Family History Of Asthma Research Articles

Predictors of lung function trajectories in population-based studies: A systematic review.

Despite the growing body of evidence on lung function trajectories over the life course and their risk factors, the literature has not been systematically synthesized. Publications related to lung function trajectories were identified from PubMed, EMBASE and CINAHL databases. Two authors independently identified publications for inclusion according to predefined selection criteria. Studies that modelled lung function trajectories and reported associated exposures were included. Meta-analyses could not be conducted due to heterogeneity in the exposures and methods used to model lung function trajectories. Nine publications were eligible for inclusion of which four used group-based trajectory modelling to model lung function trajectories, while five used latent profile analysis. Studies with repeated lung function measurements over the life course identified more trajectories than others. Only one study spanning from childhood to middle age reported catch-up trajectory. The following childhood risk factors for subnormal lung function trajectories were observed in at least across two studies: low birth weight, early wheezing, asthma, allergic sensitization, eczema, allergic rhinitis, lower respiratory tract infections, family history of asthma and second-hand smoke exposure. Adult active asthma and personal cigarette smoking were observed to be associated with accelerated decline lung trajectories. Our review identified 10 risk factors associated with the growth, catch-up, reduced plateau and decline trajectories of lung function. Intervention directed at childhood asthma and infections, and tobacco smoke exposure at all ages would help promote lung health and prevent subnormal lung function trajectories.

Relationship Between Concomitant Atopic Diseases With Atopic Dermatitis Severity And Persistence.

Introduction: The atopic march consists of atopic dermatitis (AD), allergic rhinitis or sinusitis (AR), allergic conjunctivitis (AC) and bronchial asthma (BA). The influence of concomitant atopic diseases on AD is under-explored. We determined the relationship between personal and family history of atopic diseases with AD severity and persistence. Methods: A cross sectional study involving AD patients was performed at dermatology clinics of two tertiary hospitals. Inclusion criterion was all patients diagnosed with AD. Demographic data, personal and family history of atopy (BA, AR and AC) were obtained by face-to-face interview. AD severity was evaluated using Investigator’s Global Assessment (IGA). AD was considered persistent if continued beyond age 12 years. Results: Sixty patients aged 21.6±17.2 participated. There were 25(41.7%) with concomitant AR, 16(26.7%) BA and 12(20%) AC. Forty seven (78.3%) patients had family history of atopy, 25(41.7%) had eczema, 24(40%) AR, 19(31.7%) BA and 2(3.3%) AC. Patients with BA [OR=3.8, 95%CI 1.04 to 14.4)], BA and AR [OR=9.74, 95%CI 1.13 to 83.67) and family history of BA [OR= 4.00, 95%CI 1.20 to 13.27) were more likely to exhibit moderate-severe AD. Personal AR, AC and family history of AD and BA were significantly more prevalent in patients with persistent AD. Conclusions: AR was the most common atopic disease associated with AD. Family history of eczema and AR were common. Personal BA, BA with AR and family history of BA were predictors of severe AD. Personal AR, AC and family history of AD and BA were associated with AD persistence.

Influence of Childhood Exposure to a Farming Environment on Age at Asthma Diagnosis in a Population-Based Study.

PurposeAsthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis.MethodsA cross-sectional population-based study was carried out with subjects aged 20–69 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (0–11 years), intermediate diagnosis (12–39 years), and late diagnosis (40–69 years).ResultsThe prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, ex-smoker, occupational exposure, and BMI ≥ 30 kg/m2 were associated with a higher likelihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87–1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12–4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30–0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47–1.18).ConclusionOdds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late.

English

BACKGROUND Bronchial asthma is a major public health concern especially in the paediatric population. An elevated immunoglobulin E (IgE) level is considered as an objective marker of allergy. Because IgE is a mediator of allergic response, quantitative measurement of IgE together with other clinical markers, can provide useful information for the differentiation between atopic and non-atopic diseases. In this study, we wanted to determine serum IgE and absolute eosinophil count (AEC) levels and correlate both levels with severity of asthma in children in the age group of 2 - 15 years admitted in the paediatric department. METHODS This is a descriptive cross-sectional study. After taking the informed consent from the parent or guardian, relevant information on asthmatic symptoms and severity, other associated manifestations, precipitating factors, and family history of asthma were recorded in a pre-designed proforma. A total of 65 children (age group 2 – 15 years old) with bronchial asthma were studied. Investigations such as hemogram and serum IgE levels were determined. Asthma severity was assessed according to global initiative for asthma (GINA) guidelines. RESULTS Among 65 children, 69.2 % were boys. Receiver operating characteristic curve (ROC) analysis showed that total IgE cut-off concentration of 168 IU/ml, distinguishes children with intermittent asthma from those with mild persistent disease. IgE cut-off concentration of 989 IU/ml distinguishes mild persistent from those with moderate persistent asthma. Both showed adequate or good diagnostic efficacy. Cut off value of 168 IU/ml may prove useful in practice, indicating that 75 % of children in intermittent group will have serum concentration of total IgE < 168 IU/ml. No association was observed between AEC and increasing severity of asthma. Only atopic dermatitis with asthma showed increasing trend of IgE levels. CONCLUSIONS Asthmatic children with higher asthma severity have a higher serum total IgE concentration (168 IU/ml and 989 IU/ml are the cut off values for differentiating intermittent from mild persistent and mild persistent from moderate persistent). KEYWORDS Serum IgE, Absolute Eosinophil Count, Childhood Asthma, Asthma Severity

Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study

Background and objectiveChronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults.MethodsParticipants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated.ResultsThe individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0–13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) “Healthy” (70%) with average of 1.95 conditions; 2) “Respiratory and Atopy” (11%, 3.65 conditions); 3) “Non-cardiometabolic” (14%, 4.77 conditions), and 4) “Cardiometabolic” (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions.ConclusionMultimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.

Family history of asthma influences outpatient respiratory outcomes in children with BPD

Preterm children with bronchopulmonary dysplasia (BPD) are at increased risk for intermittent and chronic respiratory symptoms during childhood and adult life. Identifying children at higher risk for respiratory morbidities in the outpatient setting could help improve long-term outcomes. In this study, we hypothesized that a family history of asthma (FHA) is a risk factor for higher acute care usage and respiratory symptoms in preterm infants/children with BPD, following initial discharge home. Subjects were recruited from the Johns Hopkins Bronchopulmonary Dysplasia outpatient clinic between January 2008 and February 2020 (n = 827). Surveys were administered to caregivers and demographics and clinical characteristics were obtained through chart review. Demographic features associated with FHA included public health insurance, lower median household income, and nonwhite race. Children with FHA had higher odds of emergency department (ED) visits, systemic steroid use, nighttime respiratory symptoms, and activity limitations. There was no association between FHA and BPD severity. This study found that children with BPD and FHAwere more likely to have respiratory symptoms and acute care usage during the first 3 years of life and that FHA was associated with lower socioeconomic status. Although there was no association between FHA and BPD severity, FHA could predict an increased likelihood of both ED visits and need for systemic steroids in infants/children with BPD followed in the outpatient setting.

Four subtypes of childhood allergic rhinitis identified by latent class analysis.

Childhood allergic rhinitis (AR) is clinically heterogenous. We aimed to identify distinct phenotypes among children with AR using data-driven techniques and to ascertain their association with patterns of symptoms, allergic sensitization, and comorbidities. We recruited 510 children with physician-diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy). A four-class solution was selected as the optimal model based on statistical fit. We labeled latent classes as: (1) AR with grass mono-sensitization and conjunctivitis (n=361, 70.8%); (2) AR with house dust mite sensitization and asthma (n=75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n=35, 6.9%); and (4) AR among children with tonsils and adenoids removed (n=39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95% CI 3.42-9.94, p<.001) and Class 3 (OR 2.88, 95% CI 1.36-6.13, p=.006). Mild and intermittent AR symptoms were significantly more common in children in Class 2 compared to those in Class 1. AR was more severe in Class 1 compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma. We have identified 4 phenotypes in school-age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.

Pediatric asthma

Introduction Asthma is a heterogeneous chronic airway disease that is common in childhood. Childhood asthma is commonly related to other atopic diseases. The potential correlation of allergic sensitization and asthma in children has been contributed to the allergic model of the March. Aim The study aims to estimate the age of onset of asthma in children in Minia governorate, in middle Egypt, and also to see the presenting features of bronchial asthma in our locality and compare this with what is present in different parts of the world. Patients and methods This study was carried out in the Pediatric and Chest Departments of Minia University hospitals. The study included 100 children with a clear diagnosis of bronchial asthma. Detailed medical history concerned mainly with the respiratory events were recorded between birth and the time of study enrollment. This also included some asthma family history or other allergic disorders (allergic rhinitis, eczema, and allergic conjunctivitis). Results In most cases, asthma symptoms started less than 1 year of age (64% of the studied group). Asthma symptoms started between the age of 1.1 and 2 years in 16% of patients and above 6 years of age in only 12% of cases. Overall, 40% of the studied group had a positive family history of bronchial asthma in their mothers and 44% of them had a positive family history of bronchial asthma in their fathers. Only 10% of the studied group had a positive family history of bronchial asthma of both parents. Conclusion A great portion of asthmatic children fulfill the criteria of bronchial asthma diagnosis in the first year of their life. Only a small portion of asthmatic children start their asthma after the age of 6 years.

