Severity Of Asthma Symptoms Research Articles

Development of a Novel, Interactive, Electronic Pediatric Asthma Diary for Self-Report of Symptom Severity and Disease Impact by Young Children With Asthma

No comprehensive diary is available to assess the severity and impact of asthma symptoms for self-completion by children aged 6-11 years. We developed a novel electronic pediatric asthma symptom diary (ePASD) administered via an animated digital application with visuals, sounds, and written and audible text to facilitate self-report by young children with asthma with varying reading levels.

Allergenicity at component level of sub-pollen particles from different sources obtained by osmolar shock: A molecular approach to thunderstorm-related asthma outbreaks.

The so-called "thunderstorm asthma" (TA) is an uncommon but dramatic outbreak of asthma attacks occurring during a thunderstorm in the pollen and moulds season. Mechanisms which make the pollen able to enter the deeper airways and provoke severe asthma symptoms are still unclear. To test the hypothesis that sub-pollen particles (SPPs) originated from the rupture by an osmotic shock of pollen associated with TA contain allergens. After hydration, SPPs released from pollen grains of grass, pellitory, olive, cypress, ragweed and birch were isolated and determined by microscopy. Allergens were determined by in vitro ELISA inhibition tests indirectly using the sera from 10 polyreactive patients. An inhibition <50% was considered as negative, 50%-75% moderate and>75% complete. The inhibition experiments showed that the SPPs from birch and cypress were unable to inhibit serum IgE reactivity to Bet v 1 and Cup a 1, respectively. Ragweed SPPs inhibited ragweed pollen extract and Amb a 1 by 75.8±0.11% and 81.2±0.15%, respectively. Olive and pellitory SPPs retained almost the whole IgE-binding capability in all cases tested. Grass SPPs inhibited 32±0.06% of Lolium perenne Lol p 1 and 65% of Phleum pratense extracts, but results were highly variable for individual allergens (97.5%-0.03% for Phl p 2, 45.3±0.12% for Phl p 5, 24.7±0.22% for Phl p 6, and 38.3±0.2% for Phl p 1). Inhibition experiments confirm the hypothesis that SSPs obtained after the osmotic shock of pollen involved in TA, namely grass, pellitory and olive tree pollen, contain allergens and therefore they can induce severe asthma attacks during thunderstorms.

The Impact of Tobacco Smoking on Adult Asthma Outcomes.

Background: Tobacco smoking is associated with more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids. Our objective was to compare asthma outcomes in terms of disease control, exacerbation rates, and lung function in a population of asthmatic patients according to their smoking status. Methods: We compared patients’ demographics, disease characteristics, and lung-function parameters in current-smokers (CS, n = 48), former-smokers (FS, n = 38), and never-smokers (NS, n = 90), and identified predictive factors for asthma control. Results: CS had a higher prevalence of family asthma/atopy, a lower rate of controlled asthma, impaired perception of dyspnea, an increased number of exacerbations, and poorer lung function compared to NS. The mean asthma control questionnaire’s (ACQ) score was higher in CS vs. NS and FS (1.9 vs. 1.2, p = 0.02). Compared to CS, FS had a lower rate of exacerbations, a better ACQ score (similar to NS), a higher prevalence of dyspnea, and greater lung-diffusion capacity. Non-smoking status, the absence of dyspnea and exacerbations, and a forced expiratory volume in one second ≥80% of predicted were associated with controlled asthma. Conclusions: CS with asthma exhibit worse clinical and functional respiratory outcomes compared to NS and FS, supporting the importance of smoking cessation in this population.

