Reduced lung function at birth and the risk of asthma at 10 years of age

BACKGROUND

Reduced lung function in early infancy has been associated with later obstructive airway diseases. We assessed whether reduced lung function shortly after birth predicts asthma 10 years later.

METHODS

We conducted a prospective birth cohort study of healthy infants in which we measured lung function shortly after birth with the use of tidal breathing flow-volume loops (the fraction of expiratory time to peak tidal expiratory flow to total expiratory time [t(PTEF)/t(E)]) in 802 infants and passive respiratory mechanics, including respiratory-system compliance, in 664 infants. At 10 years of age, 616 children (77%) were reassessed by measuring lung function, exercise-induced bronchoconstriction, and bronchial hyperresponsiveness (by means of a methacholine challenge) and by conducting a structured interview to determine whether there was a history of asthma or current asthma.

RESULTS

As compared with children whose t(PTEF)/t(E) shortly after birth was above the median, children whose t(PTEF)/t(E) was at or below the median were more likely at 10 years of age to have a history of asthma (24.3% vs. 16.2%, P=0.01), to have current asthma (14.6% vs. 7.5%, P=0.005), and to have severe bronchial hyperresponsiveness, defined as a methacholine dose of less than 1.0 micromol causing a 20% fall in the forced expiratory volume in 1 second (FEV1) (9.1% vs. 4.9%, P=0.05). As compared with children whose respiratory-system compliance was above the median, children with respiratory compliance at or below the median more often had a history of asthma (27.4% vs. 14.8%; P=0.001) and current asthma (15.0% vs. 7.7%, P=0.009), although this measure was not associated with later measurements of lung function. At 10 years of age, t(PTEF)/t(E) at birth correlated weakly with the maximal midexpiratory flow rate (r=0.10, P=0.01) but not with FEV1 or forced vital capacity.

CONCLUSIONS

Reduced lung function at birth is associated with an increased risk of asthma by 10 years of age.

Asthma in every fifth child in Oslo, Norway: a 10-year follow up of a birth cohort study

BACKGROUND

The western world's increase in childhood asthma is suggested to level off. We aimed to investigate asthma prevalence in 10-year-old children within the prospective birth cohort Environment and Childhood Asthma (ECA) Study in Oslo established in 1992/1993.

SUBJECTS AND METHODS

Six hundred and sixteen (77%) of 803 children (mean age 10.9 +/- 0.9 (SD) years) with lung function measurements at birth were reinvestigated at age 10 years. At birth they corresponded to the entire birth cohort (n = 3754) regarding gender, socio-demographic factors, parental allergic diseases, pet keeping and maternal smoking. Results from structured parental interview, spirometry, and skin prick test for inhalant and food allergens are presented. Asthma definition required minimum two positive criteria, (i) doctor's diagnosis of asthma, (ii) wheeze and/or chest tightness, (iii) use of anti-asthmatic treatment. Current asthma required asthma definition plus either (ii) and/or (iii) in the last 12 months, and/or > or = 10% fall in forced expired volume in 1 s after treadmill running.

RESULTS

Lifetime prevalence of asthma was 20.2%; current asthma 11.1%, doctor diagnosis of asthma 16.1% and wheezes ever 30.3%. Allergic sensitization (29.3% overall) was more common among children with current (56.3%) compared to asymptomatic (last 12 months) (26.0%) or no asthma (27.6%) (P < 0.001). Boys more often than girls had current asthma (14.4 vs 7.1%, P = 0.004), wheeze ever (36.9 vs 22.5%, P = 0.002) and allergic sensitization (36.2 vs 22.1%, respectively, P < 0.001).

CONCLUSION

Childhood asthma apparently continues to increase in Oslo, having affected every fifth 10-year-old child.

Severe asthma in childhood: assessed in 10 year olds in a birth cohort study

BACKGROUND

Limited information is available regarding the prevalence of severe asthma in children. The present study aimed at investigating the prevalence of severe asthma in an urban child population; secondarily evaluating the applicability of the chosen definition by clinical characteristics.

