Risk Factor For Childhood Asthma Research Articles

Correlations of LTα and NQO1 gene polymorphisms with childhood asthma.

To explore the correlation of the lymphotoxin alpha (LTα) and nicotinamide adenine dinucleotide phosphate quinone oxidoreductase 1 (NQO1) gene polymorphisms with childhood asthma. A total of 102 asthma children (observation group) and 80 healthy children (control group) were enrolled. The information was collected via questionnaires and the polymorphisms of LTα rs2844484 and NQO1 rs2917666 were examined with the TaqMan-MGB probe. Observation group had higher constituent ratios of contact with animal furs, personal history of infection, personal history of allergy, familial infection history and familial allergic history than those of control group (p<0.05). However, there were no differences in age, sex, passive smoking, purchase of new furniture and mask wearing between the two groups (p>0.05). The frequency of LTα rs2844484 genotype AA was significantly higher than that of genotype AG and GG (p<0.01), and NQO1 rs2917666 genotype CC showed notably higher frequency than that of genotype CG and GG (p<0.05). The frequency of LTα rs2844484 A allele was significantly higher than that of G allele (p<0.01), while NQO1 rs2917666 C allele had remarkably higher frequency than G allele (p<0.05). The comparisons of the recessive and additive modes revealed differences between the two groups (p<0.05). However, we did not observe significant difference in dominant mode between the two groups (p>0.05). The risk factors for childhood asthma include the contact with animal furs, personal history of infection, personal history of allergy, familial infection history and familial allergic history. Polymorphisms of LTα and NQO1 genes are correlated with childhood asthma.

Dietary risk factors for childhood asthma in a semi-urban area of South India: A cross-sectional study

Background: Although inhaled allergens are more likely to trigger asthma than food allergens, global trends of asthma prevalence emphasize the role of changing dietary habits in modulating the inflammatory mediators involved in the pathogenesis of asthma. Objective: The objective of the study was to identify the dietary risk factors associated with childhood asthma in a semi-urban region of South India. Materials and Methods: This was a cross-sectional study done at a medical college hospital in South India from October 2016 to January 2017. After obtaining the Ethical Committee approval, children aged 3–15 years attending the pediatric outpatient department were enrolled in the study. Parents were interviewed with a precoded Food Frequency Questionnaire. Details regarding common dietary practices followed at home, frequency of consumption of specific food groups and history of food allergy were obtained. Chi-square tests and logistic regression analysis were used to analyze the data. Results: Among 500 subjects, 293 (58.6%) children had physician-diagnosed asthma. Duration of breastfeeding was &lt;1 year (OR 2.01, 95% CI 1.35–2.99); frequent intake of fast food (OR 2.70, 95% CI 1.61–4.52), usage of coloring agents and taste enhancers in cooking (OR 3.93, 95% CI 1.53–10.06), and history of allergy to specific foods (OR 2.21, 95% CI 1.42–3.45) were found to be independent risk factors for childhood asthma. The absence of fish in the diet was significantly associated with increased risk of asthma (OR 1.50, 1.04–2.15) and non-vegetarians were at lesser risk (OR 0.43, 0.24–0.76) of developing asthma. Conclusion: Prolonged duration of breastfeeding (&gt;1 year), restriction of fast food, and avoidance of food additives decrease the risk of asthma in children. Non-vegetarian diet with the inclusion of fish offers a protective effect against asthma. Early identification and appropriate management of coexisting food allergies in children with asthma are necessary.