Seasonality of asthma exacerbation in children caused by respiratory virus infection and allergen sensitization

Purpose: Acute asthma exacerbations in children have seasonal variations and occur frequently in fall. Respiratory viral infections and environmental allergens are associated with asthma exacerbation. This study aimed to identify seasonal trends of asthma exac-erbation and the effects of respiratory viral infection and allergen sensitization on the seasonality of asthma exacerbation in children. Methods: Children under the age of 18 years who visited to the Emergency Department or hospitalized for acute asthma exacerba-tions from 2011 to 2019 were included. We reviewed medical records, including demographics, date of asthma exacerbation, results of respiratory virus and allergen sensitization, and they were analyzed to identify the seasonal trends of asthma exacerbation. Results: A total of 320 asthma exacerbations were included, with the highest frequency in fall. Human rhinovirus was positive in 64.7% and 60.0% in fall and spring exacerbations, respectively. House dust mite sensitization was highest in fall at 78.5%, while food sensitization was highest in spring at 76.9%. In patients who were sensitized to house dust mites or food allergens, respiratory viral infections further increased asthma exacerbation in fall and spring, respectively. Conclusion: Respiratory virus may be associated with asthma exacerbation in fall and spring. House dust mite and food sensitiza-tions may be associated with fall and spring asthma exacerbations by worsening the severity of asthma symptoms caused by respi-ratory viral infections. In childhood asthmatic patients with allergen sensitization, avoidance of sensitized allergens, prevention of viral infection, and more active treatment of viral infection may help prevent acute asthma exacerbations. (Allergy Asthma Respir Dis 2021;9:238-244)

Aspirin-Exacerbated Respiratory Disease: Association Between Patient-Reported Sinus and Asthma Morbidity

The association between sinonasal and pulmonary symptoms in aspirin-exacerbated respiratory disease is not fully established. To characterize sinonasal and asthma symptomatology, and to determine whether reported sinonasal symptoms predict asthma severity. Prospectively collected data from an aspirin-exacerbated respiratory disease registry cohort were included from 2013 to 2018. Sinonasal symptomatology measured by Sino-Nasal Outcomes Test (SNOT) 22-item total scores was used as the predictor variable, with Asthma Control Test (ACT) scores and percent predicted FEV1 (FEV1% predicted) as primary outcomes. All instances of paired data on the same date were used. ACT score was also evaluated with FEV1% predicted as the outcome. Mixed effects regression was completed. From 1065 aspirin-exacerbated respiratory disease registry subjects (mean age, 48.1 ± 12.8 years; 68.0% females, 29.8% males), mean SNOT-22 score was 42.3 ± 24.12 (n= 1307 observations from 869 subjects), mean ACT score was 19.4 ± 5.2 (n= 1511 observations from 931 subjects), and mean FEV1% predicted was 82.8 ± 19.6 (n= 777 observations from 307 subjects). SNOT-22 score significantly predicted ACT scores (P < .0001, 1185 paired observations from 845 subjects) and FEV1% predicted (P= .018, 485 observations from 246 subjects). Any 10-point increase in SNOT-22 score was associated with a 0.87-point decrease in ACT score and a 0.75% decrease in FEV1% predicted. Any 1-point increase in ACT score was associated with a 1.0% increase in FEV1% predicted (P < .0001, 616 observations from 269 subjects). The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose. SNOT-22 scores significantly predict ACT scores and FEV1% predicted, and ACT scores significantly predict FEV1% predicted. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity.

The impact of the Hazelwood coal mine fire smoke exposure on asthma

Objective In 2014, a fire at an open cut coal mine in South-eastern Australia burned for about 6 weeks. Residents of the adjacent town were exposed to high levels of fine particulate matter (PM2.5) during this period. Three and a half years after the event, this study aimed to investigate potential long-term impacts of short-term exposure to coal mine fire smoke on asthma. Methods A cross-sectional analysis was undertaken in a group of exposed participants with asthma from Morwell (n = 165) and a group of unexposed participants with asthma from the control town of Sale (n = 64). Exposure was determined by modeled PM2.5 data for the mine fire period. Respiratory symptoms were assessed with a validated respiratory health questionnaire and symptom severity score. Asthma control was assessed with a validated questionnaire. Lung function testing included spirometry, bronchodilator response, and fraction of exhaled nitric oxide. Results There was no evidence that exposed participants had more severe asthma symptoms, worse lung function, or more eosinophilic airway inflammation than unexposed participants. However, there was some evidence that Morwell participants had more uncontrolled than well-controlled asthma, compared to the participants from Sale (adjusted relative risk ratio 2.71 95% CI: 1.02, 7.21, p = .046). Conclusion Three and a half years after exposure, coal mine fire smoke did not appear to be associated with more severe asthma symptoms or worse lung function but might be associated with poorer asthma control.