METHODS

Children enrolled in the prospective birth cohort; the Environment and Childhood Asthma Study in Oslo; were reinvestigated at the age of 10 years (n = 1019). A representative population based cohort of 616 children [mean age 10.9 (SD 0.9) years] with lung function measurements at birth was used for prevalence estimates, whereas all 1019 children (154 with current asthma) attending the 10-year follow-up were included for verification of the definition of severe asthma. Clinical investigations included spirometry, tests of bronchial hyperresponsiveness, skin prick tests and exhaled nitric oxide. Severe asthma was defined as poorly controlled asthma despite treatment with > or = 800 microg budesonide or equivalent; assessed by a detailed structured interview.

RESULTS

The population point prevalence at age 10 years of current severe asthma was 0.5% (three of 616) and among children with current asthma 4.5% (three of 67). The 10/154 children identified as suffering from severe asthma more often had severe bronchial hyperresponsiveness (PD(20) methacholine <1 micromol) (60%vs 22%, P = 0.015), lower median forced expiratory volume in 1 s/forced vital capacity ratio (93%vs 99%, P = 0.04) and higher body mass index (mean BMI 22.3 vs 18.3, P < 0.001) than nonsevere current asthmatics.

CONCLUSIONS

The prevalence of severe asthma was 0.5% in all 10-year olds, and 4.5% among current asthmatics. The severe asthma definition applied in this study is supported by results of clinical investigations.

Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age

BACKGROUND

Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even when parental and children's atopic manifestations are taken into consideration.

OBJECTIVE

To assess if the severity of OAD in the first 2 years of life predicts asthma at 10 years of age.

METHODS

From a nested case control study within the Environment and Childhood Asthma study, 233 2-year-old subjects with recurrent (> or = 2 episodes) bronchial obstruction (rBO+) and 216 subjects without bronchial obstruction (rBO-) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at 2 years was calculated by frequency, persistence of bronchial obstruction and hospital admissions because of OAD.

MAIN OUTCOMES

Current asthma at 10 years (asthma with symptoms and/or asthma medication during the past year and/or positive treadmill test). Secondary outcome was metacholine BHR at 10 years.

RESULTS

Compared with rBO- subjects, adjusted odds ratio (95% CI) of current asthma among rBO+ was 7.9 (4.1, 15.3), and among rBO+ with a severity score of > 5, 20.2 (9.9, 41.3). In receiver operated characteristic analysis, positive and negative predictive values demonstrated the applicability and value of the score, with an optimal cut-off at severity score 5. Children with severity score > 5 had severe BHR more often (PD20 metacholine < 1 micromol) than children with a lower or 0 score (p = 0.0041).

CONCLUSION

Using a simple scoring system, a high severity score of OAD by 2 years of age is a strong risk factor for, and may predict, current asthma at 10 years of age.

Diagnostic value of exhaled nitric oxide in childhood asthma and allergy

Fractional exhaled nitric oxide (FE(NO) ) has been proposed as a diagnostic test of asthma. We aimed to investigate in a population based birth cohort of children the usefulness of FE(NO) as a diagnostic tool. The 10-yr follow up of the Environment and Childhood Asthma Study in Oslo included 616 children representative of the prospective birth cohort. Both FE(NO) (single breath technique) and skin prick test (SPT) were measured in 331, limited at the time by equipment availability. Structural parental interview, spirometry, methacholine challenge and exercise test were performed. FE(NO) was significantly elevated in children with current asthma (geometric mean 9.6 (95% confidence interval (CI) (6.9, 13.4) p.p.b.) compared with healthy children (5.8 (5.4, 6.3) p.p.b.; p < 0.001). FE(NO) was highest among children with current allergic asthma (asthma and positive SPT) (14.0 (8.9, 22.1) p.p.b.), whereas children with non-allergic asthma (6.1 (4.0, 9.2) p.p.b.) had comparable FE(NO) levels to healthy children (p = 0.99). Allergic sensitization was most closely associated with FE(NO) . A FE(NO) cut-off value of 20.4 p.p.b. had a high specificity (0.97), but a low sensitivity (0.41) and a Positive Likelihood Ratio of 16.1 for current allergic asthma. In the present childhood population-based study, high FE(NO) levels were closely associated with current allergic asthma and not with current asthma without allergic sensitization. Estimating the individual predictive probability of having asthma by use of FE(NO,) improves the diagnostic utility of the test.

