Family History Of Asthma Research Articles

Knowledge and perception about asthma in a Nigerian university community

Background: Asthma, a global health issue, affffects people of all ages and backgrounds. There are some misconceptions about asthma. This study assessed the knowledge and perception about asthma in a Nigerian university community. Methods: This cross-sectional study was conducted among students in University of Nigeria Nsukka on WAD 2021. A self-administered structured questionnaire was fifilled by conveniently sampled students in a strategic location on campus. Inferential statistics utilized the Pearson's Chi-Square test and multiple linear regression with P< 0.05 of statistical signifificance. Results: One hundred and fififty-eight (158) students participated in the study. Majority of the participants were between the ages of 18 to 23 years (n = 128; 81.0%), in their fifirst or second year of university (n = 106; 77.1%), and in Social Sciences or Arts (n = 147; 93.0%). Less than a tenth of the participants had been previously diagnosed of asthma (n = 12; 7.6%). Close to a quarter of them had a family history of asthma (n = 37, 23.4%). The awareness about asthma was high (n = 155; 98.1%). Less than half of the participants had good knowledge of asthma (n = 52; 32.9%) and positive perception of asthma (n = 76; 48.1%). Conclusion: Majority of the students had high awareness about asthma but with poor knowledge of the disease. In addition, less than half of the participants had positive perceptions about asthma. These necessitate the need for health education on asthma.

Time-Specific Factors Influencing the Development of Asthma in Children.

Susceptibility to asthma is complex and heterogeneous, as it involves both genetic and environmental insults (pre- and post-birth) acting in a critical window of development in early life. According to the Developmental Origins of Health and Disease, several factors, both harmful and protective, such as nutrition, diseases, drugs, microbiome, and stressors, interact with genotypic variation to change the capacity of the organism to successfully adapt and grow in later life. In this review, we aim to provide the latest evidence about predictive risk and protective factors for developing asthma in different stages of life, from the fetal period to adolescence, in order to develop strategic preventive and therapeutic interventions to predict and improve health later in life. Our study shows that for some risk factors, such as exposure to cigarette smoke, environmental pollutants, and family history of asthma, the evidence in favor of a strong association of those factors with the development of asthma is solid and widely shared. Similarly, the clear benefits of some protective factors were shown, providing new insights into primary prevention. On the contrary, further longitudinal studies are required, as some points in the literature remain controversial and a source of debate.

Residential environment in relation to self-report of respiratory and asthma symptoms among primary school children in a high-polluted urban area

Respiratory disease and its complication are the cause of children deaths worldwide every year. Several epidemiological studies pointed out an association between quality of residential in inner city and risk of children health. However, few studies had been focused in high-polluted urban area in low to middle income countries. A cross-sectional study was conducted to investigate the association between residential environments and respiratory symptoms including asthma among 658 primary school children living in urban area of Bangkok Thailand. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was modified to access symptoms during the past 12 months. Binary logistic regression model was performed. Living near garment and clothing shop is associated with shortness of breath (AOR = 1.846; 95% CI 1.034, 3.297). Vectors in home is related to dry cough at night (AOR = 1.505; 95% CI 1.052, 2.153) and phlegm (AOR = 1.414; 95% CI 1.014, 1.973). Wall dampness is increased odd of having wheezing or whistling (asthma) in the chest (AOR = 1.921; 95% CI 1.141, 3.235). Children age, gender, and a family history of asthma were modified the associations. Our finding may provide strategies focusing on living environment improvement with a specific group of children to address respiratory disease prevention.

Occurrence of infectious diseases during the first two years and symptoms of asthma in six-year-old children

Objective: To observe possible association between the occurrence of infectious diseases during the first two years of life and the occurrence of asthma symptoms in six-year-old children. Methods: Cross-sectional study involving 956 six-year-old schoolchildren. Asthma symptoms were assessed through International Study of Asthma and Allergies in Childhood questionnaires. Socio-demographic data, mother-reported infectious diseases during the child's first two years of life, family history of asthma and breastfeeding were included. Multivariate analysis was performed with all significant variables and those with a p-value <0.20 using Poisson Regression with a robust estimator. Results: The reported wheezing or whistling in the chest in the past 12 months prevalence was 18.7%. There was found a 9% higher prevalence of asthma at six years of age in children who had had respiratory infections in the first two years of life. Children with a family history of asthma had a 7% higher and independent prevalence of asthma at six years of age and those breastfed presented 6% lower independent prevalence of asthma at six years of age. Conclusions: Higher prevalence of asthma reports at six years of age was found in children whose mothers reported infectious respiratory diseases during the first two years and with family history of asthma. Lower prevalence was observed in breastfed children in the first two years of life.

