptive study of PEx diagnosis and management in 628 outpatient clinical encounters with spirometry in 178 patients with CF ages 6−17 years at Riley Hospital for Children during 2019. Odds ratios (OR) of symptoms associated with clinician‐defined PEx diagnosis and antibiotic management stratified by ΔFEV1 decline were determined.ResultsClinician‐diagnosed PEx occurred at 199 (31.7%) visits; increased cough (77.4%) and sputum/wet cough (57.8%) were the most frequently reported symptoms. Compared to no ΔFEV1, the odds of a clinician‐diagnosed PEx were increased when ΔFEV15%−9% and ΔFEV1≥10% was present with increased cough (OR 1.56, 95% confidence interval [CI] 1.25−1.94 and OR 1.82, 95% CI 1.52−2.19, respectively), increased sputum (OR 1.59, 95% CI 1.20−2.12 and OR 1.78, 95% CI 1.37−2.32, respectively), and increased cough and sputum together (OR 1.51, 95% CI 1.08−2.13 and OR 1.68, 95% CI 1.22−2.31, respectively).ConclusionsΔFEV1 is associated with increased likelihood that cough and sputum are diagnosed as a PEx. Spirometry is essential for PEx diagnosis and treatment and is a necessary component of all clinical encounters.

Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial

IntroductionPrimary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving...

The Probiotics in Pediatric Asthma Management (PROPAM) study: A Post Hoc analysis in allergic children

Type 2 inflammation is prevalent in children with asthma and increases susceptibility to respiratory infections.1 Furthermore, acute airway infections usually precede asthma exacerbations in children.2 Consequently, an ideal therapeutic strategy should be targeted to dampen inflammation and prevent infections. There is also evidence to suggest that children with asthma have intestinal and respiratory dysbiosis that promotes airway inflammation and allergy.3 It is speculated that probiotics could restore “eubiosis,” dampen inflammation, and prevent infections.

Assessing socioeconomic bias in machine learning algorithms in health care: a case study of the HOUSES index.

Artificial intelligence (AI) models may propagate harmful biases in performance and hence negatively affect the underserved. We aimed to assess the degree to which data quality of electronic health records (EHRs) affected by inequities related to low socioeconomic status (SES), results in differential performance of AI models across SES. This study utilized existing machine learning models for predicting asthma exacerbation in children with asthma. We compared balanced error rate (BER) against different SES levels measured by HOUsing-based SocioEconomic Status measure (HOUSES) index. As a possible mechanism for differential performance, we also compared incompleteness of EHR information relevant to asthma care by SES. Asthmatic children with lower SES had larger BER than those with higher SES (eg, ratio = 1.35 for HOUSES Q1 vs Q2-Q4) and had a higher proportion of missing information relevant to asthma care (eg, 41% vs 24% for missing asthma severity and 12% vs 9.8% for undiagnosed asthma despite meeting asthma criteria). Our study suggests that lower SES is associated with worse predictive model performance. It also highlights the potential role of incomplete EHR data in this differential performance and suggests a way to mitigate this bias. The HOUSES index allows AI researchers to assess bias in predictive model performance by SES. Although our case study was based on a small sample size and a single-site study, the study results highlight a potential strategy for identifying bias by using an innovative SES measure.

Use of systemic steroids during pulmonary exacerbations in children and adolescent with Cystic fibrosis.

To determine the role of systemic steroids in cystic fibrosis patients and its effects on pulmonary exacerbation in children and adolescents. The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from January 2015 to December 2019 of cystic fibrosis patients aged 3-18 years hospitalised with pulmonary exacerbations. The patients were divided into systemic steroid group A and non-systemic steroid group B. Patients in group A received parenteral steroids during acute exacerbation of cystic fibrosis in the first two weeks of admission, while those in group B did not receive systemic steroids. Length of hospital stay and number of days on oxygen support were compared between the groups. Data was analysed using SPSS 22. Of the 124 patient charts evaluated, 84(67.7%) were included; 40(47.6%) in group A and 44(52.4%) in group B. There were no significant differences between the groups related to age, age at diagnosis, weight, height, and pulmonary exacerbations (p>0.05). Group A had significantly fewer days on oxygen support compared to group B (p<0.001), but there was inter-group difference in mean length of hospital stay (p=0.53). Systemic steroid usage during hospitalisation for acute exacerbation of cystic fibrosis was associated with decreased duration of oxygen requirement with standard treatment.