The Children\u2019s Respiratory and Environmental Workgroup (CREW) birth cohort consortium: design, methods, and study population

BackgroundSingle birth cohort studies have been the basis for many discoveries about early life risk factors for childhood asthma but are limited in scope by sample size and characteristics of the local environment and population. The Children’s Respiratory and Environmental Workgroup (CREW) was established to integrate multiple established asthma birth cohorts and to investigate asthma phenotypes and associated causal pathways (endotypes), focusing on how they are influenced by interactions between genetics, lifestyle, and environmental exposures during the prenatal period and early childhood.Methods and resultsCREW is funded by the NIH Environmental influences on Child Health Outcomes (ECHO) program, and consists of 12 individual cohorts and three additional scientific centers. The CREW study population is diverse in terms of race, ethnicity, geographical distribution, and year of recruitment. We hypothesize that there are phenotypes in childhood asthma that differ based on clinical characteristics and underlying molecular mechanisms. Furthermore, we propose that asthma endotypes and their defining biomarkers can be identified based on personal and early life environmental risk factors. CREW has three phases: 1) to pool and harmonize existing data from each cohort, 2) to collect new data using standardized procedures, and 3) to enroll new families during the prenatal period to supplement and enrich extant data and enable unified systems approaches for identifying asthma phenotypes and endotypes.ConclusionsThe overall goal of CREW program is to develop a better understanding of how early life environmental exposures and host factors interact to promote the development of specific asthma endotypes.

Association between overweight or obesity and the risk for childhood asthma and wheeze: An updated meta-analysis on 18 articles and 73252 children.

Overweight or obesity is increasingly recognized as a possible risk factor for childhood asthma. We aimed to meta-analyse the association between overweight or obesity and the risk for childhood asthma and wheeze and meanwhile explore potential causes of between-study heterogeneity. Literature search, study selection, and data extraction were performed independently and in duplicate. Data were analysed by STATA software. Eighteen articles and 73252 children were analysed. In overall analyses, there was a significant association between overweight or obesity and the risk for childhood asthma (odds ratio [OR]=1.30; 95% confidence interval [CI], 1.23-1.39; P<0.001) and wheeze (OR=1.90; 95% CI, 1.38-2.63; P<0.001), with none/marginal publication bias as revealed by the Egger test (P=0.938/0.038), respectively. Subgroup analyses showed that children with obesity (OR=1.40; 95% CI, 1.29-1.52) were more likely to have asthma than children with overweight (OR=1.22; 95% CI, 1.14-1.31), and in children with overweight or obesity, girls (OR=1.34; 95% CI, 1.16-1.56) were more likely to have asthma than boys (OR=1.27; 95% CI, 1.15-1.40). Our findings indicate that overweight or obesity is a significant risk factor for childhood asthma and wheeze and in children with overweight or obesity, the risk is more evident in girls than in boys.

Toxocara Infection in Asthmatic Children: A Case-Control Study in Karaj District, Iran

Background: It has been proposed that the migration of Toxocara canis larvae through the lungs is a contributing factor in the development of asthma and association of asthma and toxocariasis has been reported. The seroprevalence of toxocariasis varies widely among children living in different countries and even in different regions of a single country. Objectives: The aim of this study is to compare seroprevalence of anti-Toxocara antibodies in asthmatic and healthy children in Karaj, Iran. Methods: A serological study was conducted in children aged 1 to 15 years old for detection of antibodies to Toxocara canis in two groups (92 asthmatic children and 100 non-asthmatic children as control group), using commercial ELISA method for determination of IgG antibodies against Toxocara. Results: Only one patient (1.09%) had positive levels of anti-Toxocara antibodies in the case group, while no one had them in the control group. The results showed that there was no significant correlation between IgG antibodies against Toxocara canis and asthma. More than 90% of children in both case and control groups were residents of urban areas. Conclusions: We did not find any association between Toxocara infection and childhood asthma, suggesting that it may not be a common risk factor for childhood asthma in our urban area.