Clinical and demographic profile of patients diagnosed as bronchial asthma

The overall burden of Asthma in India is estimated at more than 15 million. In different studies gender preponderance was variable. According to an Indian study published by Jindal et al., the prevalence of asthma in India is around 2.05% and advanced age, smoking, family history of asthma and unclean habits contributed to asthma. Asthma is a complex disease identifying and studying the genotypes and correlating with phenotypes can help in the study of epidemiology of asthma. Sputum differential count and exhaled nitric oxide can help in categorizing asthma. Study of Demographic data, history of atopy, family history and season of attack and time of acute episode can help us understand the illness better to give a better relief to the patient.

Prevalence and risk factors of allergic rhinitis and asthma in the southern edge of the plateau grassland region of northern China: A cross-sectional study

BackgroundThe prevalence rates of allergic rhinitis (AR) and asthma in the border region of China may be different from those in the central region of plateau grasslands. A survey was performed to investigate the prevalence and risk factors for AR, asthma, and AR combined with asthma among adults (age ≥ 20 years) residing in the southern border of plateau grasslands in northern China. MethodsFrom May to August 2018, a cross-sectional survey was completed by subjects that were selected using a cluster random sampling method. The subjects completed a questionnaire and were administered skin prick tests (SPTs). Risk factors for AR, asthma, and AR combined with asthma were examined by multivariate logistic regression analyses. ResultsA total of 1815 adult subjects in the selected region completed study. The prevalence rates of physician-diagnosed AR, asthma, and AR combined with asthma were 13.9% (253), 9.8% (177), and 2.9% (52), respectively. Among the patients with AR, 20.6% were found to have concurrent asthma; among the patients with asthma, 29.4% were found to have concurrent AR. Artemisia and Humulus pollen were the most common sensitizing pollen types. Approximately 70% of subjects with AR and <30% of asthma patients were sensitized to Artemisia and Humulus pollen. Symptoms of AR and asthma mainly appeared during August. A multivariable logistic regression analysis identified sensitization pollen as an independent risk factor for both AR and AR combined with asthma (AR: OR = 16.23, 95% CI: 10.15–25.96; AR combined with asthma: OR = 6.16, 95% CI: 1.28–29.66). An age >40 years old, family history of asthma, moderate-to-severe AR, adverse food reactions, and mold allergies were independent risk factors for AR combined with asthma. ConclusionsThis study identified the prevalence rates of AR and asthma in the southern borders of the plateau grassland in northern China (>1500 m above sea level). Sensitization pollen is an independent risk factor for AR and AR combined with asthma.

Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study

BackgroundLimited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings.MethodA cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy.ResultsThe participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001).ConclusionIn this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.

Factors associated with persistence of early-onset atopic dermatitis up to the age of 12 years: a prospective cohort study in China

BackgroundAtopic dermatitis (AD) can remit as age increases. However, long-term follow-up studies evaluating disease evolution and related factors of persistence of early-onset AD are sparse.ObjectivesThis study aimed to identify factors associated with the persistence of early-onset AD.Materials & MethodsIn this prospective cohort study, 260 patients with onset of AD before age two years old were enrolled. Clinical examination was performed and a questionnaire survey completed at enrolment. In addition, the filaggrin gene (FLG) of all participants was sequenced to identify mutations within this gene. Patients were followed at age six and 12.ResultsThe remission rate was 50.8% at age six and 70.3% at age 12. Persistent AD was associated with a higher SCORAD index at baseline (p < 0.001), a family history of asthma (p = 0.003) and food allergen sensitization (p = 0.033). However, the presence or absence of FLG mutation did not show any significant association with persistent AD. Prognostic factors for persistence of AD were analysed by logistic regression analysis. Disease severity according to SCORAD index at baseline (OR: 1.039; 95% CI: 1.018–1.059; p < 0.001) and family history of asthma (OR: 3.008; 95% CI: 1.297–7.007; p = 0.011) were risk factors that may predict persistent AD based on multivariate regression analysis.ConclusionIt is important to stratify early-onset AD according to severity and investigate family allergic history in order to establish appropriate individual management. Moreover, genetic factors other than FLG mutation may play more important roles in persistent early-onset AD.