Paediatric Acute Respiratory Distress\xa0Syndrome Neuromuscular Blockade study (PAN-study): a phase IV randomised controlled trial of early neuromuscular blockade in moderate-to-severe paediatric acute respiratory distress syndrome

BackgroundPaediatric acute respiratory distress syndrome (PARDS) is a manifestation of severe, life-threatening lung injury necessitating mechanical ventilation with mortality rates ranging up to 40–50%. Neuromuscular blockade agents (NMBAs) may be considered to prevent patient self-inflicted lung injury in PARDS patients, but two trials in adults with severe ARDS yielded conflicting results. To date, randomised controlled trials (RCT) examining the effectiveness and efficacy of NMBAs for PARDS are lacking. We hypothesise that using NMBAs for 48 h in paediatric patients younger than 5 years of age with early moderate-to-severe PARDS will lead to at least a 20% reduction in cumulative respiratory morbidity score 12 months after discharge from the paediatric intensive care unit (PICU).MethodsThis is a phase IV, multicentre, randomised, double-blind, placebo-controlled trial performed in level-3 PICUs in the Netherlands. Eligible for inclusion are children younger than 5 years of age requiring invasive mechanical ventilation with positive end-expiratory pressure (PEEP) ≥ 5 cm H2O for moderate-to-severe PARDS occurring within the first 96 h of PICU admission. Patients are randomised to continuous infusion of rocuronium bromide or placebo for 48 h. The primary endpoint is the cumulative respiratory morbidity score 12 months after PICU discharge, adjusted for confounding by age, gestational age, family history of asthma and/or allergy, season in which questionnaire was filled out, day-care and parental smoking. Secondary outcomes include respiratory mechanics, oxygenation and ventilation metrics, pulmonary and systemic inflammation markers, prevalence of critical illness polyneuropathy and myopathy and metrics for patient outcome including ventilator free days at day 28, length of PICU and hospital stay, and mortalityDiscussionThis is the first paediatric trial evaluating the effects of muscular paralysis in moderate-to-severe PARDS. The proposed study addresses a huge research gap identified by the Paediatric Acute Lung Injury Consensus Collaborative by evaluating practical needs regarding the treatment of PARDS. Paediatric critical care practitioners are inclined to use interventions such as NMBAs in the most critically ill. This liberal use must be weighed against potential side effects. The proposed study will provide much needed scientific support in the decision-making to start NMBAs in moderate-to-severe PARDS.Trial registrationClinicalTrials.govNCT02902055. Registered on September 15, 2016.

Correlation of Serum Selenium in Asthma Patients with Severity of the Disorder.

Asthma is characterized by reversible airway obstruction, increased bronchial hyper-responsiveness and chronic inflammation, as well as higher levels of oxidative stress mainly due to decreased antioxidant defenses. Our primary aim was to investigate the correlation of serum selenium (Se) levels with the severity of asthma across gender, age, family history, and prevalence from childhood. Selenium levels in blood samples in 103 asthmatic patients and 103 healthy individuals were evaluated. The obtained data indicated that the mean serum Se levels in asthma patients were found to be twofold lower as compared to the controls (p < 0.001). However, there were no significant differences in the asthmatic patients when gender and age were considered. Patients characterized by family history of asthma and inhaler usage had 8% and 7% lower serum Se concentrations, although the difference was only border significant (p = 0.05). Multiple regression analysis demonstrated a significant inverse association of inhaler usage (β = - 0.226; p < 0.001) with serum Se levels even after adjustment for asthma severity (β = - 0.644; p < 0.001). While this report clearly necessitates a more detailed study, it is plausible that Se deficiency leads to impaired immune response, and therefore, Se supplementation might modulate oxidative stress in the lung and could potentially alleviate asthma pathophysiology.