T cell-specific T-box transcription factor haplotype is associated with allergic asthma in children

BACKGROUND

T cell-specific T-box transcription factor (T-bet) is a member of the T-box family of transcription factors regulating lineage commitment of T(H) lymphocytes toward a predominant T(H)1 phenotype. Asthma and allergy are common complex diseases characterized by T(H)2-mediated inflammation.

OBJECTIVE

We aimed to assess possible relationships between the T-bet gene (TBX21) and asthma and allergy in children.

METHOD

Twelve single nucleotide polymorphisms (SNPs) in the TBX21 region were genotyped in 948 children from the Environment and Childhood Asthma study. Allele and haplotype frequencies were compared in children with and without asthma (by 10 years) and allergy (> or =1 positive skin prick test response), as well as for the quantitative traits bronchial hyperresponsiveness determined by means of methacholine bronchial challenge testing, lung function determined by means of forced flow volume loops, fractional exhaled nitric oxide measurement, eosinophil count, and serum total IgE level.

RESULTS

Allergic asthma was significantly associated with 2 of the tested SNPs (rs11650354 and rs16947078) and further associated with the particular haplotype including these SNPs, with homozygote status resulting in an odds ratio of 8.3 (95% CI, 2.5-26.9) for allergic asthma. Neither nonallergic asthma or "allergy alone" nor the remaining quantitative variables were associated with TBX21 SNPs or haplotypes.

CONCLUSION

An association between a specific TBX21 haplotype and allergic asthma in children is demonstrated for the first time and might explain previously detected associations between SNPs within TBX21 and asthma and bronchial hyperresponsiveness.

HLA Dr-Dq haplotypes and the TNFA-308 polymorphism: associations with asthma and allergy

BACKGROUND

The HLA (human leukocyte antigen) class II genes DQB1 and DRB1 and the Tumor Necrosis Factor alpha gene (TNFA) within the HLA complex (chromosome 6p21) have been associated with asthma and allergy. Due to the strong linkage disequilibrium characterizing this complex and the multiple asthma/allergy expressions, we aimed to determine which of these genes were primarily involved in specific asthma/allergy traits.

METHODS

The DRB1-DQB1 alleles and TNFA-308 polymorphism were genotyped in 959 children from the Environment and Childhood Asthma study and analyzed for possible associations with allergic and non-allergic asthma (with/without at least one positive skin prick test for allergens) and specific allergic sensitization, as well as bronchial hyperresponsiveness and total IgE, using both allele and extended haplotype analyses.

RESULTS

Different genes within the HLA complex were associated with separate asthma and allergy traits. Nonallergic asthma was associated with both the TNFA-308A allele [Odds ratio (OR) 1.7 (1.3-2.3)] and DRB1 03 allele [OR 1.6(1-2.6)], but extended DRB1 03-TNFA-308 haplotype analysis suggested that the DRB1-DQB1 association was secondary to linkage disequilibrium with the TNFA-308 polymorphism. Allergies were associated with HLA class II alleles only; birch sensitization with DQB1 0603-DRB1 13 [OR 2.3 (1.4-4.0)] and mugwort sensitization with DQB1 0609-DRB1 13 [OR 7.1 (1.9-27.0)] and DQB1 0501-DRB1 01 [OR 2.0 (1.0-4.0)].

CONCLUSIONS

Our data suggests that asthma is not associated with DRB1 or DQB1 but rather TNFA or a gene(s) in linkage disequilibrium, while sensitization to specific allergens is associated with particular alleles at the DQ and/or DR loci. A novel association between DQB1 0603-DRB1 13 and birch allergy is identified.

