Asthma Triggers Research Articles

Detailed two-dimensional gel proteomic mapping of the feces of the house dust mite Dermatophagoides pteronyssinus and comparison with D. farinae: Reduced trypsin protease content in D. pteronyssinus and different isoforms

Major domestic mite allergens are present in feces. We present a detailed 2D–E-MS/MS proteomic analysis of the Dermatophagoides pteronyssinus feces. Precise cultivation yielded a pure fecal extract. We detected differences in fecal allergens/digestive enzymes between D. pteronyssinus and D. farinae using 2D–E fingerprinting, including unique information on species-specific protease isoforms. Proteomic analysis was performed by 2D–E coupled with MALDI-TOF/TOF identification. The species-specific differences in the fecal extracts of the mites were attributed to trypsin-like proteases known as group 3 allergens. In D. farinae, Der f 3 exhibited high abundance with a pI similar (acidic) to that of the cysteine protease Der f 1 and the chymotrypsin protease Der f 6, whereas in D. pteronyssinus, Der p 3 was rarely detected and exhibited low abundance only at basic pI. Moreover, Der p 9 was detected at a pI of ~ 10, in contrast to Der p 1 and Der p 6, suggesting different compartmentalization in the body. Overall, in D. pteronyssinus feces, allergens of groups 1, 2, 6, and 15 were quantitatively similar to those of D. farinae with the exception of the group 3 and 9 allergens. This work provides novel insights into mite-defecated proteins/digestive enzymes, which are important allergens. SignificanceMillions of people are affected by allergy and asthma, and their number is growing. In homes, the major triggers of allergy and asthma are the house dust mites Dermatophagoides farinae and D. pteronyssinus, and a clear understanding of the development of diseases caused by these mites is needed. The major sources of mite allergens are their feces, which are deposited in the environment and are easily inhaled as part of aeroplankton. However, descriptions of and comparisons between the major fecal allergens of these two mites are lacking. This study shows that similar group 1 (cysteine protease), 2 (NPC2 family), 6 (chymotrypsin) and 15 (chitinase-like) allergens are present in the feces of these two mite species, as determined by 2D–E mapping, whereas group 3 (trypsin) and 9 (collagenolytic protease) allergens in the feces of the two species are different. The results provide unique MS/MS mapped fingerprints of mite species-specific isoforms in feces. The presence of ubiquitin in mite feces suggests that these proteins participate in the post-translational modification of fecal proteins. The findings are essential for understanding differences between D. farinae and D. pteronyssinus with respect to immunoreactivity, protease activation mechanisms, association with microbes, and food utilization.

BMAL1 links the circadian clock to viral airway pathology and asthma phenotypes.

Patients with asthma experience circadian variations in their symptoms. However it remains unclear how specific aspects of this common airway disease relate to clock genes, which are critical to the generation of circadian rhythms in mammals. Here, we used a viral model of acute and chronic airway disease to examine how circadian clock disruption affects asthmatic lung phenotypes. Deletion of the core clock gene bmal1 or environmental disruption of circadian function by jet-lag exacerbated acute viral bronchiolitis caused by Sendai virus (SeV) and influenza A virus (IAV) in mice. Post-natal deletion of bmal1 was sufficient to trigger increased SeV susceptibility and correlated with impaired control of viral replication. Importantly, bmal1−/− mice developed much more extensive asthma-like airway changes post-infection, including mucus production and increased airway resistance. In human airway samples from two asthma cohorts, we observed altered expression patterns of multiple clock genes. Our results suggest a role for bmal1 in the development of asthmatic airway disease via the regulation of lung antiviral responses to common viral triggers of asthma.

Environmental triggers and avoidance in the management of asthma.

Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs), molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and hospitalizations. Since avoidance is not easy to achieve, clean air policies remain the most effective strategy. Indoor air is also affected by air pollutants, such as cigarette smoke and volatile organic compounds generated by building and cleaning materials. Occupational exposures include work-exacerbated asthma and work-related asthma.

An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children.