Prevalence of Allergic Rhinitis Among Students in the Age Group of 16-20 Years in a South Indian City

ABSTRACT Introduction: Allergic Rhinitis (AR) is often viewed as a trivial disease but it can significantly affect the quality of life by causing fatigue, headache, sleep disturbances, cognitive impairment. According to World Health Organization (WHO) report (2007), the global burden of allergic rhinitis was estimated to be 400 million, and the prevalence among adults ranges between 10% and 32% in the Asia Pacific region. The prevalence of allergic rhinitis and other allergic diseases has increased globally in the last three decades. Despite the high burden, there is a paucity of community-based studies in India, determining the burden of allergic rhinitis. Hence we undertook this study to determine the prevalence of allergic rhinitis among students (16-20 Years) of age. Materials and Methods: Students of age group 16-20 years of age, both Girls and boys in and around Mangaluru city, Dakshina Kannada district were included in the study. This was a questionnaire based cross sectional study. A standardized questionnaire (adopted from ISAAC) was prepared and was administered to students of 12 different colleges. The sample size was calculated after carefully analyzing previous Indian studies on the prevalence of allergic rhinitis. Considering an 8% prevalence rate and a 10% allowable error, sample size was estimated as N= 4600. Purposive sampling, among students of various colleges in Mangaluru city was done. The diagnosis of allergic rhinitis was done clinically as per ARIA guidelines. Students were interviewed in their class room for one hour. First the study objectives and the questionnaire was explained to the students. Then each student was given the questionnaire to fill. Informed consent was taken from each student. The statistical analysis was performed by Frequency and percentage method to calculate the prevalence. Chi-square test, odds ratio (OR), and 95% confidence interval (95%CI) were used to measure the association between the variables, and a p-value of &lt;0.05 was considered to be significant. Results: In our study group, the age distribution was from 16-20 years. 961(20.8%) students were 16 years of age, 1196(26.0%) students were 17 years of age, 905(19.7) were 18years of age, 697(15.2%) 19 years of age &amp; 841(18.3%) students were 20 years of age. The prevalence of allergic rhinitis among students (16-20) years of age was 11.9%. The prevalence was higher among girls (12.0%) compared to boys (11.7%). The prevalence of allergic rhinitis was more among students of 20 years of age. The prevalence of allergic rhinitis was more in girls (12.0%) compared to boys (11.7%). Smokers were found to be 2.6 times more prone to develop eczema. Statistically significant correlation between bronchial asthma with allergic rhinitis and eczema was found. Incidence of allergic rhinitis among asthma patients was 5.7times more compared to normal subjects. A significant association of asthma was observed with the incidence of eczema. Incidence of asthma among the people who have a family history of asthma was 7.08 times more compared to other population. Incidence of allergic rhinitis among the people who had a family history of asthma was 2.63 times compared to other population. Incidence of eczema among the people who have a family history of asthma is 11 times compared to other population. Conclusions: The prevalence of allergic rhinitis among students (16-20) years of age was 11.9%. The prevalence was slightly higher among girls (12.0%) compared to boys (11.7%).

Periostin and IFN-γ levels in serum and nasopharyngeal aspirate in infants with viral-induced wheezing - 2 year follow-up.

The present study assesses the immune response in children with viral-induced wheezing by examining the two factors-interferon-gamma (IFN-γ) and periostin in serum and nasopharyngeal aspirate (NPA). The aim was to find a pattern with the severity and frequency of wheezing episodes. Sixty-nine infants (40 boys and 29 girls), with a mean age of 11.4±6 (2 - 23) months, hospitalized with a first or recurrent episode of bronchial obstruction were enrolled in this study. The serum and NPA concentrations of IFN-γ and periostin were assessed by ELISA methodology. Fifty of the children (72%) were followed for 2 years. We detected lower NPA IFN-γ production in boys, infants with atopic status, family history of asthma, and respiratory syncytial virus infection. Recurrent wheezing in children was associated with a twice lower concentration of IFN-γ in NPA compared to those with the first episode (7.1 vs. 14.8 pg/ml, p=0.05). Higher serum periostin level was established in children over 12 mo in the group of recurrent wheezers with persistent manifestations compared to those without symptoms during the follow-up (410.5 vs. 269.7 ng/ml, p = 0.03). Multivariate logistical regression model assessed high level of serum periostin, male gender, atopy, family history of asthma, and severity of the attack as significant risk factors for persistent compared to intermittent wheezing (r < sup > 2 < /sup > = 0.87, p = 0.04). Our results demonstrated that recurrent viral-induced wheezing is associated with decreased IFN-γ production and increased periostin response and their correlation with severity and persistence of symptoms were the main outcome measures.