The role of high carbohydrate-rich food intake and severity of asthma exacerbation in children between 2 to 6 years aged

Introduction Over the last decades, dietary habits in developing countries have been characterized by low intake of fruits and vegetables and high consumption of sweetened drinks. Most of the evidence linking carbohydrate intake and asthma comes from children over 6 years of age. The aim of this study was to examine the association between macronutrient intake and the severity of asthma exacerbations in children aged 2–6 years. Methods We performed a cross-sectional study that included all children aged 2–6 years hospitalized due to an asthma exacerbation. Dietary data were collected using a food frequency questionnaire (FFQ) validated in the Colombian population. The GINA classification of acute asthma was used to define the severity. To identify factors independently associated with asthma exacerbation severity, we fit the data to ordinal logistic regression. Results During the study period, 228 cases of patients with asthma exacerbation were included. Asthma severity was dose-dependently associated with protein and carbohydrate-rich intake. The variables included in the multivariable analysis included reactive C protein (OR 1.05, CI 95% (1.03–1.07)), smoking at home (OR 3.92 (1.82–8.44)), atopic dermatitis (OR 3.82 (1.59–9.21)), and protein and carbohydrate-rich food intake (OR 0.11 (0.03–0.33)) and (OR 2.42 (1.09–5.80)), respectively. Conclusion High carbohydrate-rich food intake is associated with the severity of asthma exacerbation adjusted by other known risk factors such as atopy, smoking, and reactive C protein. This evidence should motivate the development of public health policies to control the consumption of sugar-rich products in children under 6 years.

DO FAST/JUNK FOODS HAVE AN EFFECT ON ASTHMA IN CHILDREN

Certain types of food may increase or decrease the frequency of asthma exacerbations. The study is aimed at determining whether there is an association between consuming fast/junk foods and asthma. A well-adjusted, standardized questionnaire was used for the collection of information. This study is focused on finding a relationship between fast food intake and frequency and severity of asthma exacerbation rather than a causative relationship. This is a cross-sectional study done in the southern part of India in the state of Kerala. The correlation between fast food and asthma is established through a detailed analysis of the results. After adjusting for confounding variables like Environmental Tobacco Smoke (ETS) and allergens at home we were able to indicate that fast/junk food consumption is a risk factor for asthma symptom exacerbation in children.

DO FAST/JUNK FOODS HAVE AN EFFECT ON ASTHMA IN CHILDREN

Certain types of food may increase or decrease the frequency of asthma exacerbations. The study is aimed at determining whether there is an association between consuming fast/junk foods and asthma. A well-adjusted, standardized questionnaire was used for the collection of information. This study is focused on finding a relationship between fast food intake and frequency and severity of asthma exacerbation rather than a causative relationship. This is a cross-sectional study done in the southern part of India in the state of Kerala. The correlation between fast food and asthma is established through a detailed analysis of the results. After adjusting for confounding variables like Environmental Tobacco Smoke (ETS) and allergens at home we were able to indicate that fast/junk food consumption is a risk factor for asthma symptom exacerbation in children.

Risk Factors and Outcomes Associated With Antibiotic Therapy in Children Hospitalized With Asthma Exacerbation.

Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma. The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (β) with 95% CIs for regression analyses. Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever. Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.

Effect of the COVID-19 Lockdown on Asthma Biological Rhythms.

Asthma has a striking temporal character, in which time-of-day, patient age, and season each influence disease activity. The extent to which rhythms in asthma activity reflect exposure to specific disease triggers remains unclear. In this study, we examined how virus mitigation strategies enacted during the COVID-19 pandemic ("lockdown measures") affected rhythms in asthma clinical activity in children. To this end, we retrospectively analyzed asthma clinical presentations in children aged <18 years to our regional academic medical center, comparing 4 years of medical records prior to COVID-19 lockdown measures with the 12 months immediately after the institution of such measures. We correlated these data to positive viral test results, febrile seizures, and allergic clinical surrogates (allergic reaction visits and Emergency Department [ED] antihistamine prescriptions, respectively) over the same time frame. In the 12 months following the institution of the COVID-19 lockdown, positivity rates for common respiratory viruses dropped by 70.2% and ED visits for asthma among children dropped by 62% compared to pre-COVID years. Lockdown suppressed seasonal variation in positive viral tests and asthma ED visits, while diurnal rhythms in asthma visits were unchanged. Asthma seasonality correlated most strongly with rhinovirus positivity both before and after the institution of COVID lockdown measures. Altogether, our data support a causal role for viruses in driving seasonal variability in asthma exacerbations in children.