Does Acetaminophen-Use in Early Life Cause Asthma in Children and the Role of Lower Respiratory Tract Infection on that Association

Background: Use of acetaminophen in early life is thought to be a modifiable risk factor for childhood asthma. However, the relationship is still inconclusive. From April 23, 2013 to January 22, 2014, all OTC acetaminophen syrups were recalled in South Korea. This study aimed to investigate the removal-effect of OTC acetaminophen, and the subsequent risk of doctor-prescribed acetaminophen-powder on asthma-development among children born during recall period. Methods: A retrospective birth cohort (n=827,743), who were born from 2011 to 2013, was constructed utilizing a Healthcare Insurance Review and Assessment (HIRA) database in Korea. Incidence of asthma (up to age 3 years) was compared to investigate the removal-effect of the OTC acetaminophen. The risk of doctor-prescribed acetaminophen-powder within the first year on later asthma was analyzed in a sub-cohort (n=195,597) born during the recall period. Lower respiratory tract infections (LRTIs) and antibiotic use within the first year of life was adjusted for controlling potential confounding by indication. Findings: Incidence of asthma (per 100 person-months) did not decrease, but rather increased (1·99 in 2011 birth cohort, 2·24 in 2012, and 2·49 in 2013) during the study period. In the sub-cohort during the recall period, acetaminophen-use within the first-year increased risk of asthma (OR=1·145, 95% CI 1·121-1·170), attenuated risk after adjustment for LRTIs (OR=1·029, 95% CI 1·007-1·051), and became null after further adjustment for use-of antibiotics (OR=0·904, 95% CI 0·883-0·925). In stratified model, LRTIs increased the risk (OR=4·134, 95% CI 3·965-4·311) of asthma-development in the group with exposure to acetaminophen, but attenuated the risk in group without acetaminophen exposure (OR= 1·618, 95% CI 1·585-1·652). Interpretation: Contrary to the previous reports, use of acetaminophen in early life reduced the risk of asthma up to 3 years of age after controlling for the effect of LRTIs and antibiotic use. Funding Statement: This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1302), and Soonchunhyang University Research Fund. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The research protocol for this study was approved by the Ethical Review Board of Soonchunhyang University Seoul Hospital (approval number: SCHUH 2016-04-024). The requirement for informed consent was waived due to the retrospective nature of the study.

Household dampness-related exposures in relation to childhood asthma and rhinitis in China: A multicentre observational study

During 2010–2012, we conducted an observational study on household environment and health outcomes among 40,010 preschool children from seven cities of China. Here we examined associations of six dampness-related indicators (visible mold spots, visible damp stains, damp clothing and/or bedding, water damage, condensation on windowpane, moldy odor) in the current residence and three dampness-related indicators (visible mold spots, condensation on windowpane, moldy odor) in the early residence with childhood asthma and rhinitis. In the multi-level logistic regression analyses, visible mold spots and visible damp stains in the current residence were significantly associated with the increased odds of doctor-diagnosed asthma and allergic rhinitis during lifetime-ever (adjusted odd ratios (AORs) range: 1.18–1.35). All dampness-related indicators were significantly associated with increased odds of wheeze and rhinitis during lifetime-ever and in the past 12 months (AORs range: 1.16–2.64). The cumulative numbers of damp indicators had positively dose-response relationships with the increased odds of the studied diseases. These associations for wheeze and rhinitis were similar between northern children and southern children. Similar results were found in the sensitive analyses among children without a family history of allergies and among children without asthma and allergic rhinitis. For 3–6 years-old children in mainland of China in 2011, we speculated that about 90,000 (2.02%) children with asthma and about 59,000 (1.09%) children with allergic rhinitis could be attributable to exposing to visible mold spots in the current residence. Our results suggested that early and lifetime exposures to household dampness indicators are risk factors for childhood asthma and rhinitis.