Reducing exposure to environmental triggers is a critical part of asthma management. To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies. The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors. Residents with asthma were recruited through 3 mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings. The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted 3 to 6 months after the initial visit. The analysis compares improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated. Among 1465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, health care access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and health care access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group. Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to health care access and self-management. This evaluation demonstrates that a low-intensity home-based environmental intervention is effective as well as practical and feasible. Health care payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

Using Concept Mapping to Explore and Engage Parent and Youth Residents of an Economically Underserved Minority Community around Children's Asthma

Using Concept Mapping to Explore and Engage Parent and Youth Residents of an Economically Underserved Minority Community around Children's Asthma Michael Yonas, DrPH, MPH, Anita Zuberi, PhD, Anna Kasunic, MA, Patricia Bamwine, Stephanie Boddie, PhD, Shannah Tharp-Gilliam, PhD, and John Wallace, PhD COMMUNITY/POLICY BRIEF What is the Purpose of the Study? Our study engages residents of an economically underserved, minority community around the issue of children's asthma to understand the specific triggers and issues of care facing parents and youth in this community, which is a necessary first step in designing a community-based intervention. What Is the Problem? Economically underserved and minority communities continue to shoulder a higher than average burden of asthma among children, where asthma is more likely to go uncontrolled. Thus, it is important to design interventions that target these communities to help reduce racial disparities in children's asthma. For these interventions to be effective, we need to tailor the intervention to the community, and specifically to children with asthma and their caregivers. What Are the findings? Our study finds that there are several themes that are important around the triggers and care of asthma for residents of this economically underserved and minority community, some of which differ for adults and youth. • Asthma triggers. For all residents in the sample, in addition to the more common triggers of asthma that include irritants in the home and community as well as allergies, violence is also important for triggering asthma among children within this community. Not only can violence can trigger asthma by creating fear, but also when children experience bad memories about a violent incident or when a family member died. • Youth ranked emotions and stress related to school more highly than adults as a trigger for asthma. • Adults were more concerned about trouble with access to care or medicine. • Asthma Care. With respect to the care of asthma, medical and other relievers were ranked most as most important by both youth and adults. • Youth ranked supports who help to care for asthma, such as having friends with asthma or music to calm down, more highly in comparison to adults. • Adults were more focused on appliances to help with asthma than youth. [End Page 331] Who Should Care the most? The findings of our study are important for all caregivers of children in an underserved community who are more likely to come in contact with children who have asthma. These include community organizations, schools and school nurses, coaches of sports teams, afterschool program coordinators, and daycare providers, as well as those who have children with asthma living in their homes. These findings are also of importance to public health and social work practitioners who are aiming to reduce racial disparities in children's asthma by targeting communities who shoulder the highest burden. Recommendations for Action These data can be used to tailor interventions for children with asthma in this community, and to focus on different issues for children with asthma and their caregivers. • Youth • Focus on dealing with emotions and past trauma associated with violence and/or death that can precipitate asthma attacks. • Focus on building support networks among youth with asthma, either through school or other after-school / community-based organizations. • Adult Caregivers • Focus on issues related to the care of asthma, specifically the use of medicine and appliances. • Make parents aware of the emotional triggers of asthma and address inconsistencies in local asthma knowledge. Future research also needs to assess whether the issues facing children with asthma and their caregivers in this community are also issues common in other communities, and whether interventions that are aimed at these issues are effective. [End Page 332] Michael Yonas, DrPH, MPH The Pittsburgh Foundation Anita Zuberi, PhD Department of Sociology, Duquesne University Anna Kasunic, MA Homewood Children's Village Patricia Bamwine School of Social Work, University of Pittsburgh Stephanie Boddie, PhD School of Social Work, Baylor University Shannah Tharp-Gilliam, PhD Homewood Children's Village John Wallace, PhD School of Social Work, University of Pittsburgh Copyright © 2017 Johns Hopkins University Press

Asthma triggers in primary school pupils aged 6-11 years in a Nigerian population

Introduction: Asthma is a chronic respiratory disease with rising incidence the world over even in the pediatric population. This study aims to identify the common triggers of asthma in the environment. Methods: The study was descriptive cross-sectional, with a study population of 836-registered Nigerian primary school pupils from 39 randomly selected schools in Kano metropolis. Information was obtained from the pupils and their parents/caregivers using questionnaires. The data obtained were analyzed using Statistical Package for Social Science (SPSS) version 16 developed by IBM cooperation. Qualitative data (sex, social class, and suspected trigger factors) were represented as percentages, Chi-square (χ2 ) test was used to determine associations between the categorical variables and a P ≤ 0.05 was presumed statistically significant. Results: Asthma was diagnosed in 101 pupils. There were 56 (55.4%) males and 45 (44.6%) females, and a corresponding male: female ratio of 1.24:1. It was observed that common cold, household dust exposure, physical exercise as well as exposure to wood smoke and insecticides were the most common trigger factors but patients can have more than one trigger factor for their acute exacerbations. Conclusion: Against the background of the common disease provocateurs, it is suggested that the relevant control strategies along with the required avoidance recommendations of the common risk agents be pursued by the appropriate health policy-making bodies and managing physicians, respectively. For maximum relevance to the vulnerable population, these control strategies may be usefully included as part of a comprehensive package of the school health program.

Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations

Background Asthma exacerbations are a common reason for Emergency Department (ED) visits in children. Aim To analyze differences among age groups in terms of triggering factors and seasonality and to identify those with higher risk of severe exacerbations. Methods We retrospectively revised the files of children admitted for acute asthma in 2016 in our Pediatric ED. Results Visits for acute asthma were 603/23197 (2.6%). 76% of the patients were <6 years old and 24% ≥6. Infections were the main trigger of exacerbations in both groups; 33% of the school-aged children had a triggering allergic condition (versus 3% in <6 years; p < .01). 191 patients had a previous history of asthma; among them, 95 were ≥6 years, 67% of whom were not using any controller medication, showing a higher risk of a moderate-to-severe exacerbation than those under long-term therapy (p < .01). Exacerbations peaked in autumn and winter in preschoolers and in spring and early autumn in the school-aged children. Conclusions Infections are the main trigger of acute asthma in children of any age, followed by allergy in the school-aged children. Efforts for an improved management of patients affected by chronic asthma might go through individualized action plans and possibly vaccinations and allergen-avoidance measures.

Using Concept Mapping to Explore and Engage Parent and Youth Residents of an Economically Underserved Minority Community around Children's Asthma.

Asthma continues to disproportionately impact children living in economically underserved urban neighborhoods, and contributes to persistent racial and economic disparities in health. Furthermore, asthma is often exacerbated by the presence of social and environmental factors that are prevalent in, and sometimes particular to, these communities. The present study uses a community-based participatory research (CBPR) approach to explore and define the experience and issues around children's asthma in an economically underserved community. These findings will be used to inform the design of a community intervention. Through a community and academic partnership called Healthy Living, Healthy Learning, Healthy Lives (HL3), we engaged neighborhood youth and adult residents (N = 21) in a concept mapping activity to identify triggers and health care-related factors that influence children with asthma. Findings highlight that the most important triggers of asthma included indoor and outdoor irritants and allergens, as well as violence and fear-related emotions. The most important factors perceived to influence the care of asthma included medical relievers such as asthma medication, appliances such as a humidifier, and supports for asthma like the school nurse. Differences between adults and youth perceptions of factors triggering and influencing asthma are highlighted. Engaging community residents as experts provided a deeper understanding of the issues around children's asthma in the community, which can contribute to the design of a more effective intervention.

Raynaud Fenomeni Olan Hastalarda Allerjik Hastalıkların Sıklığı

Objective: Raynaud phenomenon (RP) is an exaggerated vascular response to cold or emotional stress. Cold is also a trigger for allergic diseases like asthma, vasomotor rhinitis and urticaria (cold urticaria, idiopathic urticaria, dermographism). The aim of the present study was to investigate the prevalence of allergic diseases in patients with primary and secondary Raynaud’s phenomenon. Materials and Methods: A total of 53 consecutive patients with RP who were followed at Hacettepe University Hospital’s Division of Rheumatology and volunteered for allergic evaluation were enrolled between April 2013-September 2013. An additional 20 patients with rheumatologic diseases and without Raynaud phenomenon were included as the control group. A questionnaire evaluating the presence of allergic diseases was administered to all patients. Either skin prick test or specific IgE (phadiatop) was requested depending on oral corticosteroid usage. Pulmonary function and ice cube tests were performed for all patients. Results: Among the patients included in the study, 90.4%were women and 72.6% had RF. The most common rheumatologic diseases were scleroderma and rheumatoid arthritis. Patients with vasomotor rhinitis (12.3%), dermographism (8.2%) and cold urticaria (4.1%) all had RF. Thirty seven percent of all patients had at least one allergic disease. Having allergic diseases was not associated with RF. Conclusion: In conclusion, it has been shown that cold-related diseases such as asthma, vasomotor rhinitis, cold urticaria and dermographism were more frequent in patients with RF. In addition, the frequency of allergic diseases in patients with rheumatoid arthritis was not less than that of the normal population.

