Asthma Outcomes In Children Research Articles

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort.

BackgroundThe interplay between COVID‐19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID‐19 pandemic on childhood asthma outcomes.MethodsThe PeARL multinational cohort included 1,054 children with asthma and 505 non‐asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID‐19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.ResultsDuring the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty‐six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre‐bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non‐asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.ConclusionChildhood asthma outcomes, including control, were improved during the first wave of the COVID‐19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID‐19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.

Role of food allergy in the development of different levels of asthma severity in childhood

Background: Different risk factors including previous history of food allergy may play an important role in predicting the development and also the outcome of asthma in children. This study aims to assess the relationship of previous food allergy in infancy with asthma severity later in childhood. Methods: Infants and children of up to 14 years old referred to the Allergy Clinics of Azad University Hospitals from October 2018 to October 2019 for asthma were enrolled in this cross-sectional study. After confirming the diagnosis by a physician expert in this field and determining the level of severity, the patients’ caregivers were asked to fill out an eight-item questionnaire. The questionnaire focused on family history of allergy, as well as that of the child, specifically a previous history of physician-diagnosed food allergy. Results: A total of 170 asthmatic patients were enrolled in the study with a mean age of 7.1±3 years. A meaningful relationship between food allergy and asthma (p value < 0.001) was found. There was also a significant relationship according to history of food allergy in children with moderate and also severe asthma, compared to those with mild asthma (p<0.001). But a meaningful relationship was not found when comparing moderate and severe asthma (p=0.6). Conclusion: To conclude, food allergy in conjunction with a positive family history is suggested as a risk factor for persistent problematic asthma which places patients at greater risk for morbidities. A history of previous food allergy was significantly associated with moderate to severe asthma compared to mild asthma.

The Added Burden of Allergen Sensitization Among Children with Severe or Poorly Controlled Asthma

Allergen sensitization (AS) may negatively affect asthma outcomes in children with severe or poorly controlled (SPC) asthma. To examine the impact of AS on asthma exacerbations, health care use, and costs among children with SPC asthma in private and public insurance settings. This retrospective study analyzed children with SPC asthma aged 6 to 11 years from the MarketScan Commercial (private insurance) and Medicaid databases. Selection of children with SPC asthma was based on medical claims and asthma medication prescription claims. AS status was based on diagnoses of extrinsic asthma and allergic conditions. Children were followed for at least 12 months. Outcomes included asthma exacerbations, days with oral corticosteroids (OCS), and asthma-related health care use and costs. Adjusted generalized linear models were fit to compare outcomes in children with versus those without AS. Among children with SPC asthma, 34% had AS (private insurance: N= 11,448; Medicaid: N= 10,800), 20% did not have AS (private insurance: N= 7744; Medicaid: N=6535), and, in the remainder, AS status could not be determined. Claims data were available for ≥3 years on average. Children with AS had significantly higher adjusted rates of asthma exacerbations during follow-up than children without AS, and significantly more days with OCS use. Rates of asthma-related hospitalizations, emergency department visits, and health care costs were significantly higher among children with AS than among children without AS. Children with SPC asthma and AS have relatively greater asthma-related health care use and costs compared with children with SPC asthma without AS.

Indoor endotoxin, proximity to a major roadway, and severe asthma exacerbations among children in Puerto Rico

BackgroundFew studies have examined concurrent exposure to household endotoxin and traffic-related air pollution in relation to childhood asthma, yet both factors are associated with asthma outcomes. ObjectiveTo examine whether proximity to a major roadway (a traffic-related air pollution proxy) modifies the estimated effects of indoor endotoxin on asthma outcomes in children. MethodsCross-sectional study of 200 children with asthma (ages, 6-14 years) living in Puerto Rico. Residential distance to a major roadway was calculated as the distance from the participant’s residential US census block centroid to the nearest major road. The outcomes of interest were severe asthma exacerbations, missed school days for asthma, atopy, lung function, and bronchodilator response (BDR). Logistic, linear, or negative binomial regression was used for the multivariable analysis. ResultsIn the multivariable analysis, there was an interaction between indoor endotoxin and residential distance to a roadway on severe asthma exacerbations (P = .02) and BDR (P = .07). In an analysis stratified by distance to a roadway, each log10-unit increase in endotoxin was associated with 4.21 times increased odds of severe asthma exacerbations among children living within 499 m (the lower 3 quartiles of residential distance) to a road (95% confidence interval, 1.5-12.0). Among subjects living further than 499 m away from a roadway, each log10-unit increase in endotoxin was associated with reduced odds of severe asthma exacerbations (odds ratio, 0.03; 95% confidence interval, 0.001-0.67). Similar but less substantial findings were observed for BDR. ConclusionOur findings suggest that residential proximity to a major road modifies the estimated effect of endotoxin on severe asthma exacerbations in children.