Spatial Estimation of PM2.5 Exposure and its Association with Asthma Exacerbation: A Prospective Study in Thai Children.

Background:The acceptable fine particulate matter (PM2.5) level in Thailand is double the recommendation of the World Health Organization. It is necessary to have an accurate measure of PM2.5 exposure and its association with health problems in vulnerable groups such as asthma exacerbation in Thai children to urge the Clean Air Act in Thailand, which is currently in the process of revision.Objective:To study the association between PM2.5 exposure and asthma exacerbation in children living in Bangkok Metropolitan Region and Chiang Mai Province.Methods:A pilot prospective observational study was conducted at the Chest and Allergy clinic at Ramathibodi Hospital, Mahidol University, Bangkok and at the Chest Clinic at Nakornping Hospital, Chiang Mai, Thailand, from June 2020 to February 2021. Children with asthma, aged 5–18 years old, were recruited. Respiratory symptoms, including cough, chest tightness, dyspnea or wheezing, peak expiratory flow rate, and asthma exacerbation, were recorded twice daily by caregivers. Estimated average daily PM2.5 exposure levels were calculated using ArcGIS® at exacerbation day, three days before exacerbation (lag day 3), and 7 days before exacerbation (lag day 7). Regression analysis was applied to examine the association between PM2.5 exposure and asthma exacerbation.Findings:Seventy asthmatic patients were enrolled. The median age was 9.7 (IQR 5–18) years old. There were 53 respiratory symptoms, 5 admissions, and 1 intensive care unit admission. Daily PM2.5 levels above 12 mcg/m3 (the US cut-off level for the sensitive group) has higher sensitivity to detect asthma exacerbation compared to Thai cut-off level for the sensitive group (37 mcg/m3) (sensitivity 98.2% vs 32.1%). The average daily PM2.5 level exposure at lag day 3 in the exacerbation vs the non-exacerbation group was 27.5 and 13.6 mcg/m3 (p < 0.01), respectively. The daily PM2.5 level at lag day 3 was also correlated with an acute asthmatic attack (r = 0.62, p < 0.01) with the 0.2 events increasing of asthmatic exacerbation every 10 mcg/m3 of increment of daily PM2.5 level.Conclusions:Our findings suggest that asthmatic children are sensitive to daily PM2.5 levels above 12 mcg/m3. Exposure to high daily PM2.5 levels can lead to asthma exacerbation within three days. Further participant recruitment is needed to emphasize this association and establish the national data.

Impact of azithromycin on serum inflammatory markers in children with cystic fibrosis and new Pseudomonas

Chronic azithromycin improves outcomes in cystic fibrosis (CF), but its mechanism of action is unclear. The OPTIMIZE trial demonstrated improvement in time to first pulmonary exacerbation in children with new Pseudomonas treated with azithromycin. Azithromycin effect on systemic markers of inflammation over 18 months was assessed by change from baseline for high-sensitivity C-reactive protein, myeloperoxidase, calprotectin and absolute neutrophil count in the OPTIMIZE population. Subjects treated with chronic azithromycin or placebo had samples collected at baseline, 39 and 78 weeks of treatment. In 129 subjects, a significant decrease in high-sensitivity C-reactive protein was present at 39 weeks in the azithromycin group compared to placebo, but no significant difference between the groups at 78 weeks. No differences in change from baseline in myeloperoxidase, calprotectin or absolute neutrophil count were present at either time point. This supports the concept of a transient immunomodulatory effect for chronic azithromycin therapy in children with CF.

Associations between high ambient temperatures and asthma exacerbation among children in Philadelphia, PA: a time series analysis

ObjectivesHigh ambient temperatures may contribute to acute asthma exacerbation, a leading cause of morbidity in children. We quantified associations between hot-season ambient temperatures and asthma exacerbation in children ages 0–18...

Risk of asthma exacerbation associated with opioid and nonopioid analgesic use in children with current asthma.