Facteurs environnementaux favorisant le développement d’un asthme

The prevalence of asthma has increased rapidly since the early 1970s, and only changes in exposure to environmental factors; which go together with changes in lifestyle, are likely to explain such a rapid increase. Exposure to allergens is a risk factor for allergic sensitization, and allergic sensitization is a risk factor for allergic asthma. However, apart from indoor mold exposure as a risk factor for childhood asthma, there is insufficient evidence to conclude that the associations between allergen exposure and asthma development are causal. A new challenge for research is to analyze the huge amount of data derived from the metagenomic characterization of the environmental and human microbiome, to understand the role of interactions between viruses, bacteria and allergens in the development of asthma. It is recognized that prenatal and postnatal exposure to air pollution and maternal smoking increase the risk of developing asthma in children. In adults, the data are scarce and the results remain controversial as regards these exposures and asthma incidence. Further research is needed to appraise the effect of exposure to phenols, phthalates and perfluorinated compounds, which are widespread in the environment and may be associated with asthma, especially in children. Frequent use of chemicals for home cleaning especially in the form of sprays -which is a common practice at the population level- is a risk factor for the development of adult asthma. The domestic use of cleaning products might also be a risk factor for asthma in children exposed at home. The chemicals involved in these relationships are still to be identified. Occupational asthma is a major phenotype of adult asthma. A significant part of these asthma cases might relate to occupational exposure to cleaning products. While there is evidence of associations between diet during pregnancy or during childhood and the risk of developing asthma in children, the data in adults are insufficient. Beyond genetic factors, body composition is influenced by dietary choices and physical activity. Further research is needed to clarify the complex interplay between these nutritional factors and asthma development. The new challenge for research is to decipher the role of all the environmental factors to which the individual is exposed since conception ("exposome") in the development of asthma, using a holistic approach.

Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke

We studied indoor sources of indoor particulate matter (PM), outdoor air pollution and antibiotic use in relation to asthma, rhinitis and eczema among pre-school children and investigated synergistic effects between PM and antibiotics use. Children (3-6y) from randomly selected day care centres in seven cities across China were included (n = 39,782). Data on ambient temperature and air pollution were collected from local monitoring stations. Data on indoor PM sources (ETS, burning of incense or mosquito coils and biomass for cooking), antibiotics use and health (doctor diagnosed asthma and rhinitis, lifetime eczema, current wheeze and current rhinitis) were assessed by a parental questionnaire. Associations were calculated by multilevel logistic regression. Asthma diagnosis was associated with outdoor temperature, NO2 and burning mosquito coils. Rhinitis diagnosis was associated with NO2, ETS, gas cooking and burning biomass for cooking. Lifetime eczema was associated with temperature, PM10, NO2, ETS, biomass cooking and burning mosquito coils. Burning incense was associated with current wheeze and current rhinitis. Children using antibiotics had more asthma, wheeze, rhinitis, and eczema. Excluding children with respiratory infections did not change associations with antibiotics use. Antibiotics use enhanced the effects of ETS and PM10 (a synergistic effect). In conclusion, a warmer climate, outdoor NO2 and PM10, ETS, gas cooking and burning biomass, incense and mosquito coils can increase the risk of asthma, wheeze, rhinitis and eczema among pre-school children in China. Antibiotics use is a risk factor for childhood asthma, wheeze, rhinitis and eczema and ETS and outdoor PM10 can enhance the effect.

Iron deficiency anemia as a risk factor of childhood asthma

Background: There are many risk factors for asthma occurrence like gender, atopy, and infection. Trace elements like Fe, Mg and Zn play a role in decreasing airway hyper-responsiveness. Objectives: To assess Iron Deficiency Anemia (IDA) as a risk factor for childhood asthma and its possible effect on pulmonary functions. Patients and Methods: Across-sectional comparative study was carried out on 200 children, 6-14 years old who attended the outpatient pediatric clinics and emergency department of Albatool Teaching hospital in Diyala governorate from Oct. 2017 to Oct 2018, they were classified into: group I:100 children with IDA-who was subdivided into group Ia: Asthmatic children and group Ib: Non asthmatic children. Group II: 100 children without IDA, subdivided into group IIa: asthmatic children and group II b: non-asthmatic children. Results: Children with asthma in group Ia the male to female ratio was 1.75/1.0 and in group II b the ratio was 1.4/1.0. The anemic group with asthma constitutes 66% of group I, while in group II the asthmatic children constituted 24% of included children. Anemic asthmatic children had significant difference regarding Pulmonary Function Tests (PFT) (FEV1, FVC, FVC/FEV1) in comparison to non-anemic asthmatics. Conclusion: Asthma was more common in males, anemic asthmatics group constituted 66%, and anemia had significant detrimental effects on PFT in comparison to non-anemic asthmatics.