NSAID-exacerbated respiratory disease: a population study.

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent European Academy of Allergy and Clinical Immunology position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD.MethodsIn 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%.ResultsThe prevalence was 1.4% for N-ERD, and 0.7% for aspirin-exacerbated respiratory disease (AERD). The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis. The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The subphenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the fewest symptoms.ConclusionWe conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity.

Prevalence of asthma symptoms among bakery workers in Abidjan (Côte d'Ivoire)

The objective of the present study was to determine the prevalence of occupational asthma symptoms among bakery workers. A cross-sectional study was done in the District of Abidjan from February to September 2019 among bakery workers. The study covered all workers aged 18 and over, employed and present in the bakery during interviews and lung tests. The socio-demographic and professional questionnaire of the American Thoracic Society was used, and the obtained qualitative and quantitative data obtained were analyzed with Stata 15.1 software. Out of the 599 workers included in our study, we had 405 bakers (67.6%, IC 95% [0.637–0.712]), 127 salespersons/cashiers (21.2%, IC 95% [0.181–0.247]), 38 cleaning persons (6.3%, IC 95% [0.046–0.086]) and 29 administrative staff (4.8%, IC 95% [0.034–0.069]). 85.8% (IC 95% [0.828–0.884]) of workers did not have the professional qualification in the bakery sector and 11.3% (IC 95% [0.090–0.142]) were illiterate. The prevalence of probable occupational asthma was 9.7%, 2.3%, 0.6% and 1.2%, respectively, among bakers, salespersons/cashiers, cleaning persons and administrative staff. Furthermore, logistic regression analysis revealed a relationship between probable occupational asthma and family history of asthma among the bakers. As a conclusion, the exposure of bakery workers to flour appeared to be one of the risk factors for probable occupational asthma and the work-related asthma. Also, bakers with a family history of asthma had high risk of developing probable occupational asthma.

Air Pollution and Family Related Determinants of Asthma Onset and Persistent Wheezing in Children: Nationwide Case-Control Study

To identify risk factors (air pollution and family related) for the onset of asthma and persistent wheezing in children.All Danish children born from 1997 to 2014 who were managed for asthma onset and persistent wheezing from the age of 1 year to 15 years by using a national registry based, matched case-control design.Children were managed in the Danish National Patient Register for the classification of asthma or persistent wheezing after hospital discharge, or with a minimum of 2 prescriptions for asthma medications. Information regarding concentration of air pollutants (several gases, aerosols, particular matter <2.5µm [PM2.5] and particular matter <10µm), parental asthma diagnoses and asthma medication prescriptions, maternal smoking habits, highest completed parental education, and parental income levels were collected and analyzed for hazard ratios (HRs).From 1997–2014, 3 192 785 children were included in the study, and 122 842 (3.84%) children developed asthma and/or persistent wheezing, with a mean age of development of 1.9 years. Maternal asthma had a higher risk than paternal asthma (adjusted HR): 1.72 (95% CI: 1.72 to 1.77) vs 1.51 (95% CI: 1.48 to 1.53)], but having 2 parents with asthma was associated with a 2.40-fold (2.34-fold to 2.47-fold) risk of childhood asthma. Maternal smoking during pregnancy (adjusted HR: 1.23 [1.18 to 1.28]) or quitting during pregnancy (HR: 1.20 [1.18 to 1.22]) increased the risk of childhood asthma. Exposures to PM2.5, particular matter <10µm, and nitrogen dioxide were also associated with development of asthma, with PM2.5 exposure being the most consistent. Higher parental income levels, together and independently, had a reduced risk for childhood asthma (adjusted HR: 0.85 [95% CI: 0.81 to 0.89) for the highest parental income level, compared with 1.04 (95% CI: 1.00 to 1.08) for the lowest parental income level]. Higher parental education levels, together and independently, had a reduced risk for childhood asthma (adjusted HR: 0.72 [95% CI: 0.69 to 0.75]) for the highest parental education level, compared with 0.98 [95% CI: 0.95 to 1.00] for the lowest parental education level).Parental history of asthma, higher levels of exposure to PM2.5, and maternal smoking during pregnancy all increase a child’s risk of developing asthma and persistent wheezing. High levels of parental educational attainment and income are associated with a lower risk of developing asthma and persistent wheezing in children.Strengths of this study include the use of a large database that covered 18 years. In this study, researchers did not analyze atopy, lung function, or inflammatory markers. A family history of asthma, tobacco exposure and environmental pollutants were confirmed as risk factors for asthma development. Smoking cessation campaigns and environmental strategies to decrease particulate matter exposure may reduce the number of children who develop asthma.