Patient Reported Value and Usability of a Digital Health Intervention for Asthma

Background: Digital health tools are increasingly recognized as effective in improving asthma clinical outcomes such as control and adherence; however, few studies have evaluated patient perspectives on the usability and value of these tools in supporting asthma self-management. Patient perceptions of digital health tools, including usability and satisfaction, will determine the success of these digital health interventions and the durability of their effects. Objective: We aimed to assess patients’ usability feedback and satisfaction with an asthma digital health platform after 12 months of use. Methods: We administered surveys to participants of a randomized controlled clinical study designed to measure the clinical effectiveness of the Propeller Health Asthma Platform. The electronic surveys evaluated patients’ feedback on the usability of the sensor and the perceived value of the platform and information provided after 12 months of use. The clinical study had enrolled patients (N=495) in parallel arms from specialty and primary care clinics. Intervention group patients (n=250) used electronic inhaler sensors to track the date, time and geographic location of medication use. Patients received access to a digital health platform including smartphone and Web-based applications that provided information about their asthma medication use trends, real-time asthma control, guidelines-based education, and personalized support for 12 months. Physicians could monitor the status of their patients and receive notifications about short-acting beta agonist (SABA) overuse. Survey results reported here represent adult participants from the intervention group who completed the exit survey at 12 months. Results: Respondents (n=89) reported being very satisfied (79%) or somewhat satisfied (20%) with the inhaler sensor, stating that the sensor was “small,” “unobtrusive,” and “easy to use” and carry. A total of 90% of respondents found the information they received via the platform useful, with 93% expressing satisfaction with the information. In open-ended responses, participants cited valuing how the platform increased awareness about their asthma control status and medication use, provided “relevant” and “timely” information, and identified potential environmental triggers that exacerbated their symptoms, with 65% of respondents identifying 1-7 new triggers as result of the information. Respondents described improved communication with their doctors: 46% of the respondents had talked with their doctor about the information they received, and 22% stated that their doctor recommended or changed a specific aspect of their asthma management as a result of the information. Over 50% of respondents said that they felt their asthma was more controlled as a result of the information they received, which is supported by the clinical results demonstrating 63% of uncontrolled patients achieved control during the program. Conclusions: Patients reported positive usability of a digital health platform for asthma self-management, citing that it was easy to use and fit into their lives unobtrusively. Almost all patients perceived value from the digital health platform in contributing to their self-management, finding value in increasing self-awareness, identifying asthma triggers, offering actionable information, and improving communication with their doctors. ClinicalTrial: Clinicaltrials.gov NCT01509183; https://clinicaltrials.gov/ct2/show/NCT01509183 (Archived by WebCite at http://www.webcitation.org/6nIIEejW7). [iproc 2016;2(1):e36]

Emotionally triggered asthma and its relationship to panic disorder, ataques de nervios, and asthma-related death of a loved one in Latino adults

ObjectiveResearch has demonstrated high comorbidity between asthma and panic disorder (PD). Less is known about the relationship between asthma and the Latino cultural idiom of distress of ataques de nervios, as well as the role that psychosocial stressors play. The current study tested the hypotheses that Latino asthma patients who experience PD, ataques de nervios, and/or asthma-related death of a loved one endorse greater psychological triggers of asthma, greater perceived impact of asthma triggers, and greater difficulty controlling such triggers than do those without these conditions. MethodsData originated from an interview conducted prior to a randomized controlled trial in which 292 Latino adults with self-reported asthma were recruited from outpatient clinics in the Bronx, NY. The PRIME-MD Patient Health Questionnaire (PHQ) was used to screen for PD symptoms, while the Structured Clinical Interview for DSM-IV (SCID-I) was used to confirm diagnosis of PD. Lifetime history of ataques de nervios and asthma-related death of a loved one were based upon self-report. Asthma triggers were examined using the Asthma Trigger Inventory (ATI). ResultsPD, ataques de nervios, and asthma-related death of a loved one each predicted a higher frequency of psychological asthma triggers, controlling for gender and comorbid medical conditions. Participants with PD also reported greater impact of asthma triggers than those without PD, while no significant differences in perceived control were observed. ConclusionProviders should screen for PD, ataques de nervios, and asthma-related death of a loved one in Latino asthma patients, given their observed association with emotionally triggered asthma.