The association of prenatal risk factors with childhood asthma

Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR = 2.87, 95% CI = 1.60–5.14) and wheezing (aOR = 5.57, 95% CI = 2.32–13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR] = 5.86 (3.03–11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.

Risk Factors for Childhood Asthma and Wheeze: Comparisons from an International Study

Background and objectives: International differences in childhood asthma prevalence have been reported with the environment suspected to play a role. We sought to investigate risk factors for asthma and wheeze and their consistency between countries.Methods: This was an international, cross-sectional study of children (6-13 years) living in an urban centre from Belarus, Canada, Republic of Georgia (Adjara), Republic of Macedonia, Poland, and Ukraine. History of physician-diagnosed asthma and wheeze in the past 12 months were ascertained from parent completed survey. Basic survey information was standardized but each site could include questions on additional potential risk factors. Multiple logistic regression was used to adjust for confounding.Results: In total, 12257 children participated (response rates: 26%-91%). Asthma prevalence was highest in Canada (12.6%) followed by Poland (10.3%) then the remaining sites (range: 1.0%-1.5%). Wheeze prevalence followed similar patterns but was higher than asthma (3.7% to 14.0%). In adjusted analyses using data from sites with the most comprehensive information (Canada, Poland, Macedonia), we found increased risk of asthma associated with antibiotic use, traditional medicine use, home mould or dampness, and family history of allergic conditions but a lower risk with being female (p&amp;lt;0.05). Similar results were seen when considering the outcome wheeze except that exposure to mice or pests increased the risk of wheeze and there was no association with home mould. There were some statistically significant interactions suggesting that the associations were not consistent between sites. Finally, when comparing no asthma or wheeze to those with wheeze without asthma as well as comparing no asthma or wheeze to those with asthma, risk factors were similar.Conclusions: Our findings suggest that in general, risk factors for asthma or wheeze are similar to what we expect but that some of these may be specific to certain locations.

Effects of Fine Particulate Matter and Its Constituents on Asthmatic and Allergic Symptoms in Preschool Children: A Cross-Sectional Study in Six Cities of China

Background/Aim: Few studies examined the effects of specific PM2.5 constituents on childhood asthma and allergy in China. We aimed to investigate the effects of various PM2.5 constituents on asthmatic and allergic symptoms in preschool children in China.Methods: A cross-sectional study was conducted among 48219 preschool children in six cities (Shanghai, Nanjing, Chongqing, Changsha, Urumqi and Taiyuan) based on China , Children ,Home and Health (CCHH) project in China. Information on allergic symptoms as well as demography were collected by questionnaires. Data for ambient PM2.5 concentration and its 5 constituents: BC, NH4&amp;#43;, SO42-, NO3- and OC were obtained from the global burden disease project to 205 kindergartens at a spatial resolution of 0.01&amp;#215;0.01(1km&amp;#215;1km) in six cities. A hierarchical logistic regression model was performed to explore the associations between kindergarten-level PM2.5 components and individual-level outcomes of asthmatic and allergic symptoms controlling for demography and other covariates.Results: A total of 30759 participants (51.7% male) were finally completed the study due on the missing data. Both the single-pollutant and two-pollutants model showed that ambient PM2.5 per 10ug/m3 increase positively associated with the prevalence of diagnosed asthma by an adjusted odds ratio (AOR) and 95% confidence interval(CI) of 1.18(1.01-1.35) and 1.13(1.02-1.24), respectively. Furthermore, the concentration of SO42- and NO3- were significantly associated with the prevalence of asthma and current rhinitis by the AOR for each 1ug/m3 increase in SO42-, and NO3- concentrations of 1.09(1.03-1.15) for asthma and 1.04(1.00-1.07) for current rhinitis, respectively.Conclusion: Components of PM2.5, especially NO3- and SO42- exposure were associated with asthmatic and allergic diseases in preschool children in China. Considering the related sources and combustion, it may represents an preventable risk factor for childhood asthma and allergic diseases.