Vitamin D deficiency in children with bronchial asthma in southern Jordan: a cross-sectional study.

ObjectivesTo assess serum 25-hydroxycholecalciferol (25-OH vitamin D) levels in Jordanian children with bronchial asthma, and to examine correlations between 25-OH vitamin D levels and asthma severity and control.MethodsA cross-sectional study was conducted at the Paediatric Chest Clinic, Al-Karak Governmental Hospital, Southern Jordan, between May 2015 and February 2016. Serum 25-hydroxyvitamin D level was determined in children aged 1–14 years diagnosed with bronchial asthma (6–14 years) or recurrent wheezing episodes (<6 years). Asthma severity was determined based on the Global Initiative for Asthma assessment, the Asthma Control Test, and the Childhood Asthma Control Test. Demographic and clinical characteristics were compared between patients with low and normal 25-OH vitamin D levels, and correlations between asthma severity and 25-OH vitamin D level were assessed.ResultsOut of 98 included children, 25-OH vitamin D levels were deficient and insufficient in 41 (41.8%) and 34 (34.7%) children, respectively. Only 23 (23.5%) had sufficient 25-OH vitamin D levels. A significant correlation was found between severity of asthma symptoms and 25-OH vitamin D deficiency.Conclusion25-OH vitamin D deficiency is highly prevalent in Jordanian children with bronchial asthma and correlates significantly with asthma severity.

Effectiveness and safety of a glutaraldehyde-modified, L-tyrosine-adsorbed and monophosphoryl lipid A-Adjuvanted allergen immunotherapy in patients with allergic asthma sensitized to olive pollen: A retrospective, controlled real-world study

BackgroundAllergy to olive pollen is one of the primary causes of allergic asthma in Spain. Even though allergen immunotherapy (AIT) has shown clinical benefits in patients sensitized to different allergens, studies in asthmatic patients sensitized to olive pollen are insufficient. ObjectiveTo assess the effectiveness and safety of an ultra-short course of AIT with an L-tyrosine-adsorbed and monophosphoryl lipid A-adjuvanted olive pollen and olive/grass pollen extract (Pollinex Quattro®) in patients with allergic asthma in the real-world setting. MethodsRetrospective, controlled study including patients with asthma, with and without allergic rhinitis, caused by sensitization to olive pollen from 11 centers in Spain. Patients received out-of-season (October–March) treatment with AIT in addition to their pharmacological treatment (active group) or pharmacological treatment (control group). Effectiveness variables, including unscheduled visits to the healthcare center, emergency room admissions, symptoms of asthma and rhinitis (following GEMA and ARIA classifications, respectively), and use of medication to treat asthma and rhinitis during the subsequent pollen season were compared between treatment groups. ResultsOf 131 study patients, 42 were treated with their usual asthma medication (control group) and 89 were treated with AIT (active group), either Pollinex Quattro® 100% olive pollen (n = 43, 48.3%) or 50% olive pollen/50% grass pollen (n = 46, 51.7%). Patients’ demographic and clinical characteristics were similar between groups. The mean (SD) number of unscheduled visits to a healthcare center and emergency room admissions due to allergy symptoms was 2.19 (1.40) and 0.43 (0.63) in the control group, and 1.09 (1.25) and 0.11 (0.51) in the active group (P = 0.001 and P = 0.006, respectively). Severity and control of asthma symptoms remained unchanged (P = 0.347 and P = 0.179, respectively), rhinitis type improved (P = 0.025), and severity remained unchanged in the active compared to the control group. The use of short-acting beta-agonists and inhaled corticosteroids to treat asthma symptoms decreased in the active vs. the control group (P = 0.001 and P = 0.031, respectively). Twelve (13.5%) and two (2.2%) patients in the active group experienced local adverse reactions (edema, swelling, erythema, hives, pruritus, and heat), and systemic adverse reactions (hypertensive crisis and low-grade fever) to AIT, respectively; none was serious. ConclusionAIT with Pollinex Quattro® specific for olive pollen and olive/grass pollens resulted in reduced visits to the healthcare center and emergency room and the use of asthma medication during the pollen season, indicating that this treatment was safe and effective in treating asthma in patients sensitized to these pollens.