METHODS FOR CLUSTERING TIME SERIES DATA ACQUIRED FROM MOBILE HEALTH APPS.

In our recent Asthma Mobile Health Study (AMHS), thousands of asthma patients across the country contributed medical data through the iPhone Asthma Health App on a daily basis for an extended period of time. The collected data included daily self-reported asthma symptoms, symptom triggers, and real time geographic location information. The AMHS is just one of many studies occurring in the context of now many thousands of mobile health apps aimed at improving wellness and better managing chronic disease conditions, leveraging the passive and active collection of data from mobile, handheld smart devices. The ability to identify patient groups or patterns of symptoms that might predict adverse outcomes such as asthma exacerbations or hospitalizations from these types of large, prospectively collected data sets, would be of significant general interest. However, conventional clustering methods cannot be applied to these types of longitudinally collected data, especially survey data actively collected from app users, given heterogeneous patterns of missing values due to: 1) varying survey response rates among different users, 2) varying survey response rates over time of each user, and 3) non-overlapping periods of enrollment among different users. To handle such complicated missing data structure, we proposed a probability imputation model to infer missing data. We also employed a consensus clustering strategy in tandem with the multiple imputation procedure. Through simulation studies under a range of scenarios reflecting real data conditions, we identified favorable performance of the proposed method over other strategies that impute the missing value through low-rank matrix completion. When applying the proposed new method to study asthma triggers and symptoms collected as part of the AMHS, we identified several patient groups with distinct phenotype patterns. Further validation of the methods described in this paper might be used to identify clinically important patterns in large data sets with complicated missing data structure, improving the ability to use such data sets to identify at-risk populations for potential intervention.

The Implementation of Global Asthma Management Guidelines in Two General Respiratory Outpatient Clinics in Greece

BACKGROUND: The implementation of global guidelines for asthma management aims at asthma control. The aim of this study was to investigate the implementation of asthma management guidelines by both patients and physicians in two general pulmonary outpatient clinics in Greece. METHODS: Two questionnaires were administered to pulmonologists (n=43) and patients (n=181) separately. Asthma control was assessed by Asthma Control Test. RESULTS: All physicians informed their patients about asthma and suggested regular visits. The vast majority educated their patients to recognize symptom deterioration (n=42, 97.7%) and asthma triggers (n=41, 95.3%), to readjust treatment (n=41, 95.3%) and use correctly the inhaler devices (n=40, 93%). Greek pulmonologists suggested physical activity (n=40, 93%), peak flow meter use (n=13, 30.2%) and asthma physiotherapy (n=10, 23.3%), while 13 (30.2%) provided a written action plan. Among 181 participants with asthma, 41 (22.7%) had hyperventilation, while 117 (64.6%), mostly young men, had controlled asthma with high FEV1% predicted and without hyperventilation. Only 21 (11.6%) visited the emergency room in the past 6 months, while 98 (54.1%) had regular follow-up. They had developed a partnership with their physician (n=151, 83.4%) and confirmed their response to education on asthma triggers (n=156, 86.2%), symptom deterioration (n=171, 94.5%), inhaler medication technique (n=168, 92.8%) and peak flow meter use (n=40, 22.1%). Moreover, 118 (65.2%) patients recognized medication categories and 34 (18.8%) had a written action plan. They complied with physical activity suggestion (n=141, 77.9%), while 11 (6.1%) have performed breathing exercises. CONCLUSION: The recommendations for asthma management are significantly integrated into clinical practice in Greece, leading to high prevalence of asthma control.