Lung function at 10 yr is not impaired by early childhood lower respiratory tract infections

The causal relationship between lower respiratory tract infections (LRIs) in early life and reduced lung function later in childhood is unsettled. Therefore, we assessed whether LRIs the first 2 yr of life influenced lung function development from birth to school age. In the prospective Oslo birth cohort, 'the Environment and Childhood Asthma (ECA) study' lung function was measured at birth in 802 infants by tidal flow volume loops and in 664 infants by passive respiratory mechanics and half yearly questionnaires, including LRI questions, were completed until 2 yr of age. The present study includes 607 children with information about LRIs the first 2 yr of life and successfully forced expiratory flow (FEF) volume measurements at the 10-yr follow-up assessment. At 10 yr of age, FEF at 50% of forced vital capacity (FEF(50)) (mean 95% confidence interval) was reduced in children with at least one bronchiolitis (85.0, 80.6-89.5, p = 0.020) or bronchitis (86.2, 82.6-89.8, p = 0.030) or > or =3 LRIs (83.4, 78.1-88.8, p = 0.017) when compared with no LRIs (90.6, 88.8-92.5) by 2 yr of life. The effects were significant in girls only when stratifying for gender. Among girls with later bronchiolitis compliance of the respiratory system (3.64, 3.17-4.10 vs. 4.18, 3.98-4.37, p = 0.031) and the ratio of time to peak tidal expiratory flow to total expiratory time (t(PTEF)/t(E)) measured at birth was significantly reduced (0. 26, 0.23-0.29 vs. 0.32, 0.30-0.33, p = 0.005) when compared with children with no LRIs. Change in lung function from birth (by t(PTEF)/t(E)) to 10 yr of age was not significantly associated with LRIs the first 2 yr of life, and LRIs by 2 yr of life were not significantly associated with lung function at 10 yr of age in regression analyses including lung function at birth and other possible predictors of lung function at 10 yr. In our study, LRIs during the first 2 yr of life did not impair lung function development from birth until 10 yr of age.

Do allergic families avoid keeping furry pets?

Studies addressing the relationship between pet keeping and development of asthma and allergies may be influenced by pet avoidance in families with a history of allergic disease. Following a cohort of 1019 children in Oslo till 10 years of age, we studied the association of pet keeping with socio-economic factors and allergic disease in the family. A family history of asthma and rhinoconjunctivitis was not significantly associated with pet ownership at birth or with pet removal by 10 years. Acquiring cats and dogs was less likely if the child had allergic rhinoconjunctivitis, whereas no association was seen with asthma (in any family member). Single parenthood increased the likelihood of acquiring a cat, smoking parents more often had cats or dogs, and having older siblings was associated with keeping dogs and other furry pets. Among 319 families reporting pet avoidance, 70% never had pets, 8% had given up pets, and 22% avoided a particular type of pet only. Twenty-four per cent of the parents failed to retrospectively report pet keeping during the child's first year of life. Overall, allergic rhinitis, but not asthma was associated with actual pet avoidance, whereas the strongest predictors for keeping pets were found to be socio-economic factors.

PRACTICAL IMPLICATIONS

Allergic disease in a child most often does not lead to the removal of the family's furry pet. Pet avoidance is associated with allergic symptoms, but not asthma. Socio-economic factors like parental education, single parenthood and smoking affects the families' decisions on pet keeping, including the type of pets the families will avoid or acquire. The large recall error demonstrated points to the need for prospective data regarding pet keeping.

Effect of inhaled steroids on lung function in young children: a cohort study

The objectives of the present study were to determine the use of inhaled corticosteroids (ICS) for treating recurrent bronchial obstruction (rBO) in young children up to 2 yrs of age and to assess possible modifying effects of ICS on lung function in young children with rBO. From an observational, noninterventional birth cohort of 3,754 newborn children (3,697 with complete questionnaire data by 2 yrs of age), 306 children with documented rBO by age 2 yrs (cases) were identified along with 306 matched controls. Two tidal flow/volume measurements were taken, one at presentation of disease (children were steroid naive) and one at 2 yrs of age (mean age 11.2 and 25.6 months, respectively), from: 21 cases who subsequently received ICS (ICS+); 33 who did not (ICS-); and in 15 controls. The mean +/- SD duration of ICS treatment was 10.3 +/- 6.5 months. The main outcomes were treatment with ICS and baseline ratio of time to peak expiratory flow/total expiratory time (tPTEF/tE). From the entire cohort, 77 children (2.1%) and 21% of children with rBO had received ICS by 2 yrs of age. Baseline tPTEF/tE was significantly lower at the first visit only in ICS+ as compared to ICS- subjects, as well as in ICS+ and ICS- as compared to controls. The mean difference in baseline tPTEF/tE from first to second visit was borderline statistically significant in the ICS+ group only and correlated significantly with duration of ICS treatment. The present observational cohort study demonstrated that one-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids. Early inhaled corticosteroid treatment improved lung function by age 2 yrs, mostly in those with the longest duration of treatment.