Oral Administration of Acrylamide Worsens the Inflammatory Responses in the Airways of Asthmatic Mice Through Agitation of Oxidative Stress in the Lungs.

Acrylamide is a toxic chemical substance produced when starch-rich foods are fried at high temperatures. Asthma is a chronic and complicated respiratory disease, of which genetic and environmental factors are the main triggers. Orally-received components may have an effect on asthma pathophysiology. The aim of this study was to investigate the role of AA as a stimulus in asthma. BALB/c mice were allocated into four groups as follows: two OVA-sensitized asthmatic groups, including one treated with AA by gavage feeding and one non-treated (asthma group), and two healthy (non-asthmatic) groups, one treated with AA by gavage feeding and one non-treated (negative control group). Airway hyperresponsiveness, cell count, cytokine levels in BAL fluid, lung histopathology, IgE levels, and oxidative stress indices including plasma level of MDA, pulmonary antioxidant enzymes (SOD and CAT) levels, HP content, and collagen fiber accumulation in lung tissue were measured. We found that the group of mice treated with both OVA and AA (asthmatic and AA-treated mice) experienced higher levels of asthma-associated biomarkers, including higher enhanced pause (Penh value), eosinophilic inflammation, mucus hyper secretion, goblet cell hyperplasia, total and OVA-specific IgE levels, IL-4, IL-5, and IL-13 levels than the group sensitized only with OVA (asthmatic mice). The OVA-AA-treated mice also experienced worsened levels of oxidative stress indicators. Healthy (non-asthmatic) mice that only received AA were in similar conditions to healthy untreated mice (negative control group). The OVA-AA-treated group showed more severe allergic asthma symptoms in comparison to the group only sensitized with OVA. Therefore, food/water contaminated with AA can act as a stimulant of allergic asthma and exacerbate the bronchial inflammatory responses.

The effect of BclI polymorphism of NR3C1 gene on asthma phenotypes in Egyptian children

Background: BclI is the promoter polymorphism observed within human glucocorticoid receptor gene (hGR/NR3C1) which plays an important role in the development of bronchial asthma (BA) and resistance to Glucocorticosteroids (GCs) in the severe BA. Objective: To assess the influence of BclI gene (rs41423247) polymorphisms on phenotypic expression of bronchial asthma in a group of Egyptian asthmatic children. Methods: This case control study included 135 asthmatic children with varying degrees of asthma severity. They were recruited from Allergy and Pulmonology Outpatient Clinic, Cairo University. Ninety healthy age and sex matched children served as the control group. Determination of BclI single nucleotide polymorphism (SNP) was done by polymerase chain reaction restriction fragment length polymorphism (PCR- RFLP). Results: Our results revealed that the variants of BclI polymorphism: CC/CG/GG was found with frequency 73.3%, 26.7%, 0% in control group. While in asthmatic children, their frequency was 42.2%, 51.1%, 6.7%, respectively. This revealed a significant difference in distribution between cases and control, similarly there was a significant difference in frequency of allele G between both groups (P-value <0.001). The frequency of allele G/C showed statistically significance association with increased severity of bronchial asthma (P-value<0.001), with uncontrolled asthma and hospitalization (P value <0.001). Conclusion: The Bcl I polymorphism of hGR/NR3C1 gene is significantly associated with bronchial asthma. The GG phenotype is significantly associated with increased susceptibility to the development of severe asthma and uncontrolled asthma symptoms, with increased risk of hospitalization.