Path to health asthma study: A survey of pediatric asthma in an urban community

ABSTRACTObjective: Minority children with asthma who live in low-income urban communities bear a disproportionate burden of the disease. This study explores the perceived health care needs related to asthma care, identifies asthma triggers, potential barriers to care, and assesses the need for additional community resources. Methods: We conducted a cross-sectional survey of Hispanic and African American adults (n = 53) who take care of a child with asthma and live in an urban community of North Philadelphia. Input from community leaders was obtained in the development the survey tool resulting in a unique ‘community-centric’ questionnaire. The survey was also available in Spanish. All surveys were conducted in the community setting. Results: Variables were used to measure asthma severity and triggers. Children were categorized with intermittent (n = 24, 45.3%), mild persistent (n = 13, 24.5%), or moderate-to-severe persistent asthma (n = 16, 30.2%). Most children with persistent asthma were enrolled under Medicaid or CHIP (n = 24, p = 0.011) and reflected a low-income socioeconomic status. Persistent asthma was found to be associated with most triggers: pets, dust mites, mice, mold, and cockroaches. There was no significant association between environmental tobacco smoke and persistent asthma. Children with persistent asthma and 2 or more triggers were more likely to be hospitalized and go to the Emergency Department. Conclusion: Urban minority children living in low-income communities face neighborhood-specific asthma triggers and challenges to care. Studies conducted in urban neighborhoods, with collaboration from community members, will highlight the need of comprehensive services to account for community-centric social determinants.

Translating a Proven Pediatric Healthy Homes Asthma Intervention to Adults.

Asthma is a serious public health concern, disproportionately affecting urban, minority populations. Chicago's West and Southwest sides are among the most burdened by asthma and environmental conditions that exacerbate asthma. Home-based, community health worker (CHW)-led interventions have repeatedly demonstrated effectiveness in addressing pediatric asthma. However, evidence of such interventions among adults is limited. Helping Chicago's Westside Adults Breathe and Thrive is a longitudinal cohort study that assesses the effectiveness of a CHW-led asthma and healthy homes intervention for adults. One of the first of its kind, the program aims to improve asthma control and quality of life among adults with poorly controlled asthma. This article provides a framework for implementing the intervention from start to finish. CHWs make five or six home visits over the course of 12 months, providing comprehensive and individualized asthma education to study participants. They work closely with participants to conduct home environmental assessments, collaboratively developing techniques to eliminate or avoid asthma triggers. They also assist with smoking cessation, comorbidities, and health system navigation. Between December 1, 2013, and August 31, 2015, 202 participants enrolled in the program. This article reports on successes, challenges, and recommendations from the program's first 21 months of operation.

Detection of allergen sources in the homes of sensitized children.

To identify the presence of environmental factors linked to the onset of allergies and asthma in the homes of children participating in an early detection program that were identified with sensitivity to common allergens in the region of Sonora, Mexico. A walkthrough assessment was carried out in the homes of sensitized children; the research tools were the questionnaire and environmental checklist proposed by the Lowell Healthy Homes Program of the University of Massachusetts-Lowell. The results showed the presence of environmental allergen sources, to which most of the children in the study are sensitized, as well as the environmental conditions and habits that determine the quality of the indoor air of the households, were both related to triggering allergies and asthma in this population. A statistically significant association was found between the visual observation of dust inside homes and the sensitivity of children to dust mites. Dust found inside the home was the most relevant environmental factor related to positive cases of IgE in children. Early detection of allergies in children in the study and the methodology used in this investigation provided a useful framework for the design of plans and intervention alternatives in these homes to prevent the development of allergies and asthma panorama. These plans should be designed with a multidisciplinary approach to impact social, environmental and economic benefits in the family, improving the living conditions of the study population and contributing to the sustainable development goals of the United Nations for 2030.

Increased seroprevalence of Enterovirus 71 IgE antibodies in asthmatic compared with non-asthmatic children.

Asthma is a common pediatric chronic inflammatory airway disease. Respiratory viral infections are frequent infectious triggers for exacerbations of asthma. We sought to determine whether Enterovirus 71 (EV71), a ubiquitous virus that causes systemic inflammatory responses in children but is not a known respiratory pathogen, can also serve as an infectious trigger for asthma. Specific EV71 IgE and IgM antibodies (Abs), total serum IgE, and IL-2 and IL-4 cytokine levels in serum of asthmatic and non-asthmatic children (N=42, ages 5-19; N=35, ages 1-20, respectively) were measured (ELISA). Asthmatic children had higher EV71 IgE Ab levels than non-asthmatic (P<0.001). Non-asthmatic children had significantly higher EV71 IgM Ab levels than asthmatic (P<0.001). Despite low serum IgE levels of non-asthmatic, compared with asthmatic (P<0.001), the non-asthmatic children produced significantly more IL-2 and IL-4 than asthmatic (P<0.001; P<0.001). The ages of the asthmatics, but not the non-asthmatics had a significant effect on the levels of EV 71 IgE Abs (P=0.02; P=0.356). A test of difference between these two slopes was significant. However, the ages of the non-asthmatic, but not the asthmatic children had a significant effect on the levels of EV 71 IgM Abs; a test of difference between these two slopes was significant. Increased specific EV71 IgE Ab responses may indicate that EV71 infection may also be an infectious trigger in asthma. However, the role of specific EV71 IgM Abs, Th2 cytokines, and age in non-asthmatic children should be further studied.