Determinants of asthma in Ethiopia: age and sex matched case control study with special reference to household fuel exposure and housing characteristics

BackgroundAsthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia.MethodsWe conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma.ResultsThe response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49).ConclusionFamily history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.

Sex Differences in Baseline Risk Factors for Asthma Between Early Adolescence and Young Adulthood.

Several studies have shown sex differences in the prevalence of asthma and an association with age. The aim of the present study was to prospectively investigate the development of asthma, wheeze, rhinitis, and allergic symptoms in adolescence and adulthood. We also aimed to determine whether sex modifies the association between baseline risk factors and incidence of asthma in early adulthood. In the Screening Project Asthma in Schools (SPAIS) study, adolescents aged 12-15 years completed a standardized respiratory questionnaire (International Study of Asthma and Allergies in Childhood) and underwent measurements of fractional exhaled nitric oxide (FeNO) and lung function (FEV1) at baseline. Two follow-up assessments with similar questionnaires were performed after 4 and 16 years, with a total of 491 participants in all 3 examinations. The prevalence of asthma and wheeze were unchanged after 4 years but had increased after 16 years. However, the increase was significant only for females. The prevalence of rhinitis and allergy symptoms increased steadily, albeit with no differences between the sexes. The sex interaction analysis showed that higher FeNO (P=.01) and a family history of asthma (P=.02) increased the risk of incident asthma for males but not for females. An increased prevalence of respiratory symptoms was seen primarily between late adolescence and young adulthood; the difference was significant for females but not for males. Allergic risk factors in early adolescence for incident asthma in early adulthood were confirmed in males but not in females. Awareness of these sex differences in the development of symptoms and of the associated risk factors is important in clinical practice.

Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis.

BACKGROUNDTidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants.AIMTo assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.METHODSIn this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated.RESULTSA total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy.CONCLUSIONInfants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.

Socio-demographic and Clinical Profile of Children with Asthma attending Chest Clinic at B. P. Koirala Institute of Health Sciences, Nepal

Introduction: Asthma in children is one of the most common chronic diseases and little information available on factors associated with this disease in our part of the world.&#x0D; Objective: The present study is an attempt to find out the socio-demographic and clinical profile of children with asthma.&#x0D; Methodology: This was a retrospective analysis of data of asthmatic children below 14 years attending pediatric chest clinic from July 2014 till March 2016.&#x0D; Results: Of the 200 children, there were 142 (71%) males. The median age of presentation was 3 years and 139 (69.5%) from the age group 1-5years One third had poorly controlled asthma. Comorbidity was present in 59(29.5%) and allergic rhinitis (7%) was the most common. 90.5% had onset of wheezing before 5 years of age. Family history of asthma and/or atopy and smoking was present in 24% and 31%, respectively. 22% had exposure to pet animals. Upper respiratory tract infection (URTI) (37%) was the most common trigger for exacerbation. Cough (99%) and fast breathing (98%) were the most common symptoms.&#x0D; Conclusion: The majorities were males of young age with rhinitis as most common co-morbidity and many of them had a history of parental smoking at home. One third of them had poorly controlled asthma which shows the need for proper management of asthma including its comorbidity in younger children and changing certain habits like parental smoking at home.