Inhalation therapy for bronchial asthma in the conditions of paediatric section

The prevalence of bronchial asthma among children in different regions of Russia ranges from 10.9–9.6‰ to 50–55‰. The frequency of bronchial asthma among lyceum students is 33.1‰, while in the most overcrowded school it is 45.8‰. Bronchial asthma occurs more frequently in the mild, less frequently in the medium form. Therefore, the main burden on the management of such patients falls on the ambulatory segment. Diagnosed on the basis of respiratory symptoms such as wheezing, difficulty breathing, strain and bloating of the chest, coughing. Asthmatic attack with bronchial asthma of any degree of severity can be as severe or even asthmatic status, which, along with the prevalence of bronchial asthma, determines the primary importance of ambulatory control of the disease. It is fundamental to suppress local bronchial inflammation and remove bronchospasm. Adequacy and systematic treatment is essential for the outcome of bronchial asthma in children. Timely anti-inflammatory treatment can lead to remission. Inhalation techniques of anti-inflammatory drugs and bronchodilators are the most optimal. The possibility of application of beclometasone (inhalation glucocorticosteroid), a combination of fluticasone and salmeterol, ipratropium bromide of Russian manufacture, which efficiency is proved in practical work and economically justified, is considered. IGCS, acting locally, have a pronounced anti-inflammatory activity, suppressing both acute and chronic inflammation. Clinical examples of children with atopic dermatitis and the revealed diagnosis of bronchial asthma, with an optimum choice of treatment are given. It is proved that application of modern inhalation drugs in complex treatment leads to bronchial asthma remission.

Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support.

Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway. Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N=165; mean age=9.08, standard deviation=2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support. Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P=.07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years. This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.

Association of Childhood Asthma With Federal Rental Assistance

Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. To examine whether participation in the US Department of Housing and Urban Development's (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Participation in rental assistance provided by HUD. Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, -29.7 to -6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, -36.6; 95% CI, -54.8 to -18.4) but not housing choice vouchers (percentage point change, -7.2; 95% CI, -24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, -2.7; 95% CI, -12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (-4.3; 95% CI, -8.8 to 0.2 percentage points). Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.

A randomized trial of a one-time pest intervention: impact on childhood asthma outcomes

Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation.Study design: In a randomized controlled trial of 384 children aged 5–12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use.Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group.Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.

Mediterranean diet during pregnancy and childhood respiratory and atopic outcomes: birth cohort study.

Evidence for associations between Mediterranean diet during pregnancy and childhood asthma, allergy and related outcomes is conflicting. Few cohorts have followed children to school age, and none have considered lung function.In the Avon Longitudinal Study of Parents and Children, we analysed associations between maternal Mediterranean diet score during pregnancy (estimated by a food frequency questionnaire, using an a priori defined score adapted to pregnant women; score ranging from 0 (low adherence) to 7 (high adherence)) and current doctor-diagnosed asthma, wheeze, eczema, hay fever, atopy and lung function in 8907 children at 7–9 years. Interaction between maternal Mediterranean diet and maternal smoking in pregnancy was investigated.The maternal Mediterranean diet score was not associated with asthma or other allergic outcomes. Weak positive associations were found between maternal Mediterranean diet score and childhood maximal mid-expiratory flow (forced expiratory flow at 25–75% of forced vital capacity (FEF25–75%)) after controlling for confounders. Higher Mediterranean diet scores were associated with increased FEF25–75% z-scores adjusted for age, height and sex (β 0.06, 95% CI 0.01–0.12; p=0.03, comparing a score of 4–7 versus a score of 0–3). Stratifying associations by maternal smoking during pregnancy showed that associations with FEF25–75% were only seen in children of never-/passive-smoking mothers, but no evidence for a statistically significant interaction was found.Results suggest adherence to a Mediterranean diet during pregnancy may be associated with increased small airway function in childhood, but we found no evidence for a reduced risk of asthma or other allergic outcomes.