RISK FOR OBSTRUCTIVE LUNG DISEASE DEVELOPMENT AFTER BILATERAL OOPHORECTOMY

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Obstructive lung diseases (OLD) affect women disproportionately with higher risk of disease development and greater symptom burden. Female reproductive hormones, namely estrogen and progesterone, have been implicated as mediators in lung physiology as women advance in their reproductive lifespan. However, conflicting evidence exists on the effects of hormonal changes during menopause on lung function. We therefore studied the effect of bilateral oophorectomy (BO) on the development of OLD. METHODS: The Rochester Epidemiology Project (REP) medical records-linkage system was used to identify all premenopausal women who underwent BO for benign indications before age 50, between 1988 and 2007 in Olmsted County, Minnesota (N=1,653). Each woman was randomly matched to a referent woman born in the same year (+/-1) who had not undergone BO (N=1,653). OLD diagnostic codes were obtained from REP electronic indexes. Medical records were reviewed through 12/31/2018. Global Initiative for Chronic OLD (GOLD) and Global Initiative for Asthma (GINA) 2019 definitions were used to classify OLD on pulmonary function testing. Radiologist-interpreted reports were used to evaluate changes on computed tomography. Each woman could have more than one type of OLD. Hazard ratios were derived from Cox proportional hazards models adjusted for chronic conditions and other possible confounders at the index date, separately for each type of OLD (asthma, chronic obstructive pulmonary disease [COPD], emphysema without documented airflow limitation, or chronic bronchitis). RESULTS: Over a median of 18 years of follow up, de novo OLD was identified in 259 women who underwent BO (219 asthma, 15 COPD, 19 emphysema, 60 chronic bronchitis) and 202 referent women (168 asthma, 15 COPD, 13 emphysema, 36 chronic bronchitis). Women who underwent BO had a higher risk of asthma overall (HR 1.23, 95% CI 1.01-1.51). This was most notable in younger women age ≤45 years at BO (HR 1.54, 95% CI 1.19-1.99), especially those who did not receive estrogen treatment (ET) (HR 2.49, 95% CI 1.08-5.75). No significant risk of COPD (HR 1.01, 95% CI 0.49-2.10), emphysema (HR 1.29, 95% CI 0.66-2.53), or chronic bronchitis (HR 1.41, 95% 0.94-2.13) was found. CONCLUSIONS: Women who underwent BO, especially young women ≤45 years of age and those who did not receive ET, had an increased risk of asthma. CLINICAL IMPLICATIONS: Some studies suggest that as sex hormones wane in natural menopause, there is a decreased risk of asthma, and that ET may increase the risk. However, other studies suggest that menopause is associated with lower lung function and worse asthma symptom severity. This study suggests that age of onset of menopause and ET may influence the risks of asthma. Although a clear sexual dimorphism in airway pathology exists, further investigation is warranted to understand the impact of hormonal changes on lung pathology. DISCLOSURES: No relevant relationships by Megan Dulohery Scrodin, source=Web Response No relevant relationships by Trinh Nguyen, source=Web Response No relevant relationships by Walter Rocca, source=Web Response No relevant relationships by Carin Smith, source=Web Response Recipient of grant funding relationship with Bristol Myers Squibb Please note: >$100000 Added 03/23/2020 by Robert Vassallo, source=Web Response, value=Grant/Research Support Recipient of grant funding relationship with Sun Pharmaceuticals Please note: >$100000 Added 03/23/2020 by Robert Vassallo, source=Web Response, value=Grant/Research Support Recipient of grant funding relationship with Pfizer Please note: >$100000 Added 03/23/2020 by Robert Vassallo, source=Web Response, value=Grant/Research Support

Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis

ObjectiveTo compare the different self-management models (multidisciplinary case management, regularly supported self-management, and minimally supported self-management) and self-monitoring models against usual care and education to determine which are most effective...