The effect of breastfeeding on the risk of asthma in high-risk children: a case-control study in Shanghai, China

BackgroundIncreasing evidence shows that antibiotic use in pregnancy may increase the risk of childhood asthma but epidemiologic studies are still limited and findings are inconsistent. Meanwhile, exclusive and prolonged breastfeeding may prevent children from allergic diseases. We aimed to assess the association between prenatal antibiotic use and the risk of childhood asthma, and explore whether breastfeeding modifies the risk.MethodsWe conducted a case-control study in Shanghai, China, from June 2015 to January 2016. A total of 634 asthma cases and 864 controls aged 3–12 years were included. Multiple logistic regressions were used to estimate crude and adjusted odds ratios (aOR).ResultsThe prevalence of antibiotic use in pregnancy in the cases and controls was 7.1 and 3.5%, respectively. A significant association between prenatal antibiotic use and childhood asthma was observed (aOR: 1.7, 95% CI: 1.0–2.9), particularly in boys (aOR: 2.2, 95% CI: 1.1–4.4) and children with family history of allergic disorders (aOR: 3.1, 95% CI: 1.2–8.4). However, this association existed only in children who were not breastfed exclusively in the first six months of life (aOR 2.6, 95% CI 1.3–5.1) but not in children who were exclusively breastfed (aOR 0.9, 95% CI 0.4–2.1). Likewise, exclusive breastfeeding also decreased the association between antibiotic use in pregnancy and asthma in boys and in children with family histories of allergic diseases.ConclusionsAntibiotic use in pregnancy was a risk factor for childhood asthma. However, this risk may be attenuated by exclusive breastfeeding in the first six months of life, especially among high-risk children.

Physical Activity does not Modify the Relationship between Asthma and Obesity in African American Youth

Asthma is an important health issue in adolescents, particularly among African Americans (AA). Previous research has identified obesity as a risk factor for childhood asthma, however, less research has examined whether asthma predicts obesity. It is plausible that the presence of asthma symptoms may contribute to inactivity and subsequent obesity risk in AA youth. PURPOSE: The purpose of this study was to assess the cross-sectional relationships between the presence of asthma symptoms, weight status, moderate-vigorous physical activity (MVPA) and sedentary time (SED) among AA adolescents. METHODS: A community-based sample of 163 AA youth (55% female, 31% obese, ages 11-18 years), recruited from southeast Michigan were included in this analysis. Asthma symptoms were evaluated and given a single score from 0 (no symptoms ever) to 11 (all symptoms often) using the International Study of Asthma and Allergies in Children’s Phase Three questionnaire. MVPA and SED were measured via accelerometry. Weight status was assessed via body mass index (BMI) where weight and height were measured via an electronic scale and stadiometer, respectively. RESULTS: Of the 163 adolescents included in the analysis, 68 reported no symptoms of asthma (54% female, 22% obese). T-tests revealed those with no symptoms of asthma engaged in less MVPA (no symptom: 12.5±0.1min; ≥ one symptom: 13.6±0.1min, p<0.001) and more SED (no symptom: 758.3±1.2min; ≥ one symptom: 753.8±1.0min, p=0.004) compared to adolescents with one or more symptoms of asthma. After accounting for the confounding effects of sex, parental education, and pubertal development; asthma symptom score was positively associated with BMI (β=0.6±0.2, p=0.004). When MVPA and SED were included in the model, the relationship between asthma symptom score and BMI remained significant (β=0.5±0.2, p=0.007). CONCLUSION: A higher presence of asthma symptoms predicted increased weight status in AA adolescents. Physical activity participation and sedentary time did not modify this relationship, suggesting that other factors contribute to the increased obesity risk in children exhibiting asthma symptoms. Longitudinal studies are needed to better understand the relationship between asthma and obesity in AA adolescents.