Comparison of physical fitness between healthy and mild-to-moderate asthmatic children with exercise symptoms: A cross-sectional study.

Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7-17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children. Children with mild-to-moderate asthma presenting exercise symptoms show a reduction in cardiorespiratory fitness, muscle strength, lung function, functionality, and lifestyle when compared to healthy peers. The study provides data for pediatricians to support exercise practice aiming to improve prognosis and quality of life in asthmatic children.

Factors associated with uncontrolled asthma among Sudanese adult patients

Objectives:Uncontrolled asthma is a major health problem resulting in increased morbidity, mortality, healthcare utilization, and costs. The aim of this study was to determine the level of asthma control and its associated factors in Sudan.Materials and Methods:We performed a cross-sectional study of 362 adult asthmatics consecutively recruited from the three main tertiary hospitals in Khartoum State-Sudan, between March and June 2018. Data were collected using standardized questionnaires and the asthma control test (ACT) was used to determine the level of control. Logistic regression analysis was used to determine factors associated with uncontrolled asthma.Results:The mean age of the subjects was 40.1 years (SD 15.7) and the sex distribution was almost equal, with 195 (53.9%) females. Among all asthmatics, the prevalence of uncontrolled asthma was 84.5%, according to ACT score. Factors associated with uncontrolled asthma included; health facility (odd ratios [OR] = 2.96 [1.27–6.86]), time to reach facility (OR = 4.51 [1.68–12.06]), non-adherence to follow-up visits (OR = 5.11 [1.12–23.36]), steroids tablets use without prescription (OR = 9.01 [1.01–79.88]), family history of asthma (OR = 0.45 [0.21– 0.95]), and inhaler technique training (OR = 0.37 [0.17–0.78]).Conclusion:This study showed a high rate of uncontrolled asthma in three tertiary hospitals in Khartoum. Factors associated with uncontrolled asthma may be considered as targets for future intervention strategies.

Fungal populations in the bedroom dust of children in Havana, Cuba, and its relationship with environmental conditions.

The study of the fungal community composition in house dust is useful to assess the accumulative exposure to fungi in indoor environments. The objective of this research was to characterize the fungal diversity of house dust and its association with the environmental conditions of bedrooms. For this, the dust was collected from 41 bedrooms of children between the ages of 8 and 9 with a family history of asthma, residents of Havana, Cuba. The fungal content of each sample was determined by two methods: plate culture with malt extract agar and by direct microscopy. An ecological analysis was carried out from the fungal diversity detected. To describe the factors associated with the fungi detected, bivariate logistic regression was used. Through direct microscopy, between 10 and 2311 fragments of hyphae and spores corresponding mainly to Cladosporium, Coprinus, Curvularia, Aspergillus/Penicillium, Xylariaceae, and Periconia were identified. Through the culture, 0-208 CFU were quantified, where Aspergillus, Cladosporium, and Penicillium predominated. The culturability evidenced the differences between the quantification determined by both methods. A positive relationship was found between the type of cleaning of the furniture, the presence of trees in front of the bedroom, indoor relative humidity, indoor temperature, the presence of air conditioning, and natural ventilation with specific spore types and genera. The use of two different identification methods allowed to detect a greater fungal diversity in the residences evaluated. Monitoring the exposure to these fungal allergens in childhood can help to prevent sensitization in the allergic child, the development of asthma, and other respiratory diseases.

US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-risk Groups for Primary Prevention

Asthma is the leading chronic illness in US children, but most descriptive epidemiological data are focused on prevalence. To evaluate childhood asthma incidence rates across the nation by core demographic strata and parental history of asthma. For this cohort study, a distributed meta-analysis was conducted within the Environmental Influences on Child Health Outcomes (ECHO) consortium for data collected from May 1, 1980, through March 31, 2018. Birth cohort data of children from 34 gestational weeks of age or older to 18 years of age from 31 cohorts in the ECHO consortium were included. Data were analyzed from June 14, 2018, to February 18, 2020. Caregiver report of physician-diagnosed asthma with age of diagnosis. Asthma incidence survival tables generated by each cohort were combined for each year of age using the Kaplan-Meier method. Age-specific incidence rates for each stratum and asthma incidence rate ratios by parental family history (FH), sex, and race/ethnicity were calculated. Of the 11 404 children (mean [SD] age, 10.0 [0.7] years; 5836 boys [51%]; 5909 White children [53%]) included in the primary analysis, 7326 children (64%) had no FH of asthma, 4078 (36%) had an FH of asthma, and 2494 (23%) were non-Hispanic Black children. Children with an FH had a nearly 2-fold higher incidence rate through the fourth year of life (incidence rate ratio [IRR], 1.94; 95% CI, 1.76-2.16) after which the rates converged with the non-FH group. Regardless of FH, asthma incidence rates among non-Hispanic Black children were markedly higher than those of non-Hispanic White children during the preschool years (IRR, 1.58; 95% CI, 1.31-1.86) with no FH at age 4 years and became lower than that of White children after age 9 to 10 years (IRR, 0.67; 95% CI, 0.50-0.89) with no FH. The rates for boys declined with age, whereas rates among girls were relatively steady across all ages, particularly among those without an FH of asthma. Analysis of these diverse birth cohorts suggests that asthma FH, as well as race/ethnicity and sex, were all associated with childhood asthma incidence rates. Black children had much higher incidences rates but only during the preschool years, irrespective of FH. To prevent asthma among children with an FH of asthma or among Black infants, results suggest that interventions should be developed to target early life.