CFTR gene mutations and asthma in the Norwegian Environment and Childhood Asthma study

BACKGROUND

Several candidate genes have been implicated in the etiology of asthma, including the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). Mutations in the CFTR gene result in derangements of mucociliary clearance. Homozygotes for CFTR mutations develop cystic fibrosis (CF), a disorder characterized mainly by lung and pancreas disease.

OBJECTIVE

To investigate whether there was an increased frequency of CFTR mutations in asthma patients.

METHODS

Seven hundred and three subjects aged 10-11 years from the environment and childhood asthma (ECA) study were included in the present study. Possible associations between asthma, reduced lung function, bronchial hyperresponsiveness (BHR), and increased or decreased nitrogen oxide (NO) levels (based on structural parental interview, spirometry, PD20 methacholine challenge test and exhaled NO measurements), and the five most common CFTR mutations in Norway (DeltaF508, R117H, R117C, 4005+2T-->C, 394delTT), the modulating polymorphisms IVS8(TG)mTn and the IVS8-5T were investigated.

RESULTS

No association were found between asthma, reduced lung function, BHR or exhaled NO levels and CF heterozygosity. However, the IVS8(TG)11T7 haplotype was associated with normal lung function.

CONCLUSIONS

Our results do not support the hypothesis that CFTR mutations or polymorphisms play a role in the pathogenesis of asthma in children. However, the distribution of Tn(TG)m haplotypes differed between individuals with reduced lung function and individuals with normal lung function.

Asthma prediction in school children; the value of combined IgE-antibodies and obstructive airways disease severity score

BACKGROUND

Allergic sensitisation increases the risk for asthma development. In this prospective birth cohort (Environment and Childhood Asthma) study, we hypothesized that combining quantitative measures of IgE antibodies (Sigma-IgE) and Severity score of obstructive airways disease (OAD) at 2 years of age (Severity score) is superior to predict current asthma (CA) at 10 years than either measure alone. Secondarily, we assessed if gender modified the prediction of CA.

METHODS

A follow-up study at 10 years of age was performed in 371 2-year-old children with recurrent (n = 219) or no (n = 152) bronchial obstruction with available serum analysed for Sigma-IgE to common food and inhalant allergens through a panel test, Phadiatop Infant) (Phadia, Uppsala, Sweden). Clinical variables included allergic sensitisation and exercise testing to characterise children with CA vs not CA at 10 years and the Severity score (0-12, 0 indicating no OAD) was used to assess risk modification.

RESULTS

Severity score alone explained 24% (Nagelkerke R(2) = 0.24) of the variation in CA, whereas Sigma-IgE explained only 6% (R(2) = 0.06). Combining the two increased the explanatory capacity to R(2) = 0.30. Gender interacted significantly with Sigma-IgE; whereas Severity score predicted CA in both genders, the predictive capacity of Sigma-IgE for CA at 10 years was significant in boys only.

CONCLUSION

Combining Sigma-IgE to inhalant allergens and Severity score at 2 years was superior to predict asthma at 10 years than either alone. Severity score predicted CA in both genders, whereas Sigma-IgE significantly predicted CA in boys only.