Associations of household renovation materials and periods with childhood asthma, in China: A retrospective cohort study

BackgroundChildhood asthma is prevalent in China. However, there is a lack of evidence on whether household renovation, including the materials used and the periods, are associated with the disease. ObjectivesTo investigate the associations between household decoration materials and renovation periods, and childhood asthma and its related symptoms. MethodsDuring 2010–2012, a retrospective cohort study was initiated in seven cities of China, and 40,010 children, aged 3–6 years, were recruited. Data on demographics, health status, and home decoration conditions were collected using a parent-administered questionnaire. Two-level (city-child) logistic regression analyses with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were performed to show the target associations. Sensitivity analysis was performed by stratifying data for children in the southern and northern cities. ResultsChildren whose homes underwent renovation or the addition of new furniture within 1 year before pregnancy, during pregnancy, at age 0–1 year, and after age 1 year had significantly (p < 0.05) higher prevalence of childhood asthma and its related symptoms. The use of solid wood floors and wallpaper had significant associations (cement: AOR, 95% CI: 1.59, 1.17–2.17; lime: AOR, 95% CI: 1.31, 1.00–1.71) with an increased risk of lifetime asthma. Household renovation and the addition of new furniture during pregnancy had significant associations with lifetime asthma (renovation: AOR, 95% CI: 1.23, 1.01–1.51); lifetime wheeze (renovation: AOR, 95% CI: 1.21, 1.05–1.39; furniture: AOR, 95% CI: 1.24, 1.14–1.36), current wheeze (renovation: AOR, 95% CI, 1.21 1.05–1.40; furniture: AOR, 95% CI: 1.23, 1.12–1.34), and current dry cough (renovation: AOR, 95% CI: 1.41, 1.23–1.63; furniture: AOR, 95% CI: 1.28, 1.17–1.41). Similar associations were found between the addition of new furniture during early childhood and lifetime asthma and its related symptoms. Except for the association between lifetime wheeze and flooring materials, the studied associations were generally stronger among children from the northern cities. ConclusionsWe confirmed that using cellulose based materials in home decoration and renovation, and adding new furniture during early childhood and pregnancy could be risk factors for childhood asthma. The association between household decoration during early childhood and childhood asthma may be stronger in the northern cities of China.

Automated Chart Review for Identifying Factors Associated with Childhood Asthma by Utilizing Electronic Medical Records

Our recently validated natural language processing (NLP) algorithms using electronic medical records (EMRs) significantly reduced the time and effort for chart review for ascertaining asthma status. We extended our prior work to leverage NLP algorithms for extracting individual risk factors for childhood asthma from EMRs. We utilized a convenience sample (n=397) of the 1997-2007 Olmsted County Birth Cohort. The training cohort (n=177) was used for training the NLP systems for extracting from both children’s and their parents’ EMRs key terms/sentences related to 1) a patient (child) level (ie, history of breastfeeding and other atopic conditions [allergy rhinitis, eczema, and food allergy] and 2) a family level (ie, family history of asthma and other atopic conditions) risk factors. We assessed the performance of the NLP algorithms with manual chart review as gold standard (criterion validity) in an independent test cohort (n=220). The median age of the test cohort was 13 years (50 % female, 81% Whites, 63% asthmatics). 90% and 6% of children had history of breastfeeding and food allergy, respectively with prevalence of other histories ranging 15-52%. Positive predictive values for NLP algorithms in predicting each asthma-related variable were 87-100% and negative predictive values were 86-99%. The average time duration for collecting risk factors for asthma obtained in this study was 7 hours for manual chart review and 50 minutes for NLP algorithms. As the NLP algorithms for identifying individual risk factors for asthma from EMRs are cost-effective and suitable, it will be a useful tool for large-scale clinical studies.

Better understanding of childhood asthma, towards primary prevention - are we there yet?Consideration of pertinent literature.