Allergic rhinitis and asthma symptoms in a real-life study of MP-AzeFlu to treat multimorbid allergic rhinitis and asthma

BackgroundAsthma affects up to nearly 40% of patients with allergic rhinitis (AR). Poor control of AR symptoms is associated with poor asthma control. The goal of this study was to evaluate the effect of AR treatment with MP-AzeFlu on symptoms of AR as well as symptoms of asthma.MethodsThis prospective study used a visual analog scale (VAS) to assess symptoms of AR and asthma before and after treatment with MP-AzeFlu (Dymista®; azelastine hydrochloride plus fluticasone propionate; 1 spray in each nostril twice daily for 2 weeks). Participants suffered from moderate-to-severe AR according to Allergic Rhinitis and its Impact on Asthma criteria, with acute AR symptoms (AR-VAS scores ≥ 50 mm) on inclusion day. In addition to symptom assessment, patients recorded the impact of AR symptoms on quality-of-life measures before, during, and at the conclusion of the treatment period (approximately 14 days). Patients self-reported change in frequency of their usage of asthma reliever medication on the last day of treatment.ResultsOf 1103 study participants, 267 (24.2%) had comorbid asthma. These participants reported using a mean of 5.1 puffs of asthma reliever medication in the week before treatment with MP-AzeFlu. A total of 81.8% of patients with comorbid asthma responded to AR therapy (AR-VAS < 50 mm on at least 1 study day). Among patients with AR and comorbid asthma, MP-AzeFlu was associated with improved VAS scores across all study parameters, including AR symptom severity, asthma symptom severity, sleep quality, daily work or school activities, daily social activities, and daily outdoor activities. Asthma symptom severity decreased from a mean of 48.9 mm to 24.1 mm on the VAS. Self-reported frequency of asthma reliever medication use was reduced for 57.6% of participants (n = 139/241).ConclusionMP-AzeFlu used to relieve AR symptoms was associated with reduced asthma symptom VAS scores and frequency of asthma reliever medication usage. Changes in overall symptoms of AR and asthma were correlated.

Impact of obesity on asthma severity and control in school aged children

Background:Childhood asthma and obesity are significant public health problems. The prevalence of asthma and obesity in children have increased significantly during the past decades. The basis for the relationship between pediatric asthma and obesity is not well established. Objective: our study aimed to find the relation between obesity and bronchial asthma and whether obesity may contribute to more severe asthma symptoms in asthmatic children at Qena University Hospital. Patients and method(s): This was a cross-sectionalstudy of asthmatic school aged children who were admitted at pediatric department or attendedemergency department or the outpatient clinic of Qena University Hospital through the period from MAY 2018 to April 2019.They classified according to BMI to two groups, asthmatic obese and asthmatic non-obese. The included asthmatic children are subjected to full through history, clinical examination and pulmonary function tests. Result(s):This was a cross-sectional study which was carried out in Pediatric department of Qena university hospitaland included 60 asthmatic children with intermittent to severe persistent asthma with age range 6-12 years through the period from MAY 2018 to April 2019 and classified to two groups, 30cases asthmatic obese and 30 cases asthmatic non-obese, based on calculated BMI in both groups. The patients were diagnosed according to the global strategy for asthma management and prevention classification. The mean age in asthmatic obese patients was (8.94±1.99)versus (9.13±1.97) in asthmatic non-obese group with no significant difference between them (p-value =0.707). The percentage of moderate persistent asthma was statistically significantly higher in asthmatic obese than asthmatic non-obese group (53.3% versus 26.7%, p-value= 0.035), respectively. 13.3% of asthmatic obese had severe persistent asthma versus 0% in asthmatic non-obese group (p-value=0.038).46.7%of the asthmatic obese children received high dose of steroids versus 10%of asthmatic non-obese with statistically significant difference (p value =0.001). The mean numbers of emergency visits in asthmatic obese were significantly higher than that in asthmatic non-obese (5.9±2.66versus 3.93±1.6), (p-value= 0.001), respectively. FEV1, FVC, FEV1/FVC, were not significantly different in asthmatic obese patients compared with asthmatic non-obese (p-value =0.742, 0.849, 0.751, respectively). Conclusion:obesity was associated with significantly more severe asthma symptoms together with poor asthma control. Pulmonary function tests were not affected by increased BMI.