BACKGROUND: In the United States, asthma occurs in a vast proportion of children and adolescents. Asthma exacerbation is an acute episodic event typically characterized by difficulty in breathing, chest tightness, coughing, or wheezing. Severe asthma exacerbation can be life-threatening and lead to service utilizations such as hospitalizations and emergency department (ED) visits. Opioid analgesic use can trigger an asthma exacerbation through 2 pharmacological mechanisms. Despite the potential mechanisms, there is lack of empirical evidence to determine the risk of asthma exacerbation and its association with opioid use. OBJECTIVE: To evaluate the risk of asthma exacerbation in children with current asthma receiving an opioid vs a nonopioid analgesic. METHODS: Eligible individuals aged under 18 years with current asthma and receiving an incident analgesic prescription were identified from a large Medicaid managed care database during 2013-2018. Current asthma was defined as receipt of an asthma diagnosis and an antiasthmatic medication in the 12 months before analgesic medication initiation. Asthma exacerbation was defined as a hospitalization or ED visit with asthma as either the primary or secondary diagnosis within 3 days of receipt of an analgesic prescription. A weighted multivariable logistic regression using inverse probability treatment weighting was performed to test the association between use of analgesic medication and risk of asthma exacerbation. RESULTS: This study included 13,359 children with current asthma who filled either an incident opioid (n = 5,363, 40.1%) or nonopioid analgesic (n = 7,996, 59.9%) prescription. Asthma exacerbation was observed in 24 (0.5%) opioid analgesic recipients and 22 (0.3%) nonopioid analgesic recipients within 3 days of analgesic initiation. Weighted logistic regression results showed that children receiving opioid analgesics (adjusted odds ratio = 1.6, 95% CI = 0.9-2.9) did not have a statistically significantly higher risk of asthma exacerbation than their nonopioid analgesic recipient counterparts in the propensity score-weighted multivariable analysis. CONCLUSIONS: Asthma exacerbation associated with analgesic use in children with current asthma was an uncommon event, and the risk was comparable among children receiving opioid vs nonopioid analgesics. DISCLOSURES: This study was supported and funded by the Agency for Healthcare Research and Quality (AHRQ), Project Number: 1R03HS026790-01A1. The study content was solely the responsibility of the authors, and AHRQ had no role in the design and conduct of the study. The authors have nothing to disclose.

Viral Infection and Respiratory Exacerbation in Children: Results from a Local German Pediatric Exacerbation Cohort.

Respiratory viruses play an important role in asthma exacerbation, and early exposure can be involved in recurrent bronchitis and the development of asthma. The exact mechanism is not fully clarified, and pathogen-to-host interaction studies are warranted to identify biomarkers of exacerbation in the early phase. Only a limited number of international exacerbation cohorts were studied. Here, we have established a local pediatric exacerbation study in Germany consisting of children with asthma or chronic, recurrent bronchitis and analyzed the viriome within the nasopharyngeal swab specimens derived from the entire cohort (n = 141). Interestingly, 41% of exacerbated children had a positive test result for human rhinovirus (HRV)/human enterovirus (HEV), and 14% were positive for respiratory syncytial virus (RSV). HRV was particularly prevalent in asthmatics (56%), wheezers (50%), and atopic (66%) patients. Lymphocytes were decreased in asthmatics and in HRV-infected subjects, and patients allergic to house dust mites were more susceptible to HRV infection. Our study thus confirms HRV infection as a strong ‘biomarker’ of exacerbated asthma. Further longitudinal studies will show the clinical progress of those children with a history of an RSV or HRV infection. Vaccination strategies and novel treatment guidelines against HRV are urgently needed to protect those high-risk children from a serious course of disease.

Safety and Effectiveness of Prolonged Magnesium Sulfate (MgSO4) Infusion for Asthma Exacerbation in Children

AbstractThe objective of this study was to assess the safety and describe treatment details of prolonged magnesium sulfate (MgSO4) infusion for children with asthma exacerbation. A retrospective cross-sectional study included children under 13 years of age who were admitted with asthma exacerbation and received at least 24 hours of MgSO4 infusion. One hundred children were included. No patient developed serious adverse events. The mean infusion duration was 74.2 hours. Eighty-nine percent recovered with no other bronchodilator infusions, and 94% did not require respiratory support escalation. Prolonged MgSO4 infusion is safe at a maximum dose of 30 mg/kg/h and may be beneficial for children with asthma exacerbation.