Asthma is a chronic disease, characterized by reversible airway obstruction, airway inflammation and hyper-reactivity. The prevalence of asthma has risen dramatically over the past decade, affecting around 300,000,000 people. The etiology is multifactorial, with genetic, epigenetic, developmental and environmental factors playing a role. A complex interaction between the intrauterine environment, the developing immune system, the infant's microbiome and infectious organisms may lead to the development of allergic sensitization and asthma. Thus, a large number of studies have investigated the risk factors for childhood asthma, with a meticulous search of modifiable factors that could aid in primary prevention. We present a current literature review from 2014-2017, as well as older classic publications, on the pathogenesis and the potential modifiable factors for primary prevention of asthma. No ideal preventive measure has yet been found. Rather, creating favorable prenatal and postnatal environments, minimal exposure to hostile environmental factors, prevention of infections in early life, allergic desensitization and nutritional modifications could possibly reduce asthma inception. In the era of personalized medicine, identifying individual risk factors and tailoring specific preventive measures is warranted.

Food Allergy Is an Important Risk Factor for Childhood Asthma, Irrespective of Whether It Resolves

The risk of developing asthma in those with early food allergy is unknown, particularly when early life food allergy has resolved. To understand whether challenge-proven food allergy in infancy increases the risk of asthma at age 4 years, using data from a population-based cohort. A total of 5,276 12-month-old infants were recruited using a population-based sampling frame. Infants underwent skin prick test to egg, peanut, and sesame and those with a detectable skin prick test result had oral food challenges. At age 4 years, food challenges were repeated to determine persistence or resolution of food allergy. The association between food allergy and doctor-diagnosed asthma was examined using binomial regression in 2,789 participants. Children with food allergy at age 1 year had an increased risk of asthma (1 food allergy: relative risk [RR], 1.69; 95% CI, 1.29-2.21; 2 or more food allergies: RR, 2.76; 95% CI, 1.94-3.92). The risk of asthma was highest in children with food allergy and coexistent eczema in infancy (RR, 2.87; 95% CI, 2.22-3.70). Transient food allergy and persistent food allergy were both associated with an increased risk of asthma (transient egg allergy: RR, 1.92; 95% CI, 1.46-2.51; persistent egg allergy: RR, 2.60; 95% CI, 1.76-3.85). Asthma at age 4 years is twice as common in those with challenge-proven food allergy at age 1 year, irrespective of whether the food allergy subsequently resolves. Children with 2 or more food allergies and those with coexistent eczema were almost 3 times as likely to develop asthma compared with those with no food allergies.

Demographic and neonatal risk factors for childhood asthma in the USA

Objective: Asthma is the most common chronic condition diagnosed among children worldwide according to the World Health Organization (WHO). This study evaluated on a longitudinal basis prospectively collected medical records for demographic and neonatal information among United States (US) children diagnosed with childhood asthma in comparison to controls.Design: The Vaccine Safety Datalink (VSD) database was examined to identify cases (n = 5907) diagnosed with International Classification of Disease, ninth revision (ICD-9) healthcare provider diagnosed childhood asthma (493.xx) and controls (n = 11,662).Patients: All cases and controls were health maintenance organization (HMO)-enrolled from birth until diagnosis or sufficient time to ensure that they were unlikely to receive a diagnosis, respectively.Main outcome measures: Child’s gestational age in weeks at birth, birth weight in grams, maternal age in years at birth, Appearance-Pulse-Grimace-Activity-Respiration (APGAR) score at 1 minute and 5 minutes following birth, gender, and race.Results: The study results revealed childhood asthma was diagnosed significantly more frequently among males than females, and significantly more frequently among minority populations (Black > Hispanic > Native American > Asian) than White populations. Cases diagnosed with childhood asthma had significantly decreased mean values for the following neonatal risk factors: gestational age, maternal age, birth weight, and APGAR scores at 1 and 5 minutes following birth in comparison to controls.Conclusions: This study offers healthcare providers important demographic and neonatal factors significantly associated with childhood asthma, and should help aid in the early diagnosis and treatment of childhood asthma.