ISAAC written questionnaire versus incorporating videos before the questionnaire for asthma prevalence among middle schools students in Al-Sharkiya Egyptian Governorate

BackgroundAsthma is the most common chronic respiratory disorder in childhood with worldwide increasing in its prevalence and global burden. The International Study of Asthma and Allergies in Childhood (ISAAC) provides a standardized methodology to describe the prevalence and severity of childhood asthma symptoms all over the world using simple standardized questionnaires that allow comparisons across geographic and linguistic boundaries. This study aimed to find a suitable application of ISAAC asthma questionnaire to improve the perception and response of the middle (preparatory) school students in Al-Sharkiya Governorate as a step to update the Egyptian prevalence of asthma among children through the translation of the ISSAC written questionnaire into Arabic and to compare the student’s response to the translated questionnaire with their response to the same questionnaire after showing ISAAC videos.ResultsThe percentage of student’s positive answers for asthma symptoms in the written questionnaire after watching ISAAC videos was significantly lower when compared to their written questionnaire answers without watching videos with no significant agreement between the student’s answers in the two methods.ConclusionUsing ISAAC videos before filling the written questionnaire improved the students’ understanding of and dealing with the written questionnaire.

Food allergy in at-risk adolescents with asthma: A key area for focus

BackgroundAsthma affects more than 6.2 million children in the United States and is a major source of chronic disease burden. Concurrent food allergy (FA) may be a risk factor for worse asthma outcomes. ObjectiveTo estimate the prevalence of FA among a cohort of adolescents with persistent asthma and assess whether FA is an independent risk factor for asthma morbidity. MethodsWe included 342 adolescents aged 12 to 16 years with persistent asthma from the Rochester city school district who participated in the School-Based Asthma Care for Teens trial between 2014 and 2018. Multivariable models were used to estimate the association between FA and asthma morbidity. ResultsOverall, 29% of adolescents with asthma reported having a FA. Although there were no statistically significant differences in daytime asthma symptoms, teens with FA had higher fractional exhaled nitric oxide (47.5 vs 33.9 P = .002) and reported more days with activity limitation owing to asthma (3.1 vs 2.3 days/2 weeks, P = .03) compared with teens without FA. Less than half (42%) of adolescents with FA had an epinephrine autoinjector. ConclusionThis study found FA to be common among this cohort of adolescents with asthma. Although FA was not related to asthma symptom severity, adolescents with FA had higher fractional exhaled nitric oxide and more activity limitation, and most did not have epinephrine autoinjectors. A history of FA and lack of epinephrine autoinjector may increase near-fatal outcomes in adolescents with asthma. Preventive measures in addition to standard asthma treatments are warranted for these teens.

Association between asthma symptom scores and perceived stress and trait anxiety in adolescents with asthma.

Background: Emotional disorders, including depression and anxiety, are more prevalent in individuals with asthma than in the general population and are associated with poor asthma outcomes. Identification of patients with increased levels of stress and anxiety may be helpful when treating asthma and during asthma counseling. Objective: To further characterize the relationship between asthma symptoms and perceived stress and trait anxiety in an adolescent population. Methods: Adolescents (N = 335) ages 14-17 years were recruited to examine the effect of stress on health measures. They were included in the present analysis if they reported current asthma, defined as self-reported clinician-diagnosed asthma plus one or more episodes of asthma in the past year. Asthma symptoms were assessed on a 7-point scale by using a standardized questionnaire that targets nocturnal awakening due to asthma, symptoms on awakening, activity limitation, shortness of breath, time spent wheezing, and short-acting bronchodilator use. Stress was measured by using the Perceived Stress Scale (PSS), and trait anxiety was measured by using the State-Trait Anxiety Inventory. Linear regression was used to associate asthma symptoms with PSS and trait anxiety. Results: Thirty-eight adolescents (11.3%), with mean ± standard deviation age 16.7 ± 0.9 years, reported current asthma. Four of the six asthma symptom assessments had significant associations with PSS: symptoms on awakening (β = 4.82, p < 0.001), nocturnal awakening due to asthma (β = 4.47, p < 0.001), activity limitation (β = 2.78, p = 0.005), and shortness of breath (β = 1.73, p = 0.014). These associations remained significant after adjusting for gender, race, and the body mass index percentile. Trait anxiety had significant associations with nocturnal awakening (β = 9.28, p = 0.002) and symptoms on awakening (β = 8.74, p = 0.002). Associations remained significant after adjusting for gender, race, and body mass index percentile. Conclusion: Asthma symptom severity is associated with increased perceived stress and trait anxiety. Adolescents with asthma may represent a population that is particularly vulnerable to perceived stress and anxiety, which highlights the importance of considering these factors in asthma counseling.