Lung function development in the first 2 yr of life is independent of allergic diseases by 2 yr

The aim of the study was to assess if lung function at birth predicts lung function at 2 yr and secondly, if lung function development was influenced by the common phenotypes of recurrent bronchial obstruction (rBO) or atopic eczema (AE) by 2 yr. Lung function was assessed at birth (n = 802) and at 2 yr within the prospective birth cohort study 'the Environment and Childhood Asthma Study' in Oslo. The 135 children with lung function measured at birth by tidal flow volume (TFV) loops and passive respiratory mechanics, who were included in a nested case-control study were reinvestigated at 2 yr with clinical examination, TFV loops (n = 90) (mean age 26.6 (3.7 s.d.) months), skin prick test and parental interview. Children were categorized into quartiles (lower, middle two, upper) according to time to peak tidal expiratory flow/total expiratory time (t(PTEF)/t(E)) at birth as well as clinical phenotype based on the presence of rBO and/or AE (ever) by 2 yr. The observed reduction in mean t(PTEF)/t(E) from birth to 2 yr within the quartiles, were not significantly different after controlling for 'regression to the mean'. t(PTEF)/t(E) at birth correlated significantly with t(PTEF)/t(E) at 2 yr, (r = 0.475, p < 0.001). Children with both rBO and AE by 2 yr had significantly lower t(PTEF)/t(E) at 2 yr (p = 0.002) and at birth (p = 0.027), compared with children with no rBO or AE. Clinical phenotype at 2 yr did not influence the change in t(PTEF)/t(E) from birth to 2 yr. This study demonstrates a clear tracking of lung function from birth, not influenced by rBO or AE by 2 yr.

No evidence that early use of inhaled corticosteroids reduces current asthma at 10 years of age

BACKGROUND

It is debated whether early treatment with inhaled corticosteroids (ICS) can change the natural course of childhood asthma.

AIM

To assess if ICS treatment before 2 years of age in children with obstructive airways disease reduces current asthma at 10 years of age.

METHODS

Children with (n=233) and without (n=219) recurrent (r) bronchial obstruction (BO) attending clinical examination at 2 years of age in the birth cohort Environment and Childhood Asthma study in Oslo, were reinvestigated at 10 years of age. Current asthma (CA) at 10 years was defined as asthma with either symptoms and/or asthma treatment during the last year, and/or 10% fall in forced expired volume in 1s after standardized treadmill run. The risk of CA was assessed by logistic regression and propensity modelling (including gender, parental atopy and severity score at 2 years) in children with rBO who received ICS or not by 2 years.

RESULTS

CA was found in 97 children, more often among rBO children with (56.9%) and without ICS treatment (30.8%) compared to no-BO children (5.5%) (p<0.001). In rBO children logistic regression analyses (adjusted odds ratio aOR (95% confidence interval)) identified male gender (aOR 1.82 (1.01-3.27), p=0.046) and severity score at 2 years 1.14 (1.03-1.28), (p=0.01), as significant and ICS treatment as non-significant 2.00 (0.98-4.12) risk factors for CA. With propensity modelling adjusting for disease severity, ICS treatment by 2 years caused a non-significant increased risk aOR of CA of 1.84 (0.89-3.82).

CONCLUSION

No evidence was found that early use of ICS before age two in children with rBO reduces current asthma 8 years later.

Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children

Early intervention with inhaled corticosteroid (ICS) treatment for lung function development in childhood is debated. In view of lung function at birth, we aimed to assess if early use of ICS influenced lung function at 10 yrs of age. A 10-yr follow-up study of 614/802 children (mean age 10.9 +/- 0.9 yrs) with lung function measurements at birth in the Environment and Childhood Asthma study in Oslo included information on ICS treatment (124 with history of asthma) obtained at 2 and 10 yrs by parental interviews. Main outcomes at 10 yrs were the best values (% predicted and Z-scores) of forced expiratory volume in 1 s (FEV(1)) and mid-expiratory flow. The main explanatory factors were never, past or current use of ICS and Z-scores of the tidal flow-volume ratio t(PTEF)/t(E) [time to peak expiratory flow (t(PTEF)) and total expiratory time (t(E))] at birth. ICS treatment, reported by 11.9% of children in the population sample and 71.6% with current asthma, did not significantly influence lung function from birth to 10 yrs. The best values (and Z-scores) of FEV(1), and mid-expiratory flow were similar (p > 0.1) in subjects receiving ICS during and after 0-3 yrs of age, after 3 yrs only or currently compared with steroid naïve children. Almost half of the change in lung function 0-10 yrs was explained by gender, a history of asthma and t(PTEF)/t(E) at birth. ICS treatment for asthma, reported in every eighth child by age 10 yrs, did not significantly improve lung function from birth to 10 yrs.