Integrating Environmental Management of Asthma into Pediatric Health Care

The National Environmental Education Foundation (NEEF) launched an initiative in 2005 to integrate environmental management of asthma into pediatric health care. This study, a follow-up to a 2013 study, evaluated the program's impact and assessed training results by 5 new faculty champions. We surveyed attendees at training sessions to measure knowledge and the likelihood of asking about and managing environmental triggers of asthma. To conduct the program evaluation, a workshop was held with the faculty champions and NEEF staff in which we identified major program benefits, as well as challenges and suggestions for the future. Trainee baseline knowledge of environmental triggers was low, but they reported robust improvement in environmental triggers knowledge and intention to recommend environmental management. The program has a broad, national scope, reaching more than 12 000 physicians, health care providers, and students, and some faculty champions successfully integrated materials into health record. Program barriers and future endeavors were identified.

Removing asthma triggers and improving children's health: The Asthma Partnership Demonstration project

BackgroundStudies have revealed the efficacy of home-based environmental interventions on reduction of asthma symptoms as a strategy for managing asthma in children. A focus on education and behavior change alone is generally too limited to reduce exposure to asthma triggers that exist because of adverse housing conditions. ObjectiveTo demonstrate that housing conditions as a focus of a health intervention should be considered more widely as an effective means of addressing serious health problems such as asthma. MethodsResidences of 41 families of children identified with some of the highest rates of asthma-related hospital visits were assessed for the presence of asthma triggers. ResultsThe intervention had a positive effect on lessening the effect of the child's asthma on the family's lives and activities. Reductions in frequency of negative effects of children's asthma on sleeping, job or work around the house, and family activity plans, fewer worries or concerns about children getting enough sleep and performing normal daily activities, and fewer adverse effects of children's asthma medications were reported. Reduced use of asthma medication, medication applications, and health visits were noted. Households with return visits had 50% lower hospital bills for childhood asthma treatment. ConclusionHome environment conditions that lead to or exacerbate asthma may be reduced or eliminated by making minor repairs and introducing reasonable cleaning regimens that address sources of asthma triggers. This can produce greater awareness on the part of families about the presence of asthma triggers and motivate future action to address the conditions associated with these triggers.

Acute severe asthma (status asthmaticus).

Acute severe asthma, formerly known as status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy. It is a medical emergency that requires immediate recognition and treatment. Albuterol in combination with ipratropium bromide in the emergency department (ED) has been shown to decrease the time spent in the ED and the hospitalization rates. The benefits of ipratropium are not sustained after admission to the hospital. Oral or parenteral corticosteroids should be administered to all patients with acute severe asthma as early as possible because clinical benefits may not occur for a minimum of 6 to 12 hours. Viral respiratory infections are a common trigger for acute asthma; other causes include medical nonadherence, allergen exposure (especially pets and mold [e.g., Alternaria species]) in individuals who are severely atopic, nonsteroidal anti-inflammatory exposure in patients with aspirin allergy, irritant inhalation (e.g., smoke, paint), exercise, and insufficient use of inhaled or oral corticosteroids. The patient's history should focus on the acute assessment of asthma control and morbidity, including current use of oral or inhaled corticosteroids; the number of hospitalizations, ED visits, intensive care unit admissions, and intubations; the frequency of albuterol use; the presence of nighttime symptoms; activity intolerance; current medications; exposure to allergens; and other significant medical conditions. Severe airflow obstruction may be predicted by accessory muscle use, difficulty speaking, refusal to recline < 30°, a pulse of >120 beats/min, and decreased breath sounds. More objective measures of airway obstruction via peak flow or forced expiratory volume in 1 second and pulse oximetry before oxygen administration usually are helpful. Pulse oximetry values of >90% are reassuring, although CO₂ retention and a low partial pressure of oxygen may be missed.