Incidence of depression and its influencing factors in 387 patients with asthma from Xinjiang, China.

Background: Our study aimed to investigate the incidence of depression in 387 patients with asthma. Methods: The Zung self-rating depression scale and the Hamilton depression scale were used to evaluate the depression status in patients with asthma. Results: Results of logistic regression analysis indicated that, severity of asthma symptoms, taking medicine, frequency of asthma onset, and lack of education were the major risk factors for depression in patients with asthma. Conclusion: Depression is a complication with high morbidity in patients with asthma. It largely affects disease control of asthma and the quality life in patients. Multiple factors are relevant for depression in the patient with asthma. This study provided a comprehensive horizon for clinical management and treatment of depression in patients with asthma.

Examining the association between mentalizing and parental mental health in a sample of caregivers of children with asthma.

Background: Caregivers of children with asthma are at higher risk of experiencing mental health difficulties and lower quality of life than caregivers of healthy children. Mentalizing is a psychological construct that defines the ability of understanding one’s own and others’ states of mind. Poor levels of mentalizing are strongly associated with a wide range of mental health difficulties such as depression, anxiety or emotional dysregulation. This cross-sectional study is the first to examine the associations between mentalizing and mental health in a sample of caregivers of children with asthma. Method: Caregivers of children (mean age=6.53, SD=3.72, ages 1 to 17) with asthma were recruited from social media support groups and the Asthma UK charity research bulletin. Participants completed self report measures of mentalizing, family functioning, mood and anxiety difficulties. Results: A total of 88 caregivers completed the full survey. Results indicated that poorer mentalizing capacity was significantly associated with poorer family functioning and increased mood and anxiety symptomatology. Poor mentalizing was significantly associated with increased levels of depression, hypomania and anxiety, explaining 16% of variance in depression and 10% of variance in anxiety. Family functioning was not a significant predictor after controlling for the effect of mentalizing. Conclusions: These findings suggest that mentalizing capacity might be a valued new treatment target to improve the mental health of caregivers of children with asthma. The results suggest that mentalizing could complement previously identified factors such as family functioning or asthma symptom severity in understanding caregivers’ mental health. Further investigation into the role of mentalizing in the mental health of this population is warranted.

Assessment of Asthma Symptoms and Relationship to Obesity among High School Students in Fallujah City, Iraq

Introduction: Asthma attacks all age groups but often starts in childhood. Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, and occurs in people of all ages. It is the most common chronic disease among children. Many publications have shown an association between severity of asthma symptoms and obesity in children and adults. The aim of the study is to assess the symptoms of asthma and the relationship to obesity among secondary school students in Fallujah City. Method: A cross-sectional study was done during March 2018. We assessed 47 students with asthma from nine secondary schools across Fallujah city, Anbar governorate, Iraq. Simple random sampling technique has been used to select the nine schools. Results: With a total of 47 subjects with asthma, 20 (42%) male and 27 (57.4%) female subjects have been included in the study. The age of subjects was between (15-23 years with mean 17 +-1.8). With a total of 47 participants with asthma, 33 (70.2%) participants had attacks of cough or wheeze more than a couple of times per week in the last month. The corresponding weight categories of those 33 participants were as follows: six were obese, nine of over-weight,14 were normal-weight and four of under-weight. Those who had attacks of cough or wheeze less than a couple of times per week in the last month were 14 (29.8%) participants and their corresponding weight class were: None of them were obese, four were overweight, eight of normal-weight and two were under-weight. Conclusion: Obesity could be a risk factor for severe asthma symptoms among the subjects. Recommendation: Further national study is needed for assessment the association between obesity and severity of asthma symptoms among students in secondary schools.