Inhaled corticosteroids in children: use and effects of early treatment on asthma and lung function. Prevalence of asthma and the impact of severity in early life on later asthma in childhood

INTRODUCTION

The role of inhaled corticosteroids (ICS) on disease progression in asthmatic children is not yet clear.

AIMS

This study was conducted (i) to determine how often ICS were used for treatment of obstructive airways disease (OAD) in early childhood; (ii) to assess if ICS treatment had an effect on lung function in young children with recurrent bronchial obstruction (rBO); (iii) to explore if early ICS treatment in children with OAD during the first 2 years of life can modify occurrence of current asthma in school children; (iv) to define a severity score for severity of OAD during the first 2 years of life and assess if the severity score can be used to predict asthma in school children; and (v) to investigate the prevalence of asthma in children in an urban population.

SUBJECTS AND METHODS

The present study is part of a 10-year follow-up of children in the prospective birth cohort (n = 3754), the Environment and Childhood Asthma study in Oslo. For aim 1, all children from the entire cohort who had completed follow-up questionnaires as well as all children defined with rBO were assessed. For aim 2, 54 children with rBO (with and without ICS treatment) and 15 controls with tidal flow volume measurements upon presentation of the disease and 2 years of age were studied. For aims 3 and 4, 459 subjects (with and without rBO at 2 years of age) from the case control study who attended 10-year follow-up were studied. For aim 5, the 616 of 803 subjects who had lung function measurements performed after birth were reinvestigated at the age of 10 years.

RESULTS

A total of 2.1% of all the children in the cohort and 21% of children with rBO had received ICS treatment by 2 years of age. The mean difference of change in baseline tidal breathing (the ratio of time to peak expiratory flow to total expiratory time) was significantly higher in the ICS-treated group only by 2 years of age and correlated significantly with duration of ICS treatment. However, in rBO children, the use of ICS treatment before 2 years of age was not associated with reduced risk of current asthma at 10 years of age. The risk (odds ratio, 95% confidence interval) of current asthma among rBO subjects with a severity score above five was 20.2, 9.9-41.3 compared to controls. In 10-year-old children, the lifetime prevalence of asthma was 20.2%.

CONCLUSIONS

One-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids by age 2 years. Lung function appeared to improve in children using ICS from the start of symptoms of OAD until 2 years of age, mostly in children with the longest duration of treatment. However, use of ICS during the first 2 years of life in children with OAD did not reduce asthma present 8 years later. A scoring system based on severity and frequency of OAD during the first 2 years of life predicted current asthma at 10 years of age. One in five 10-year-old children in the city of Oslo at some time had asthma.

Physical activity and vitamin D in children: a review of impacts on bone health and fitness

OBJECTIVES

This review explores the relationship between physical activity and serum 25-hydroxyvitamin D (25(OH)D) levels in children and adolescents, highlighting the importance of vitamin D for bone health and muscle function.

CONTENT

A narrative mini review was conducted by searching PubMed, Google Scholar, and Scopus for studies published from January 2000 to April 2024, focusing on children aged 5-18 years. Ten studies were reviewed, including five cross-sectional, three population-based, one longitudinal, and one randomized controlled trial. Overall, physically active children and teens were more likely to maintain sufficient 25(OH)D levels and demonstrated better physical fitness, especially in muscle strength, compared to their less active peers. One study linked higher vitamin D levels to increased bone mineral content in active adolescents, while another reported a positive connection between vitamin D and bone density. Risk factors for deficiency included limited sun exposure, low physical activity, sedentary behavior, and obesity, with the latter group being more prone to low vitamin D levels, which were negatively associated with fat mass. Interventions that increased physical activity were found to improve vitamin D levels.

SUMMARY AND OUTLOOK

Regular physical activity, especially outdoor exercise, is associated with healthier vitamin D levels in children, supporting better bone health and physical fitness.

Vitamin D supplements reduce risk of viral upper respiratory infections in children with lower concentrations

AIM

Vitamin D is crucial for the immune system, as it enhances pathogen-fighting cells and reduces inflammation. We reviewed serum 25-hydroxyvitamin D (25(OH)D) concentrations in children with viral upper respiratory tract infections (URTIs) and the impact of vitamin D supplements on those infections.

METHODS

A mini literature review was conducted from 1 January 2000 to 30 April 2024. It used PubMed, Google Scholar, Cochrane and Scopus and focused on children aged 0-18 years.

RESULTS

The review comprised 12 studies: seven randomised controlled trials, two prospective studies, two case-control studies and one cross-sectional study. The findings included lower 25(OH)D concentrations in children more susceptible to URTIs and significantly lower levels in those with recurrent infections. One study found reduced 25(OH)D concentrations and immunoglobulin G levels in children with URTIs. Of the nine studies that examined vitamin D supplements, five reported benefits for children with URTIs, one only showed short-term effects and three found no significant reductions. Two reported that taking 2000 IU a day did not reduce URTIs any more than 400 IU and high-dose supplements may be unnecessary.

CONCLUSION

Children with viral URTIs often had lower vitamin D concentrations and supplements frequently helped to reduce the risk of these infections.

Vitamin D intake and status in children and adolescents: Comparing vegetarian, vegan, and omnivorous diets

AIM

This study aimed to evaluate papers analysing dietary intake, 25-hydroxyvitamin D (25(OH)D) concentrations and anthropometry in children on vegetarian, vegan and omnivorous diets, as research indicates all diets generally fall below recommended vitamin D intake.

METHODS

This mini review examined the vitamin D status of children aged 1-18 years by systematically searching PubMed, Google Scholar and Scopus databases from January 1, 2000, to December 31, 2023.

RESULTS

The review included nine studies published between 2000 and 2023. Four studies reported lower vitamin D intake in children on vegetarian and vegan diets compared to omnivores. Three studies reported lower 25(OH)D concentrations in children on vegetarian and vegan diets. Specifically, one study found lower concentrations in vegans compared to omnivores, another found lower concentrations in vegetarians and vegans not taking supplements and a third reported lower 25(OH)D concentrations in Asian children aged 3-4.5 years compared to Caucasian children. Three studies found no significant differences in 25(OH)D between diet groups. Three studies assessing anthropometry showed that vegetarians have similar body weight and height as omnivores.

CONCLUSION

Children across all dietary groups may have low vitamin D intakes; supplementation should be considered for those with inadequate sun exposure, especially those avoiding animal products.

Vitamin D concentrations were often insufficient among native Norwegian adolescents and children with a non-Western immigrant background

AIM

The aim of this study was to review papers that assessed the vitamin D intake of children living in Norway, as research has suggested that it has remained below the recommended daily allowance of 10 μg/day.

METHODS

This mini review examined the vitamin D status of Norwegian children aged 0-18 years by systematically searching the PubMed, Google Scholar and Scopus databases from 1 January 2009 to 1 July 2020.

RESULTS

The review comprised six studies published in English between 2009 and 2020 on native-born and non-Western immigrant children. Most studies defined satisfactory vitamin D status as a plasma 25-hydroxyvitamin D (25(OH)D) concentration of 50 nmol/L, with 25-50 nmol/L being classified as insufficient and below 25 nmol/L being classified as deficient. A study of healthy children found that 21% had insufficient levels and a further 1% were deficient, but this second finding was only among adolescents. Other studies showed that 47% of Norwegian children with a non-Western immigrant background were deficient, and so were 19% of overweight children, mainly adolescents.

CONCLUSION

Vitamin D concentrations were often insufficient among children living in Norway, particularly adolescents and those with a non-Western immigrant background. Higher recommended supplements may be needed.