Factors Associated With Childhood Asthma and Wheeze in Chinese Preschool-Aged Children.

This study was prepared to identify and characterize potential factors associated with childhood asthma and wheeze in Chinese preschool-aged children. A comprehensive questionnaire was designed for children aged 3–6 years and their parents or guardians in Beijing and Tangshan from September to December 2020. The least absolute shrinkage and selection operator (LASSO) model was used to identify factors in a significant association with childhood asthma and wheeze, respectively. The LASSO model was internally validated using bootstrap resampling with 100 replications. A total of 9,529 questionnaires were certified as eligible for inclusion after stringent quality control. The prevalence of doctor-diagnosed childhood asthma and parent-reported wheeze was 2.8 and 6.2%, respectively. Factors simultaneously associated with childhood asthma and wheeze were children with a history of allergic rhinitis, hay fever, eczema, initial age of using antibiotics, body mass index category, and family history of asthma. Specifically, children's vitamin D supplement duration was significantly associated with childhood asthma, whereas the association with childhood wheeze was significant for intake frequency of night meals for children and their screen time. Modeling of significant factors in nomograms had decent prediction accuracies, with C-index reaching 0.728 and 0.707 for asthma and wheeze, respectively. In addition, internal validation was good, with bootstrap C-statistic of being 0.736 for asthma and 0.708 for wheeze. Taken together, our findings indicated that the development of asthma and wheeze among preschool-aged children was probably determined by the joint contribution of multiple factors including inherited, nutritional, unhealthy lifestyles, and history of allergic disease. Further validation in other groups is necessary.

Risk Factors Associated With Health Care Utilization in Preschool Recurrent Wheezers in a Tropical Environment.

Introduction: The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear.Objective: To evaluate the factors associated with health care utilization in preschool recurrent wheezers in Cartagena, Colombia.Methods: One hundred twenty-seven recurrent wheezers (age 2–6 years old) who were admitted to the emergency room (ER) due to wheezing in a Pediatric reference hospital in Cartagena were included. Children were evaluated by means of questionnaires and classified according to the number of ER visits, need for hospitalization and history of intensive care unit (ICU) admission due to wheezing within the last year. Total serum IgE and specific IgE to house dust mite allergens (HDM) were measured by ImmunoCAP® and allergen sensitization was evaluated by skin prick tests (SPT).Results: The maternal report of nocturnal cough without fever in their children increased the risk to have ≥5 ER visits in the last year due to wheezing. The use of montelukast was negatively associated with hospitalization, while a history of pneumonia and lack of tap water, increased the risk of hospitalization due to wheezing. A history of bronchiolitis, family history of asthma, cohabiting with two or more siblings, passive exposure to smoke and lack of sewage facilities increased the risk of ICU admission due to wheezing. The presence of atopy evaluated by SPT reactivity, total IgE levels or specific IgE to HDM were not associated with health care utilization. We also found that seroprevalence of positive IgE (≥0.35 kU/L) was 27% to B. tropicalis and 20.3% to D. pteronyssinus but the prevalence of positive IgE sensitization to these allergens was below 2% and 8% when evaluated by SPT, respectively.Conclusions: Poverty indicators are associated with ICU admission in a group of preschool recurrent wheezers and should be considered as aggravating factors for wheezing. These factors must be systematically assessed in the medical approach in underdeveloped regions in the tropics. Nocturnal cough without fever is a symptom associated with frequent ER visits while atopy was not associated with health care utilization in preschool recurrent wheezers.

ANALYSIS AND INTERPRETATION OF SPIROMETRY OF PATIENTS ATTENDING RESPIRATORY MEDICINE OPD IN A TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

OBJECTIVE: To study the various spirometry ndings and look for its association with smoking history and use of biomass fuels. METHODS: Spirometry ndings of 375 patients who attend Respiratory medicine OPD from year 2017- 2019 were studied. RESULTS: Out of 375 patients, 95 patients were diagnosed as COPD, 62 as bronchial asthma, 149 had normal spirometry and 69 had restriction. CONCLUSION: In this study we concluded that spirometry plays an intergral role in the diagnosis of bronchial asthma, COPD and restrictive lung diseases. It gives an overview of the decline of lung function with increasing age, smokers, occupational lung exposures, family history of bronchial asthma. Restrictive patterns were most commonly seen in patients who came for pre operative evaluation.