Specificities of small airways dysfunction development in patients with mild asthma

The study goal was to identify specificities of small airways dysfunction development (SAD) in patients with mild asthma. Material and Methods — The study involved 114 patients with mild asthma. Depending on the condition of their small airways, the patients were split among two groups: Group 1 of 94 patients with asthma without SAD (82.5%); Group 2 of 20 patients with asthma and SAD (17.5%). The control group consisted of 25 volunteers. SAD was diagnosed by the presence of air trapping and hyperinflation. Results — SAD was diagnosed in 17.5% of patients with mild asthma. The development of SAD was observed in 80% of asthma patients with ailment duration of over 5 years and family history of asthma. Obesity was diagnosed 1.7 times more often in patients with SAD compared with those without it. Food allergy, allergic rhinitis, allergic conjunctivitis, urticaria and bronchial obstruction were identified two or more times more often in patients with SAD compared with those without it. Among all patients with mild asthma and SAD, bronchial obstruction was detected in 55% of cases. Conclusion — The development of SAD in the presence of mild asthma is characteristic for patients with ailment duration over 5 years, family history of asthma, obesity, predominant sensitization to food allergens, and concomitant non-pulmonary allergic diseases. Bronchial obstruction is not the obligatory feature of SAD development in presence of mild asthma.

Airway hyperresponsiveness in patients with normal spirometry results and symptoms compatible with asthma: Primary care retrospective chart review.

To evaluate the proportion of patients with symptoms suggestive of asthma and normal lung function who exhibit airway hyperreactivity with methacholine challenge testing (MCT) in primary care. Retrospective chart review. Primary care lung clinic in Toronto, Ont. A total of 69 patients presenting to the lung clinic who had symptoms compatible with asthma, normal spirometry test results, and were referred for MCT. Descriptive statistics, frequency counts, independent t tests, and 2 tests were used to examine differences in the proportion of clinical and demographic variables identified in patients with or without a positive MCT result. Effect size was determined between MCT-positive and MCT-negative patients for both categorical ( coefficient) and continuous (Hedges g) data. Twenty-one patients (30.4%) had positive MCT results, and 48 patients (69.6%) had negative MCT results. Family history of asthma and reduced baseline and postbronchodilator forced expiratory volume in 1 second were associated with a positive MCT result. The findings of this study provide insight into the utility of simple spirometry for asthma diagnosis and the need to further clarify the role of MCT in the primary care setting.

Prevalence of allergic diseases and their symptoms in schoolchildren according to the birth mode.

The relationship between birth by cesarean section (CS) and allergic diseases' prevalence continues to be controversial. We aimed to investigate if being born by CS is associated with the prevalence of allergic diseases and their symptoms in schoolchildren. This study included children between 6 and 7 years of age, selected by population-based sampling. We investigated the presence of allergic diseases and their symptoms, family history of asthma, smoking in parents, breastfeeding, exposure to pets, the season of birth, number of siblings, consumption of unpasteurized cow's milk, and mode of birth. We included 1003 subjects (526 girls), of which 44.2% were born through CS. The prevalence of allergic diseases did not differ according to birth mode. Asthma in either parent, current smoking by the mother, breastfeeding, and unpasteurized cow's milk consumption were associated with wheezing at some time in life. No association between CS birth mode and allergic diseases and their symptoms was found.

Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines.

Maternal psychosocial stress might be associated with development of allergic diseases in the offspring. To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association. This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13and interferon γ. We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 ± 274.8 vs. 201.6 ± 299.7, p = .04). In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.