Bronchodilator Dose Responsiveness in Children and Adolescents: Clinical Features and Association with Future Asthma Exacerbations

Bronchodilator reversibility measures are often associated with poor asthma outcomes in children. Whether bronchodilator dose responsiveness is similarly useful in children is unclear. We hypothesized that children and adolescents requiring higher doses of bronchodilator to achieve maximal bronchodilation would have unique risk factors and increased risk of future exacerbation. Children (6-11 years, N= 299) and adolescents (12-21 years, N= 331) with confirmed asthma underwent clinical phenotyping procedures and a test of maximal bronchodilation with escalating doses of albuterol sulfate up to 720 mcg. Outcome measures were assessed at 12 months and included exacerbations treated with systemic corticosteroids, emergency department (ED) visits, and hospitalizations for asthma. A total of 6.7% of children and 9.3% of adolescents had poor bronchodilator dose responsiveness, defined as attainment of maximal forced expiratory volume in 1 second with 720 mcg albuterol. Risk factors included type 2 inflammation, prior exacerbations, and greater asthma severity; historical pneumonia and tobacco exposure were also risk factors in children. Children and adolescents with poor bronchodilator dose responsiveness did not have increased current symptoms or impaired quality of life, but had approximately 2-fold increased odds of exacerbation or ED visit and approximately 3-fold increased odds of hospitalization by 12 months, independent of airflow obstruction. Bronchodilator dose responsiveness may be useful for phenotyping and may be of utility in practice and future studies focused on asthma outcomes or quantification of treatment responses. In children and adolescents, this phenotype of poor bronchodilator responsiveness may be associated with periods of relatively stable disease yet marked airway constriction in response to triggers, including tobacco smoke, respiratory infections/pneumonia, and aeroallergens.

Randomized clinical trial of parental psychosocial stress management to improve asthma outcomes

Objective Because higher parental psychosocial stress is associated with worsened asthma outcomes in children, we sought to determine if a parent-focused stress management intervention would improve outcomes among their at-risk African American children. Methods We enrolled self-identified African American parent-child dyads (children aged 4-12 years old with persistent asthma, no co-morbidities, on Medicaid) in a prospective, single-blind, randomized clinical trial with follow-up at 3, 6, and 12 months. All children received care based on the guidelines of the National Institutes of Health. Developed with extensive local stakeholder engagement, the intervention consisted of four individual sessions with a community wellness coach (delivered over 3 months) supplemented with weekly text messaging and twice monthly group sessions (both delivered for 6 months). The main outcome was asthma symptom-free days in the prior 14 days by repeated measures at 3 and 6 months follow-up. Results We randomized 217 parent-child dyads and followed 196 (90.3%) for 12 months. Coaches completed 338/428 (79%) of all individual sessions. Symptom-free days increased significantly from baseline in both groups at 3, 6, and 12 months, but there were no significant differences between groups over the first 6 months. At 12 months, the intervention group sustained a significantly greater increase in symptom-free days from baseline [adjusted difference = 0.92 days, 95% confidence interval (0.04, 1.8)]. Conclusion The intervention did not achieve its primary outcome. The efficacy of providing psychosocial stress management training to parents of at-risk African American children with persistent asthma in order to improve the children’s outcomes may be limited. ClinicalTrials.gov NCT02374138

Racial/Ethnic Disparities Among Children with Asthma Discharged from the Hospital

BACKGROUND: The prevalence and outcomes of childhood asthma are known to vary based on race and ethnicity. OBJECTIVE: To evaluate racial and ethnic disparities in children hospitalized with asthma in the United States using the 2012 Kids’ Inpatient Database (KID). DESIGN/METHODS: A cross-sectional study using the Healthcare Cost and Utilization Project 2012 Kid’s Inpatient Database (HCUP KID) was performed. Asthma in the age group from 2-17 years was identified using ICD-9-CM codes. Race/ethnicity was grouped into white, black, Hispanic, and others. Racial/ethnic distribution was compared among asthma and other discharges. …

Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity.

BackgroundAsthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions.ObjectiveWe propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app.MethodsParticipants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses.ResultsThis study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019.ConclusionsOutcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users.International Registered Report Identifier (IRRID)DERR1-10.2196/13549

Longitudinal Effect of Ambient Air Pollution and Pollen Exposure on Asthma Control: The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Study

ObjectiveAlthough exposure to air pollution and pollen is associated with asthma exacerbation and increased health care use, longitudinal effects of fine particulate matter 2.5 (PM2.5), ozone (O3), and pollen exposure on asthma control status in pediatric patients are understudied. This study investigated effects of exposure to PM2.5, O3, and pollen on asthma control status among pediatric patients with asthma. MethodsA total of 229 dyads of pediatric patients with asthma and their parents were followed for 15 months. The Asthma Control and Communication Instrument was used to measure asthma control, which was reported weekly by parents during a 26-week period. PM2.5 and O3 data were collected from the US Environmental Protection Agency Air Quality System. Pollen data were obtained from Intercontinental Marketing Services Health. Mean air pollutant and pollen exposures within 7 days before the reporting of asthma control were used to estimate weekly exposures for each participant. Linear mixed-effects models were performed to test associations of PM2.5, O3, and pollen exposure with asthma control status. Sensitivity analyses were performed to evaluate the robustness of findings by different exposure monitoring days per week and distances between monitoring sites and participants’ residences. ResultsElevated PM2.5 concentration and pollen severity were associated with poorer asthma control status (P < .05), yet elevated O3 concentration was marginally associated with better asthma control (P < .1). ConclusionsPoorer asthma control status was associated with elevated PM2.5 and pollen severity. Reducing harmful outdoor environmental ambient exposure may improve asthma outcomes in children and adolescents.

Comparison of severity of asthma hospitalization between African American and Hispanic children in the Bronx

Objective: There are racial and ethnic disparities in childhood asthma burden and outcomes. Although there have been comparisons between whites and minorities, there are few between minority groups. This study aimed to compare characteristics of asthma hospitalizations in African American and Hispanic children.Methods: A retrospective chart review was conducted to compare asthma characteristics between African American and Hispanic children aged 2–18 years hospitalized at an urban, tertiary care hospital for an acute asthma exacerbation. Length of stay (LOS), need for intensive care unit (ICU), and need for additional medications or respiratory support were compared between the groups.Results: Of the 925 children that met the inclusion criteria, 64% were Hispanic and 36% were African American. The groups were similar in age, gender, insurance status, and weight classification. African American children were more likely to have severe persistent asthma (12% vs. 7%, p = .02). They were also more likely to require magnesium sulfate (45% vs. 32%, p < .001) and admission to the ICU from the emergency department (ED) (14% vs. 8%, p = .01), which were independent of asthma severity. There was no significant difference in LOS or other characteristics of hospitalization.Conclusions: African American children hospitalized for asthma have more severe exacerbations compared to Hispanic children, which is independent of their asthma severity. However, this was not associated with longer LOS, which may indicate greater responsiveness to inpatient asthma management. Further investigation is needed to understand the mechanisms underlying asthma and exacerbation severity among minority groups.

Quality of life of the family of children with asthma is not related to asthma severity

The quality of life for the family is an important outcome of childhood asthma. The aim of the study was to describe the quality of life in families who have a child with asthma. The Pediatric Quality of Life Inventory Family Impact Module was completed by the parents of 527 children with asthma. The median overall score was 75.0 (interquartile range 63.9, 87.5). The following factors were independently associated with lower quality of life: additional difficulties such as anxiety and financial hardship (3.81 [2.45, 5.93]), waking with asthma symptoms one or more nights a week (odds ratio 2.53 [1.34, 4.75]), regular use of symptoms reliever medication (2.47 [1.57, 3.87]), and female gender (1.97 [1.27, 3.05]). Lower socioeconomic status of the family and exposure to molds at home doubled the odds for lower quality of life. Physician's diagnosed asthma severity and control were associated with quality of life in univariate, but not multivariate analysis.Conclusion: Multiple factors, several of which are not related to asthma, contribute to the family burden of having a child with asthma. Clinicians should be mindful of the impact of asthma on the child and the family, and consider exploring factors not directly related to childhood asthma. What is Known: • Childhood asthma as a chronic disease impacts the quality of life of the patient, but there is also an impact on the immediate family. • There are relatively few studies exploring the quality of life of parents of a child with asthma; the results are heterogeneous and none has been carried out in an Eastern European country. What is New: • This is the first study to describe caregiver's quality of life in an Eastern European population in the context of childhood asthma. • The quality of life of the family of asthmatic child depends not only on factors related to asthma, but also non-asthma related factors such as poverty which play even more important role.

Precision medicine in childhood asthma.

Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab.Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.

The impact of adenotonsillectomy on pediatric asthma.

To determine asthma outcomes in children undergoing adenotonsillectomy (T&A) for treatment of sleep-disordered breathing (SDB). Asthmatic children will demonstrate improvement in asthma control after T&A compared to asthmatic children not undergoing surgical treatment. Prospective cohort. 80 children with diagnosed asthma, aged 4-11, undergoing T&A and 62 controls matched to the T&A subjects by age, sex, and asthma severity classification. Parents and children completed the Childhood Asthma Control Test (C-ACT) and the Pediatric Sleep Questionnaire (PSQ). Parents were queried regarding the number of asthma exacerbations, the frequency of the use of systemic steroids, the number of emergency room visits and the number of hospitalizations in the prior 6 months. The identical questionnaires and interviews were completed 6 months after entry. The adjusted mean (95% CI) C-ACT score was 21.86 (20.94-22.68) at entry and 25.15 (24.55-25.71) at follow-up for the T&A group compared with 22.42 (21.46-23.28) and 23.59 (22.77-24.33) for the control group. There was a significant group by time interaction (P < 0.001). Simple effects analysis showed that group means did not differ at entry (P = 1.00) but did differ at follow-up (P = 0.006). Baseline PSQ was a significant predictor of improvement in C-ACT scores. Statistical modeling did not demonstrate significant group by time interactions for any of the asthma clinical outcomes, although these outcomes were very infrequent in both groups. Treatment of SDB improves asthma outcomes as measured by the C-ACT.

Change in FEV1 and Feno Measurements as Predictors of Future Asthma Outcomes in Children

Repeated measurements of spirometry and fractional exhaled nitric oxide (Feno) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing Feno will predict poor future asthma outcomes. A one-stage individual patient data meta-analysis used data from seven randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and %change in Feno between baseline and 3months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6months after baseline. Data were available from 1,112 children (mean age, 12.6 years; mean %FEV1, 94%). A 10%reduction in %FEV1 between baseline and 3months was associated with 28%increased odds for asthma exacerbation (95%CI, 3-58) and with 21%increased odds for having poor asthma control (95%CI, 0-45) 6months after baseline. A 50%increase in Feno between baseline and 3months was associated with 11%increase in odds for poor asthma control 6months after baseline (95%CI, 0-16). Baseline Feno and %FEV1 were not related to asthma outcomes at 3months. Repeated measurements of %FEV1 that are typically within the "normal" range add to clinical risk assessment of future asthma outcomes in children. The role of repeated Feno measurements is less certain because large changes were associated with small changes in outcome risk.

20-Year trends in severe childhood asthma outcomes: Hospitalizations and intensive care visits

RATIONALE: Few studies have examined trends in the rates of severe exacerbations of childhood asthma.OBJECTIVES: Our objective was to measure changes over time, and factors associated with severe asthma outcomes, namely hospitalizations and intensive care unit admissions among children.METHODS: This was a population-based retrospective multiple birth cohort study spanning the years 1996-2013. Health administrative data from the province of Ontario, Canada was used to assemble ten consecutive birth cohorts and identify children who were diagnosed with asthma between 0 and 8 years of age. Trends in the proportion of children hospitalized at the first diagnosis of asthma or admitted to intensive care units were quantified. Multivariable logistic regression was used to identify predictors of each outcome.MEASUREMENTS AND MAIN RESULTS: Of 1,241,060 Ontario-born children, 254,964 were diagnosed with asthma. The proportion of children hospitalized at first asthma diagnosis decreased over time (5.81% to 4.44%, p-trend <0.0001). Asthma-intensive care unit admissions increased 7-fold (0.03% to 0.22%, p-trend <0.0001), and ventilation admissions increased 5-fold (0.02% to 0.1%, p-trend <0.0001). Younger age at diagnosis, male sex, comorbidities, lower socioeconomic status and rurality were significant predictors of asthma admissions; more pediatrician visits and higher neighbourhood ethnic concentration were protective.CONCLUSIONS: Although a smaller proportion of children over time are hospitalized at first asthma diagnosis, these admissions may be preventable among children with previous asthma-related healthcare encounters. This, along with increases in intensive care unit admission rates, suggests health care providers need to do more to prevent severe childhood asthma exacerbations.