CYSTIC LUNG DISEASE: AN USUAL PRESENTATION OF SP-C

TOPIC: Pediatrics TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cystic interstitial lung disease (ILD) is rare in pediatrics. The differential includes genetic, congenital and acquired diseases. Often, diagnosis can be made by history and radiologic findings. However, lung biopsy and genetic testing is often necessary. CASE PRESENTATION: A 13-year-old male with PMH of asthma, allergic rhinitis (AR), eczema, chronic urticaria and no hospitalizations or surgeries was seen by an allergist for urticaria after initiation of immunotherapy. A CXR, obtained for RUL crackles heard on exam, demonstrated bilateral, R>L, upper lobe infiltrates and R hilar adenopathy. He was referred to pulmonology. Medications were Flovent and Claritin, NKDA and was a healthy term baby. No family history of asthma or CF, but mother has AR and his deceased father and paternal grandmother had sarcoidosis. No exposure to smokers, pets, carpet, farms or birds. At his pulmonology visit, repeat CXR, CBC, CMP, IgE, Aspergillus Ab, QuantiFERON gold and HP were obtained. They were normal except for the CXR, which had increased perihilar and suprahilar interstitial densities. HP panel had positive antibodies from underlying allergies. CXR prompted a chest CT which showed cystic ILD in the mid and upper lobes bilaterally with a few lesions in the lower lobes. Ground glass opacities with a honeycombing pattern were in the lung apices, but no bronchiectasis. Initial PFT showed mixed obstructive-restrictive pattern. Follow up PFT confirmed restriction, TLC 65%. DLCO mildly reduced. Normal sweat test and echo. At his bronchoscopy he complained of dyspnea on exertion. Bronchoscopy was normal. Lung biopsy showed advanced fibrotic ILD with honeycomb changes and focal dense eosinophilic aggregates, consistent with HP or surfactant deficiency. Due to dyspnea, he had pulse steroids (30mg/kg dailyx3 days), transitioned to daily steroids and weaned over 8 weeks. He was discharged with presumed diagnosis of HP, pending genetic studies. During the steroid wean, surfactant panel showed a heterozygous mutation in the surfactant protein C gene (SFTPC), c.218T>C. He was diagnosed with SP-C deficiency and started on hydroxychloroquine 400mg/day and Azithromycin 500mg 3x/week. Pulse steroids are biweekly. DISCUSSION: SP-C mutation comprises 0.36 cases per million children. Surfactant proteins A and D are involved in the immune defense and SP-B and -C prevent alveolar collapse. SP-C is a dominant condition with 55% mutations arise spontaneously. SP-C mutations are difficult to diagnose due to variability in presentation. Prognosis is variable. An interesting aspect is the family history of sarcoidosis, a disease without a definitive test. It is possible the father had SP-C deficiency and was misdiagnosed. CONCLUSIONS: This case illustrates the variable presentation of SP-C deficiency, with cystic lesions and ground glass opacities on CT. It serves as a reminder that the differential should include SP-C deficiency. REFERENCE #1: PMID: 30094155 REFERENCE #2: PMID: 24605255 REFERENCE #3: https://doi.org/10.1542/peds.2015-2725 DISCLOSURES: No relevant relationships by Emma Segal, source=Web Response No relevant relationships by Heather Staples, source=Web Response

Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study.

BackgroundThe prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts.MethodsWe studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score <LLN.ResultsThe prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio (aOR=2.55, 95% CI 2.14–3.04), preterm birth (aOR=1.84, 1.27–2.66), maternal smoking during pregnancy (aOR=1.16, 95% CI 1.01–1.35) and family history of asthma (aOR=1.44, 95% CI 1.25–1.66) were associated with a higher prevalence of obstructive, but not restrictive, phenotype across ages (5–25 years). A higher current body mass index (BMI was more often observed in those with the obstructive phenotype but less in those with the restrictive phenotype (aOR=1.05, 95% CI 1.03–1.06 and aOR=0.81, 95% CI 0.78–0.85, per kg·m−2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05–1.46).ConclusionObstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes.