1
|
Korang SK, Baker M, Feinberg J, Newth CJ, Khemani RG, Jakobsen JC. Non-invasive positive pressure ventilation for acute asthma in children. Cochrane Database Syst Rev 2024; 10:CD012067. [PMID: 39356050 PMCID: PMC11445801 DOI: 10.1002/14651858.cd012067.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2024]
Abstract
BACKGROUND Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review. OBJECTIVES To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication. SELECTION CRITERIA We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence. AUTHORS' CONCLUSIONS The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.
Collapse
Affiliation(s)
- Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Anesthesiology Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, California, USA
| | | | - Joshua Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christopher Jl Newth
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Robinder G Khemani
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Janus C Jakobsen
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Hospital, Holbaek, Denmark
| |
Collapse
|
2
|
Ahn KM, Yang MS, Won HK, Lim JA. Pilot study: Unveiling the impact of bisphenol A and phthalate exposure on women with asthma. Medicine (Baltimore) 2024; 103:e39840. [PMID: 39331870 PMCID: PMC11441913 DOI: 10.1097/md.0000000000039840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
Endocrine disruptors are considered estrogenic disruptors, and recent researches suggested that they may have a link to the severity of asthma. We aim to validate the correlation between endocrine disruptors and various clinical measurements of asthma, depending on the menopausal status. A pilot case-control study was performed in female asthmatic patients who visited allergy clinic in SMG-SNU Boramae Medical Center. Medical information and the urinary concentrations of 4 endocrine disruptors on their first visit were collected and analyzed: bisphenol A, mono (2-ethyl-5-hydroxyhexyl) phthalate, mono (2-ethyl-5-oxohexyl) phthalate, and mono-n-butyl phthalate. A total of 35 female participants enrolled in the study, including 20 asthmatic patients and 15 healthy controls. The average concentrations of urinary endocrine disruptors in patient and control group did not demonstrate significant differences. Twenty asthmatic patients were divided into 2 groups according to their menstrual state. Using the Spearman rank correlation test in premenopausal asthmatic patients (n = 7), we found negative correlations between urinary concentration of mono-n-butyl phthalate and asthma control test score, as well as postbronchodilator forced expiratory flow at 25% to 75% of forced vital capacity (P-value = .007 and .04, respectively). In contrast, it did not show any correlation with asthma control test or postbronchodilator forced expiratory flow at 25% to 75% of forced vital capacity (P-value = 1.00 and .74, respectively) in postmenopausal group (n = 13). Endocrine disruptors might have an impact on the decline of small airway function and asthma management among premenopausal, but not postmenopausal, female asthmatic patients.
Collapse
Affiliation(s)
- Kyung-Min Ahn
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min-Suk Yang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Jung Ah Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Medical Center, Seoul, Korea
| |
Collapse
|
3
|
Shacham E, Scroggins SE, Gilmore A, Cheng J, Nava R. Predictors of Pediatric Asthma Management: Identifying Actionable Results With Geographic Determinants. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00355. [PMID: 39259970 DOI: 10.1097/phh.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
BACKGROUND Pediatric asthma remains one of the most prominent chronic health conditions among US youth. Geographic determinants such as air pollutants have been identified as playing a role in asthma development and exacerbation. The purpose of this study was to determine geospatial predictors of pediatric asthma exacerbation events and to prioritize housing remediation resources. METHODS Electronic medical records were abstracted from a health plan in Southern California. The inclusion criteria that created a sample of 51 557 members were those aged 21 years and younger, who had at least 1 asthma-related encounter between January 2019 and December 2021. Diagnoses, age, number of clinic and emergency department visits, and home addresses were included. The air quality index from the closest monitoring station during the study period, residential distance from a primary roadway, and residential distance from manufacturing sites were included in the spatial analysis. RESULTS The average number of asthma-related clinic visits was 2 across the sample. Individuals with more asthma-related clinic visits residing in public housing were more likely to live within 4 km of industrial manufacturing locations (P < .001), reside closer to a major roadway (P < .001), and experience a higher number of poor air quality days (P < .001). Modeling results show these factors were also significantly predictive of an increase of asthma-related health care encounters. CONCLUSIONS The findings of this study were consistent with previous studies linking asthma and poor air quality and further highlighted some of the additive and potentially exponential challenges that public housing, major roadways, and manufacturing sites provide communities in their proximity. This research can guide environmental interventions, including the frequency of public housing inspections, community outreach, and the development of communication strategies, to reduce asthma-related experiences across neighborhoods.
Collapse
Affiliation(s)
- Enbal Shacham
- Author Affiliations: Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri (Drs Shacham and Scroggins and Mr Gilmore); and Inland Empire Health Plan Rancho Cucamonga, California (Mss Cheng and Nava)
| | | | | | | | | |
Collapse
|
4
|
Kaviany P, Shah A. Current Practices in Pediatric Asthma Care. Clin Chest Med 2024; 45:611-623. [PMID: 39069325 DOI: 10.1016/j.ccm.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
This article is a comprehensive review of the latest knowledge and developments on pediatric asthma. It serves as a guide for general practitioners and subspecialists who treat asthma. The pathophysiology and critical features of asthma that should be addressed and the latest therapies available are discussed. The areas where further investigation is needed are also highlighted.
Collapse
Affiliation(s)
- Parisa Kaviany
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Avani Shah
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 155 East Superior Street, Box #48, Chicago, IL 60611, USA.
| |
Collapse
|
5
|
Rogerson C, AbuSultaneh S, Sanchez-Pinto LN, Gaston B, Wiehe S, Schleyer T, Tu W, Mendonca E. A matched analysis of the use of high flow nasal cannula for pediatric severe acute asthma. Pediatr Pulmonol 2024. [PMID: 39212235 DOI: 10.1002/ppul.27233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
RATIONALE The high-flow nasal cannula (HFNC) device is commonly used to treat pediatric severe acute asthma. However, there is little evidence regarding its effectiveness in real-world practice. OBJECTIVES We sought to compare the physiologic effects and clinical outcomes for children treated for severe acute asthma with HFNC versus matched controls. METHODS This was a single-center retrospective matched cohort study at a quaternary care children's hospital. Children ages 2-18 hospitalized for severe acute asthma from 2015 to 2022 were included. Encounters receiving treatment with HFNC within the first 24 h of hospitalization were included as cases. Controls were primarily treated with oxygen facemask. Logistic regression 1:1 propensity score matching was done using demographics, initial vital signs, and medications. The primary outcome was an improvement in clinical asthma symptoms in the first 24 h of hospitalization measured as percent change from initial. MEASUREMENTS AND MAIN RESULTS Of 693 eligible cases, 443 were matched to eligible controls. Propensity scores were closely aligned between the cohorts, with the only significant difference in clinical characteristics being a higher percentage of patients of Black race in the control group (54.3% vs. 46.6%; p = 0.02). Compared to the matched controls, the HFNC cohort had smaller improvements in heart rate (-11.5% [-20.9; -0.9] vs. -14.7% [-22.6;-5.7]; p < 0.01), respiratory rate (-14.3% [-27.9;5.4] vs. -16.7% [-31.5;0.0]; p = 0.03), and pediatric asthma severity score (-14.3% [-28.6;0.0] vs. -20.0% [-33.3;0.0]; p < 0.01) after 24 h of hospitalization. The HFNC cohort also had longer pediatric intensive care unit (PICU) length of stay (LOS) (1.5 days [1.1;2.1] vs. 1.2 days [0.9;1.8]; p < 0.01) and hospital LOS (2.8 days [2.1;3.8] vs. 2.5 days [1.9;3.4]; p < 0.01). When subgrouping to younger patients (2-3 years old), or those with the highest severity scores (PASS > 9), those treated with HFNC had no difference in clinical symptom improvements but maintained a longer PICU LOS. CONCLUSIONS Encounters using HFNC for severe acute pediatric asthma had decreased clinical improvement in 24 h of hospitalization compared to matched controls and increased LOS. Specific subgroups of younger patients and those with the highest severity scores showed no differences in clinical symptom improvement suggesting differential effects in specific patient populations.
Collapse
Affiliation(s)
- Colin Rogerson
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
- Regenstrief Institute Center for Biomedical Informatics, Indiana, USA
| | - Samer AbuSultaneh
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
| | - L Nelson Sanchez-Pinto
- Anne & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Illinois, USA
| | - Benjamin Gaston
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
| | - Sarah Wiehe
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
- Regenstrief Institute Center for Health Services Research, Indiana, USA
| | - Titus Schleyer
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
- Regenstrief Institute Center for Biomedical Informatics, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University, Indiana, USA
| | - Eneida Mendonca
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Indiana, USA
- Department of Pediatrics, Division of Critical Care, Cincinnati Children's Hospital and Medical Center, Ohio, USA
| |
Collapse
|
6
|
Basnet S, Wroblewski K, Hansen E, Perez E, Lyu R, Abid Z, Roach A, Latham C, Salibi N, Battle B, Giles L. Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation. J Community Health 2024; 49:682-692. [PMID: 38388809 PMCID: PMC11306379 DOI: 10.1007/s10900-024-01331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2-18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.
Collapse
Affiliation(s)
- Sweta Basnet
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Elizabeth Hansen
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ernestina Perez
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ruobing Lyu
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Zain Abid
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Alexis Roach
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Catina Latham
- Harris School of Public Policy, The University of Chicago, Chicago, IL, USA
| | - Nadia Salibi
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Brenda Battle
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| | - Louise Giles
- Department of Pediatric Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Joseph A, Ganatra H. Status Asthmaticus in the Pediatric ICU: A Comprehensive Review of Management and Challenges. Pediatr Rep 2024; 16:644-656. [PMID: 39189288 PMCID: PMC11348376 DOI: 10.3390/pediatric16030054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024] Open
Abstract
This narrative review addresses the significant burden of pediatric status asthmaticus, which comprises almost 20% of admissions to pediatric intensive care units (PICUs). It highlights the diverse modalities employed in the PICU for managing this life-threatening condition, and thoroughly discusses the literature in support of or against these treatment modalities.
Collapse
Affiliation(s)
| | - Hammad Ganatra
- Pediatric Critical Care Medicine, Pediatric Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA;
| |
Collapse
|
8
|
Wang N, Nurmagambetov T. Sociodemographic Factors of Asthma Prevalence and Costs Among Children and Adolescents in the United States, 2016-2021. Prev Chronic Dis 2024; 21:E54. [PMID: 39052508 PMCID: PMC11318947 DOI: 10.5888/pcd21.230449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Introduction Asthma is a chronic condition with a high prevalence and cost of care among children and adolescents. While previous research described the association of sociodemographic factors with childhood asthma prevalence, there is limited knowledge of these factors' association with medical expenditures. In this study, we examined disparities in treated asthma prevalence and medical expenditures among US children and adolescents. Methods Using nationally representative data from the 2016-2021 Medical Expenditures Panel Survey, we conducted a cross-sectional study of 2,365 children and adolescents (aged 0-17 y) with treated asthma compared with 40,497 children and adolescents without treated asthma. Treated asthma was defined as whether the child or adolescent had a medical event (emergency department visit, hospital inpatient stay, hospital outpatient visit, office-based medical visit, home health, and/or prescribed medicines) due to asthma. We controlled for sociodemographic factors of race and ethnicity, age, sex, health insurance coverage, family poverty status, and census region. We used 2-part models and generalized linear models to estimate annual per-person incremental medical expenditures associated with asthma. Results Children and adolescents with treated asthma were more likely than those without treated asthma to be non-Hispanic Black or Hispanic, male, and publicly insured. Children and adolescents with treated asthma had $3,362.56 in additional annual medical expenditures, of which $174.06 was out-of-pocket, compared with children and adolescents without treated asthma. The additional expenditures included $955.96 for prescribed medicines, $151.52 for emergency department visits, and $858.17 for office-based medical visits. Non-Hispanic Black children with treated asthma had significantly lower total ($2,721.28) and office-based visit expenditures ($803.19) than non-Hispanic White children with treated asthma. Conclusion Disparities among children and adolescents in the US persist in treated asthma prevalence and associated medical expenditures by sociodemographic factors.
Collapse
Affiliation(s)
- Nianyang Wang
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Health Science and Practice, Asthma and Air Quality Branch, 4770 Buford Hwy, S106-6, Atlanta, GA 30341
| | - Tursynbek Nurmagambetov
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Health Science and Practice, Asthma and Air Quality Branch, Atlanta, Georgia
| |
Collapse
|
9
|
Fitzpatrick AM, Grunwell JR, Gaur H, Kobara S, Kamaleswaran R. Plasma metabolomics identifies differing endotypes of recurrent wheezing in preschool children differentiated by symptoms and social disadvantage. Sci Rep 2024; 14:15813. [PMID: 38982241 PMCID: PMC11233605 DOI: 10.1038/s41598-024-66878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
Preschool children with recurrent wheezing are a heterogeneous population with many underlying biological pathways that contribute to clinical presentations. Although the morbidity of recurrent wheezing in preschool children is significant, biological studies in this population remain quite limited. To address this gap, this study performed untargeted plasma metabolomic analyses in 68 preschool children with recurrent wheezing to identify metabolomic endotypes of wheezing. K-means cluster analysis was performed on metabolomic dataset including a total of 1382 named and unnamed metabolites. We identified three metabolomic clusters which differed in symptom severity, exacerbation occurrence, and variables associated with social disadvantage. Metabolites that distinguished the clusters included those involved in fatty acid metabolism, fatty acids (long chain monounsaturated fatty acids, long chain polyunsaturated fatty acids, and long chain saturated fatty acids), lysophospholipids, phosphatidylcholines, and phosphatidylethanolamines. Pathway analyses identified pathways of interest in each cluster, including steroid metabolism, histidine metabolism, sphingomyelins, and sphingosines, among others. This study highlights the biologic complexity of recurrent wheezing in preschool children and offers novel metabolites and pathways that may be amenable to future study and intervention.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia.
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hina Gaur
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | | |
Collapse
|
10
|
Skeen EH, Moore CM, Federico MJ, Seibold MA, Liu AH, Hamlington KL. The Child Opportunity Index 2.0 and exacerbation-prone asthma in a cohort of urban children. Pediatr Pulmonol 2024; 59:1894-1904. [PMID: 38558492 DOI: 10.1002/ppul.26998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
RATIONALE Social determinants of health underlie disparities in asthma. However, the effects of individual determinants likely interact, so a summary metric may better capture their impact. The Child Opportunity Index 2.0 (COI) is one such tool, yet its association with exacerbation-prone (EP) asthma is unknown. OBJECTIVE To investigate the association between the COI and EP asthma and clinical measures of asthma severity in children. METHODS We analyzed data from two prospective observational pediatric asthma cohorts (n = 193). Children were classified as EP (≥1 exacerbation in the past 12 months) or exacerbation-null (no exacerbations in the past 5 years). Spirometry, exhaled nitric oxide, IgE, and Composite Asthma Severity Index (CASI) were obtained. The association between COI and EP status was assessed with logistic regression. We fit linear and logistic regression models to test the association between COI and each clinical measure. RESULTS A 20-point COI decrease conferred 40% higher odds of EP asthma (OR 1.4; 95%CI 1.1-1.76). The effect was similar when adjusted for age and sex (OR 1.38, 95%CI 1.1-1.75) but was attenuated with additional adjustment for race and ethnicity (OR 1.19, 95%CI 0.92-1.54). A similar effect was seen for the Social/Economic and Education COI domains but not the Health/Environment Domain. A 20-point COI decrease was associated with an increase in CASI of 0.34. COI was not associated with other clinical measures. CONCLUSIONS Lower COI was associated with greater odds of EP asthma. This highlights the potential use of the COI to understand neighborhood-level risk and identify community targets to reduce asthma disparities.
Collapse
Affiliation(s)
- Emily H Skeen
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Monica J Federico
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katharine L Hamlington
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
11
|
Nkoy FL, Stone BL, Deering-Rice CE, Zhu A, Lamb JG, Rower JE, Reilly CA. Impact of CYP3A5 Polymorphisms on Pediatric Asthma Outcomes. Int J Mol Sci 2024; 25:6548. [PMID: 38928254 PMCID: PMC11203737 DOI: 10.3390/ijms25126548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Genetic variation among inhaled corticosteroid (ICS)-metabolizing enzymes may affect asthma control, but evidence is limited. This study tested the hypothesis that single-nucleotide polymorphisms (SNPs) in Cytochrome P450 3A5 (CYP3A5) would affect asthma outcomes. Patients aged 2-18 years with persistent asthma were recruited to use the electronic AsthmaTracker (e-AT), a self-monitoring tool that records weekly asthma control, medication use, and asthma outcomes. A subset of patients provided saliva samples for SNP analysis and participated in a pharmacokinetic study. Multivariable regression analysis adjusted for age, sex, race, and ethnicity was used to evaluate the impact of CYP3A5 SNPs on asthma outcomes, including asthma control (measured using the asthma symptom tracker, a modified version of the asthma control test or ACT), exacerbations, and hospital admissions. Plasma corticosteroid and cortisol concentrations post-ICS dosing were also assayed using liquid chromatography-tandem mass spectrometry. Of the 751 patients using the e-AT, 166 (22.1%) provided saliva samples and 16 completed the PK study. The e-AT cohort was 65.1% male, and 89.6% White, 6.0% Native Hawaiian, 1.2% Black, 1.2% Native American, 1.8% of unknown race, and 15.7% Hispanic/Latino; the median age was 8.35 (IQR: 5.51-11.3) years. CYP3A5*3/*3 frequency was 75.8% in White subjects, 50% in Native Hawaiians and 76.9% in Hispanic/Latino subjects. Compared with CYP3A5*3/*3, the CYP3A5*1/*x genotype was associated with reduced weekly asthma control (OR: 0.98; 95% CI: 0.97-0.98; p < 0.001), increased exacerbations (OR: 6.43; 95% CI: 4.56-9.07; p < 0.001), and increased asthma hospitalizations (OR: 1.66; 95% CI: 1.43-1.93; p < 0.001); analysis of 3/*3, *1/*1 and *1/*3 separately showed an allelic copy effect. Finally, PK analysis post-ICS dosing suggested muted changes in cortisol concentrations for patients with the CYP3A5*3/*3 genotype, as opposed to an effect on ICS PK. Detection of CYP3A5*3/3, CYPA35*1/*3, and CYP3A5*1/*1 could impact inhaled steroid treatment strategies for asthma in the future.
Collapse
Affiliation(s)
- Flory L. Nkoy
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - Cassandra E. Deering-Rice
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Angela Zhu
- Department of Pediatrics, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA; (F.L.N.); (B.L.S.); (A.Z.)
| | - John G. Lamb
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Joseph E. Rower
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| | - Christopher A. Reilly
- Department of Pharmacology and Toxicology, Center for Human Toxicology, University of Utah, 30 S 2000 E, Room 201 Skaggs Hall, Salt Lake City, UT 84112, USA; (C.E.D.-R.); (J.G.L.); (J.E.R.)
| |
Collapse
|
12
|
Stransky ML, Bremer-Kamens M, Kistin CJ, Sheldrick RC, Cohen RT. Using Electronic Health Records to Identify Asthma-Related Acute Care Encounters. Acad Pediatr 2024:S1876-2859(24)00158-X. [PMID: 38761891 DOI: 10.1016/j.acap.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Leveraging "big data" to improve care requires that clinical concepts be operationalized using available data. Electronic health record (EHR) data can be used to evaluate asthma care, but relying solely on diagnosis codes may misclassify asthma-related encounters. We created streamlined, feasible and transparent prototype algorithms for EHR data to classify emergency department (ED) encounters and hospitalizations as "asthma-related." METHODS As part of an asthma program evaluation, expert clinicians conducted a multi-phase iterative chart review to evaluate 467 pediatric ED encounters and 136 hospitalizations with asthma diagnosis codes from calendar years 2017 and 2019, rating the likelihood that each encounter was actually asthma-related. Using this as a reference standard, we developed rule-based algorithms for EHR data to classify visits. Accuracy was evaluated using sensitivity, specificity, and positive and negative predictive values (PPV, NPV). RESULTS Clinicians categorized 38% of ED encounters as "definitely" or "probably" asthma-related; 13% as "possibly" asthma-related; and 49% as "probably not" or "definitely not" related to asthma. Based on this reference standard, we created two rule-based algorithms to identify "definitely" or "probably" asthma-related encounters, one using text and non-text EHR fields and another using non-text fields only. Sensitivity, specificity, PPV, and NPV were >95% for the algorithm using text and non-text fields and >87% for the algorithm using only non-text fields compared to the reference standard. We created a two-rule algorithm to identify asthma-related hospitalizations using only non-text fields. CONCLUSIONS Diagnostic codes alone are insufficient to identify asthma-related visits, but EHR-based prototype algorithms that include additional methods of identification can predict clinician-identified visits with sufficient accuracy.
Collapse
Affiliation(s)
- Michelle L Stransky
- Center for the Urban Child and Healthy Family (ML Stransky and M Bremer-Kamens), Boston Medical Center, Boston, Mass; Department of Pediatrics (ML Stransky, RT Cohen), Boston University Chobanian and Avedisian School of Medicine, Boston, Mass.
| | - Miriam Bremer-Kamens
- Center for the Urban Child and Healthy Family (ML Stransky and M Bremer-Kamens), Boston Medical Center, Boston, Mass
| | - Caroline J Kistin
- Hassenfeld Child Health Innovation Institute (CJ Kistin), Brown University, Providence, RI; Department of Health Services (CJ Kistin), Policy and Practice, Brown University, Providence, RI
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School (RC Sheldrick), Worcester, Mass
| | - Robyn T Cohen
- Department of Pediatrics (ML Stransky, RT Cohen), Boston University Chobanian and Avedisian School of Medicine, Boston, Mass; Division of Pediatric Pulmonary and Allergy (RT Cohen), Boston Medical Center, Boston, MA
| |
Collapse
|
13
|
Chevalier A, Kennedy K, Clegg D, White BR. Noninvasive Respiratory Support in Pediatric Critical Asthma: What to Start and Where to Go? Respir Care 2024; 69:629-631. [PMID: 38649273 PMCID: PMC11147621 DOI: 10.4187/respcare.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Andrew Chevalier
- Division of Pediatric Critical CareDepartment of PediatricsUniversity of UtahSalt Lake City, Utah
| | - Kenzie Kennedy
- Division of Respiratory Care ServicesPrimary Children's HospitalSalt Lake City, Utah
| | - David Clegg
- Division of Respiratory Care ServicesPrimary Children's HospitalSalt Lake City, Utah
| | - Benjamin R White
- Division of Pediatric Critical CareDepartment of PediatricsUniversity of UtahSalt Lake City, Utah
| |
Collapse
|
14
|
Adebiyi E, Munoz Pareja JC, Alba-Sandoval M, Almodovar M. Impact of congenital heart disease on mortality and other associated outcomes in children hospitalised for acute asthma exacerbation. Cardiol Young 2024; 34:884-890. [PMID: 37946520 DOI: 10.1017/s1047951123003803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Acute asthma exacerbation is one of the most common reasons for paediatric emergency room visits and hospital admissions in the United States of America. OBJECTIVE To assess the impact of CHD on outcomes of children hospitalised for acute asthma exacerbation. METHODS Children primarily admitted for acute asthma exacerbation were sampled from 2006, 2009, 2012, and 2016 kid inpatient database of the Healthcare Cost and Utilization Project using ICD codes. The disease outcomes were compared between those with and without CHD using multivariate logistic regressions in Stata version 17. RESULTS There were a total of 639,280 acute asthma exacerbation admissions, of which 5,907 (0.92%) had CHD. The mortality rate was 0.079% for patients without CHD and 0.72% for those with co-existing CHD. Children with CHD had higher odds of mortality (5.51, CI 3.40-8.93, p < 0.001), acute respiratory failure (2.84, CI 2.53-3.20; p < 0.001), need for invasive mechanical ventilation (4.58, CI 3.80-5.52; p < 0.001), acute kidney injury (adjusted odds ratio 3.03, CI 3.03-7.44; p < 0.001), and in-hospital cardiac arrest (adjusted odds ratio 4.52, CI 2.49-8.19; p < 0.001) when compared with those without CHD. The adjusted mean length of hospital stays (CI 2.91-3.91; p < 0.001) and hospital charges (95% CI $31060-$47747) among children with acute asthma exacerbation and CHD were significantly higher than in those without CHD. CONCLUSION AND SIGNIFICANCE CHD is an independent predictor of mortality, more severe disease course, and higher hospital resource utilisation. Strategies that improve CHD care will likely improve the overall health outcomes of children with CHD hospitalised for acute asthma exacerbation.
Collapse
Affiliation(s)
- Ebenezer Adebiyi
- Pediatric Cardiology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Monica Alba-Sandoval
- Department of Pediatric Critical Care Medicine, University of Miami/Jackson Health System, Miami, FL, USA
| | - Melvin Almodovar
- Department of Pediatric Cardiology, University of Miami/Jackson Health System, Miami, FL, USA
| |
Collapse
|
15
|
Rashid MM, Ahmed S, Owens L, Hu N, Jaffe A, Homaira N. Asthma-community acquired pneumonia co-diagnosis in children: a scoping review. J Asthma 2024; 61:282-291. [PMID: 37943507 DOI: 10.1080/02770903.2023.2280843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This scoping review investigated the existing literature and identified the evidence gaps related to diagnosis and management in children aged 2-18 years presenting to hospitals with a co-diagnosis of asthma and community-acquired pneumonia. DATA SOURCES We designed a scoping review following Arksey and O'Malley's scoping review framework and PRISMA extension for a scoping review. We searched literature using five electronic databases: PubMed, CINAHL, Scopus, Web of Science, and Embase from 2003 to June 2023. RESULTS A total of 1599 abstracts with titles were screened and 12 abstracts were selected for full review. Separate guidelines including Modified Global Initiative for Asthma (GINA) guidelines; modified Integrated Management of Childhood Illness (IMCI) guidelines; and a consensus guideline developed by the Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) were used for diagnosing asthma and CAP individually. Chest X-rays were used in 83.3% (10/12) of studies to establish the co-diagnosis of asthma-CAP in children. Variations were observed in using different laboratory investigations across the studies. Infectious etiologies were detected in five (41.7%) studies. In 75% (9/12) of studies, children with asthma-CAP co-diagnosis were treated with antimicrobials, however, bacterial etiology was not reported in 44.4% (4/9) of the studies. CONCLUSIONS Our scoping review suggests that chest X-rays are commonly used to establish the co-diagnosis of asthma-CAP and antibiotics are often used without laboratory confirmation of a bacterial etiology. Clinical practice guidelines for the management of asthma and pneumonia in children who present with co-diagnosis may standardize clinical care and reduce variation.
Collapse
Affiliation(s)
- Md Mahbubur Rashid
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Shamim Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Louisa Owens
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
| | - Nan Hu
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Adam Jaffe
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
| | - Nusrat Homaira
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
16
|
Rogerson CM, White BR, Smith M, Hogan AH, Abu-Sultaneh S, Carroll CL, Shein SL. Institutional Variability in Respiratory Support Use for Pediatric Critical Asthma: A Multicenter Retrospective Study. Ann Am Thorac Soc 2024; 21:612-619. [PMID: 38241011 PMCID: PMC10995549 DOI: 10.1513/annalsats.202309-807oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
Rationale: Over 20,000 children are hospitalized in the United States for asthma every year. Although initial treatment guidelines are well established, there is a lack of high-quality evidence regarding the optimal respiratory support devices for these patients.Objectives: The objective of this study was to evaluate institutional and temporal variability in the use of respiratory support modalities for pediatric critical asthma.Methods: We conducted a retrospective cohort study using data from the Virtual Pediatrics Systems database. Our study population included children older than 2 years old admitted to a VPS contributing pediatric intensive care unit from January 2012 to December 2021 with a primary diagnosis of asthma or status asthmaticus. We evaluated the percentage of encounters using a high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive bilevel positive pressure ventilation (NIV), and invasive mechanical ventilation (IMV) for all institutions, then divided institutions into quintiles based on the volume of patients. We created logistic regression models to determine the influence of institutional volume and year of admission on respiratory support modality use. We also conducted time-series analyses using Kendall's tau.Results: Our population included 77,115 patient encounters from 163 separate institutions. Institutional use of respiratory modalities had significant variation in HFNC (28.3%, interquartile range [IQR], 11.0-49.0%; P < 0.01), CPAP (1.4%; IQR, 0.3-4.3%; P < 0.01), NIV (8.6%; IQR, 3.5-16.1%; P < 0.01), and IMV (5.1%; IQR, 3.1-8.2%; P < 0.01). Increased institutional patient volume was associated with significantly increased use of NIV (odds ratio [OR], 1.33; 1.29-1.36; P < 0.01) and CPAP (OR, 1.20; 1.15-1.25; P < 0.01), and significantly decreased use of HFNC (OR, 0.80; 0.79-0.81; P < 0.01) and IMV (OR, 0.82; 0.79-0.86; P < 0.01). Time was also associated with a significant increase in the use of HFNC (11.0-52.3%; P < 0.01), CPAP (1.6-5.4%; P < 0.01), and NIV (3.7-21.2%; P < 0.01), whereas there was no significant change in IMV use (6.1-4.0%; P = 0.11).Conclusions: Higher-volume centers are using noninvasive positive pressure ventilation more frequently for pediatric critical asthma and lower frequencies of HFNC and IMV. Treatment with HFNC, CPAP, and NIV for this population is increasing in the last decade.
Collapse
Affiliation(s)
- Colin M. Rogerson
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Benjamin R. White
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Michele Smith
- Division of Critical Care Medicine, University of Rochester Medical Center, Rochester, New York
| | - Alexander H. Hogan
- Division of Hospital Medicine, Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher L. Carroll
- Department of Pediatrics, Wolfson Children’s, University of Florida, Jacksonville, Florida; and
| | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| |
Collapse
|
17
|
Woolf AD, Jackson JE, Corcoran P, Fritz MK, Kim SS, Maslak TM, Shah M, Hansen L. An Update on Pediatric Environmental Health Specialty Units: Activities and Impacts, 2015-19. Acad Pediatr 2024:S1876-2859(24)00108-6. [PMID: 38494060 PMCID: PMC11401956 DOI: 10.1016/j.acap.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and health care professionals. This analysis evaluated the productivity of the national PEHSU program. METHODS PEHSUs reported data on services provided to US communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS During this period, 6102 consultations and 4644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014 and 2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. CONCLUSIONS PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, health care professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program.
Collapse
Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics (AD Woolf), Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Mass.
| | | | - Peter Corcoran
- Department of Healthy Resilient Children, Youth & Families (P Corcoran), American Academy of Pediatrics, Itasca, Ill
| | - Meredith K Fritz
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Stephani S Kim
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Tanya M Maslak
- Health Economics & Outcomes Research (MK Fritz, SS Kim, and TM Maslak), Battelle, Columbus, Ohio
| | - Manthan Shah
- US Environmental Protection Agency (M Shah), Office of Children's Health Protection, Environmental Protection Agency, Washington, DC
| | - Linda Hansen
- Office of Capacity Development and Applied Prevention Science (OCDAPS) (L Hansen), Agency for Toxic Substances and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), Atlanta, Ga
| |
Collapse
|
18
|
Hong X, Jiang M, Kho AT, Tiwari A, Guo H, Wang AL, McGeachie MJ, Weiss ST, Tantisira KG, Li J. Circulating miRNAs associate with historical childhood asthma hospitalization in different serum vitamin D groups. Respir Res 2024; 25:118. [PMID: 38459594 PMCID: PMC10921757 DOI: 10.1186/s12931-024-02737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Vitamin D may help to alleviate asthma exacerbation because of its anti-inflammation effect, but the evidence is inconsistent in childhood asthma. MiRNAs are important mediators in asthma pathogenesis and also excellent non-invasive biomarkers. We hypothesized that circulating miRNAs are associated with asthma exacerbation and modified by vitamin D levels. METHODS We sequenced baseline serum miRNAs from 461 participants in the Childhood Asthma Management Program (CAMP). Logistic regression was used to associate miRNA expression with asthma exacerbation through interaction analysis first and then stratified by vitamin D insufficient and sufficient groups. Microarray from lymphoblastoid B-cells (LCLs) treated by vitamin D or sham of 43 subjects in CAMP were used for validation in vitro. The function of miRNAs was associated with gene modules by weighted gene co-expression network analysis (WGCNA). RESULTS We identified eleven miRNAs associated with asthma exacerbation with vitamin D effect modification. Of which, five were significant in vitamin D insufficient group and nine were significant in vitamin D sufficient group. Six miRNAs, including hsa-miR-143-3p, hsa-miR-192-5p, hsa-miR-151a-5p, hsa-miR-24-3p, hsa-miR-22-3p and hsa-miR-451a were significantly associated with gene modules of immune-related functions, implying miRNAs may mediate vitamin D effect on asthma exacerbation through immune pathways. In addition, hsa-miR-143-3p and hsa-miR-451a are potential predictors of childhood asthma exacerbation at different vitamin D levels. CONCLUSIONS miRNAs are potential mediators of asthma exacerbation and their effects are directly impacted by vitamin D levels.
Collapse
Affiliation(s)
- Xiaoning Hong
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Mingye Jiang
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Alvin T Kho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Anshul Tiwari
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haiyan Guo
- Department of Respiratory and Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Disease, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Sun Yat-Sen University, Shenzhen, China
| | - Alberta L Wang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Partners Personalized Medicine, Partners Healthcare, Boston, MA, USA
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Pediatrics, Division of Respiratory Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Jiang Li
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Shenzhen Key Laboratory of Chinese Medicine Active Substance Screening and Translational Research, Shenzhen, Guangdong, China.
| |
Collapse
|
19
|
Prakash KJ, Gourishankar A. Asthma care: The need for evidence-based, equitable, and affordable approaches. Pediatr Pulmonol 2024; 59:798-800. [PMID: 38149486 DOI: 10.1002/ppul.26825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/23/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Kavita Jyoti Prakash
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anand Gourishankar
- Pediatric Hospital Medicine, Children's National Hospital, Department of Pediatrics, George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
20
|
Kerr GH, van Donkelaar A, Martin RV, Brauer M, Bukart K, Wozniak S, Goldberg DL, Anenberg SC. Increasing Racial and Ethnic Disparities in Ambient Air Pollution-Attributable Morbidity and Mortality in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:37002. [PMID: 38445892 PMCID: PMC10916678 DOI: 10.1289/ehp11900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Ambient nitrogen dioxide (NO 2 ) and fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) threaten public health in the US, and systemic racism has led to modern-day disparities in the distribution and associated health impacts of these pollutants. OBJECTIVES Many studies on environmental injustices related to ambient air pollution focus only on disparities in pollutant concentrations or provide only an assessment of pollution or health disparities at a snapshot in time. In this study, we compare injustices in NO 2 - and PM 2.5 -attributable health burdens, considering NO 2 -attributable health impacts across the entire US; document changing disparities in these health burdens over time (2010-2019); and evaluate how more stringent air quality standards would reduce disparities in health impacts associated with these pollutants. METHODS Through a health impact assessment, we quantified census tract-level variations in health outcomes attributable to NO 2 and PM 2.5 using health impact functions that combine demographic data from the US Census Bureau; two spatially resolved pollutant datasets, which fuse satellite data with physical and statistical models; and epidemiologically derived relative risk estimates and incidence rates from the Global Burden of Disease study. RESULTS Despite overall decreases in the public health damages associated with NO 2 and PM 2.5 , racial and ethnic relative disparities in NO 2 -attributable pediatric asthma and PM 2.5 -attributable premature mortality have widened in the US during the last decade. Racial relative disparities in PM 2.5 -attributable premature mortality and NO 2 -attributable pediatric asthma have increased by 16% and 19%, respectively, between 2010 and 2019. Similarly, ethnic relative disparities in PM 2.5 -attributable premature mortality have increased by 40% and NO 2 -attributable pediatric asthma by 10%. DISCUSSION Enacting and attaining more stringent air quality standards for both pollutants could preferentially benefit the most marginalized and minoritized communities by greatly reducing racial and ethnic relative disparities in pollution-attributable health burdens in the US. Our methods provide a semi-observational approach to track changes in disparities in air pollution and associated health burdens across the US. https://doi.org/10.1289/EHP11900.
Collapse
Affiliation(s)
- Gaige Hunter Kerr
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randall V. Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael Brauer
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katrin Bukart
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Sarah Wozniak
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Daniel L. Goldberg
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| | - Susan C. Anenberg
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
21
|
Shan Y, Wu J, Dai X, Yuan C, Jiang J, Yan H, Tang L, Dong Y, Ren L, Pan Q, Ji J, Zhao X. Jiangqi Pingxiao formula regulates dendritic cell apoptosis in an autophagy-dependent manner through the AMPK/mTOR pathway in a murine model of OVA-induced asthma. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117405. [PMID: 37952734 DOI: 10.1016/j.jep.2023.117405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Allergic asthma is a recurring respiratory condition that typically manifests during childhood or adolescence. It is characterized by a dominant type II immune response triggered by the identification and capturing of inhaled allergens by dendritic cells (DCs). Jiangqi Pingxiao Formula (JQPXF), a prescription medicine used for the treatment of pediatric asthma, has been clinically proven to be both safe and effective. However, its mechanism of action in the treatment of asthma has not been fully been fully elucidated. Recent research suggests that several natural compounds have the potential to target dendritic cells (DCs) and alleviate ovalbumin (OVA)-induced asthma, which may also be found within JQPXF. AIM OF THE STUDY This study aimed to elucidate the effect of JQPXF on OVA-induced asthma model and its molecular mechanism targeting DCs. MATERIALS AND METHODS The main constituents of JQPXF were analyzed by ultra performance liquid chromatography (UPLC). An asthma model was established by OVA. Hematoxylin-eosin staining and measurement of respiratory function was used to evaluate the treatment effect of JQPXF on asthmatic mice. Cytokine (IL-5, IL-13 and IgE) concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Flow cytometry was employed to evaluate inflammatory cell infiltration (T helper 2 cells and DCs) in vivo and DC survival in vivo and vitro. Western blot and immunofluorescence were used to verify the molecular mechanisms. RESULTS The results suggest that JQPXF can ameliorate pathological conditions and improve lung function in asthmatic mice, as well as the Th2 cells. Treatment with JQPXF significantly reduced the number of DCs and increased the number of Propidium iodide+ (PI) DCs. Furthermore, JQPXF upregulated protein levels of the pro-apoptotic factors Cleaved-caspase-3 and Bax, while downregulating the anti-apoptotic factor Bcl-2. Simultaneously, JQPXF increased autophagy levels by facilitating p62 degradation and promoting translation from LC3B I to LC3B II of DCs in vitro, as well as reducing the integrated optical density (IOD) of p62 within the CD11c-positive area in the lung. 3-Methyladenine (3-MA) was used to block autophagic flux and the apoptotic effect of JQPXF on DCs was abolished in vitro, with the number of DCs decreased by JQPXF being reversed in vivo. We further investigated the upstream key regulator of autophagy, the AMPK/mTOR pathway, and found that JQPXF increased AMPK phosphorylation while decreasing mTOR phosphorylation levels. Additionally, we employed Compound C (CC) as an AMPK inhibitor to inhibit this signaling pathway, and our findings revealed that both autophagic flux and apoptotic levels in DCs were abolished in vitro. CONCLUSIONS In summary, we have demonstrated that JQPXF could alleviate type II inflammation in an asthmatic model by promoting the apoptosis of DCs through an autophagy-dependent mechanism, achieved by regulating the AMPK/mTOR signaling pathway.
Collapse
Affiliation(s)
- Yiwen Shan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiabao Wu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaohan Dai
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Yuan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinjin Jiang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hua Yan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lingling Tang
- School of Chinese Medicine & School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yingmei Dong
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lishun Ren
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingyun Pan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianjian Ji
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Xia Zhao
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Pediatric Respiratory Disease, Institute of Pediatrics, Medical Metabolomics Center, Nanjing University of Chinese Medicine, Nanjing, China.
| |
Collapse
|
22
|
Carroll KN. Impact of Climate Change on Dietary Nutritional Quality and Implications for Asthma and Allergy. Immunol Allergy Clin North Am 2024; 44:85-96. [PMID: 37973262 PMCID: PMC11233177 DOI: 10.1016/j.iac.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Asthma and allergic disorders are common in childhood with genetic and environmental determinants of disease that include prenatal nutritional exposures such as long-chain polyunsaturated fatty acids and antioxidants. Global climate change is implicated in asthma and allergic disorder morbidity with potential mechanisms including perturbations of ecosystems. There is support that environmental and climatic changes such as increasing global temperate and carbon dioxide levels affect aquatic and agricultural ecosystems with subsequent alterations in long-chain polyunsaturated fatty acid availability and nutrient quality and antioxidant capacity of certain crops, respectively. This article discusses asthma epidemiology and the influence of global climate change.
Collapse
Affiliation(s)
- Kecia N Carroll
- Division of General Pediatrics, Departments of Pediatrics and Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA.
| |
Collapse
|
23
|
Hall K, Barry F, Thompson LR, Ravandi B, Hall JE, Chang TP, Halterman JS, Szilagyi PG, Okelo SO. Feasibility of text message follow-up for pediatric asthma care after an emergency department visit. J Asthma 2024; 61:140-147. [PMID: 37610221 DOI: 10.1080/02770903.2023.2248507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
Background: Many children seen in the Emergency Department (ED) for asthma do not follow-up with their primary care provider. Text messaging via short message service (SMS) is a ubiquitous, but untested means of providing post-ED asthma follow-up care.Objective: To evaluate responses to an asthma assessment survey via SMS following an ED visit and estimate the likelihood of response by sociodemographic and clinical characteristics. Methods: We recruited 173 parents of children 2-17 years-old presenting for ED asthma care to receive a follow-up text (participation rate: 85%). One month later, parents received via SMS a 22-item survey that assessed asthma morbidity. We assessed response rates overall and by various sociodemographic and clinical characteristics, including age, parental education, and indicators of asthma severity.Results: Overall, 55% of parents (n = 95) responded to the SMS survey. In multivariable logistic regression (MLR), parents who graduated high school had a four-fold higher response rate compared to parents with less than a high school degree (OR: 4.05 (1.62, 10.13)). More parents of children with oral steroid use in the prior 12 months responded to survey items (OR: 2.53 (1.2, 5.31)). Reported asthma characteristics included: 48% uncontrolled, 22% unimproved/worse, 21% with sleep disruption, and 10% who were hospitalized for asthma.Conclusions: Text messaging may be a viable strategy to improve post-ED asthma assessment and to identify children with persistent symptoms in need of enhanced care or modification of care plans.
Collapse
Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Frances Barry
- Frances Barry Psychotherapy Practice, Santa Monica, CA, USA
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Bahareh Ravandi
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jeanine E Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sande O Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
24
|
Gurbani N, Schuler CL, Ignatiuk D, Albrecht J, Guo Y, Waits A, Kercsmar CM. Screening for sleep disordered breathing among children hospitalized for asthma exacerbation. Pediatr Pulmonol 2023; 58:3458-3465. [PMID: 37701984 DOI: 10.1002/ppul.26676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Sleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity. OBJECTIVE To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020. DESIGN/METHODS A multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2-18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated. RESULTS There were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed. CONCLUSION A screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high-risk population of children requiring hospitalization for asthma exacerbation.
Collapse
Affiliation(s)
- Neepa Gurbani
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christine L Schuler
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio, USA
| | - Daniel Ignatiuk
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jennifer Albrecht
- Cincinnati Children's Hospital Medical Center, Division of Quality Improvement Systems, Cincinnati, Ohio, USA
| | - Yuping Guo
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
| | - Amanda Waits
- Cincinnati Children's Hospital Medical Center, Division of Respiratory Care, Cincinnati, Ohio, USA
| | - Carolyn M Kercsmar
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
25
|
Miller AG, Rehder KJ, Rotta AT. High-flow nasal cannula in critical asthma: Time for the respiratory therapists to drive care! Pediatr Pulmonol 2023; 58:3369-3371. [PMID: 37642278 DOI: 10.1002/ppul.26661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Affiliation(s)
| | - Kyle J Rehder
- Duke University Medical Center, Durham, North Carolina, USA
| | | |
Collapse
|
26
|
Lin G, Chau CI, Hu H, Ung COL. Pharmacist intervention for pediatric asthma: A systematic literature review and logic model. Res Social Adm Pharm 2023; 19:1487-1510. [PMID: 37679253 DOI: 10.1016/j.sapharm.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Asthma is highly prevalent in children. Evidence about pharmacist-led interventions in the management of pediatric asthma is emerging. OBJECTIVE To summarize empirical evidence of pharmacist-led interventions for pediatric asthma patients, and to identify the components of a logic model, which can inform evidence-based pharmacy practice. METHODS PubMed, Web of Science, Embase Scopus, ScienceDirect, Medline and CNKI were searched. Studies concerning pharmacist-led interventions for pediatric asthma patients with an interventional design published between January 2013 and February 2023 were selected for analysis. Literature was searched and retrieved according to PRISMA guidelines. Components of pharmacist-led interventions were compiled into a logic model comprising input, activity, output, outcome and contextual factors. RESULTS The initial search retrieved 2291 records and 35 were included in the analysis. The main interventional activities included optimising medicines use and prevention and control of asthma. Commonly reported outputs were medication adherence, knowledge and inhaler technique. The main economic outcomes included cost of medication and hospitalization; clinical outcomes included Childhood Asthma Control Test/Asthma Control Test scores and lung function in FEV1% and PEF%; humanistic outcomes included patients' quality of life and satisfaction. Social, economic, political, and technological factors were identified as contextual factors. CONCLUSION The logic model summarized components of interventions evaluated in literature. It provides a blueprint for pharmacist-led management of pediatric asthma. Further research can focus on the pharmacists' role in a multidisciplinary healthcare professional team and transition of care in patient-centered management of pediatric asthma.
Collapse
Affiliation(s)
- Guohua Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao
| | - Chi Ian Chau
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao.
| |
Collapse
|
27
|
Niebur H, Rookwood A, Karki B, Abresch C. Toward a new model of childhood asthma care: community needs assessment in an underserved urban population. J Asthma 2023; 60:2064-2073. [PMID: 37171134 DOI: 10.1080/02770903.2023.2213351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The objective of this study was to utilize a community-engaged research approach to better understand gaps and opportunities for improving asthma care from the perspectives of patients, caregivers, community organization representatives, and healthcare providers in a predominantly minority community. METHODS Forty-one participants from four groups (patients, caregivers, community organization representatives, healthcare providers) participated in interviews or focus groups. A phenomenological approach to this qualitative research allowed the research team to better understand the lived experiences of families seeking asthma care in this community. RESULTS Five gaps and five corresponding opportunities were identified. The gaps identified were unequal healthcare resource distribution; underrepresentation of health professionals from diverse backgrounds; experiences of environmental racism; mistrust, bias, and discrimination in healthcare encounters; and systemic marginalization of communities. The opportunities identified include increasing healthcare infrastructure and accessibility; increasing racially, culturally, and linguistically congruent healthcare; implementing equitable improvements to the built environment; building relationships with communities and individuals; and acknowledging communities' strengths and resilience. CONCLUSION This study identified systemic gaps to asthma care that are of prominent concern to the community.
Collapse
Affiliation(s)
- Hana Niebur
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
| | - Aislinn Rookwood
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, USA
| | - Bibhusha Karki
- Division of Nursing, Midwifery and Social work, University of Manchester, Manchester, UK
| | - Chad Abresch
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
| |
Collapse
|
28
|
Shi L, Li T, Luck J, Ghanem B. The Association of Medicaid expansion with prescription drug utilization and expenditure among low-income participants with asthma. J Asthma 2023; 60:2030-2039. [PMID: 37171903 DOI: 10.1080/02770903.2023.2213331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/10/2023] [Accepted: 05/08/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVE This study estimated the association between the 2014 Medicaid expansion and asthma-related prescription drug utilization and expenditures among low-income adult participants with asthma, including those with uncontrolled asthma, in the United States. METHODS In this national analysis, using a pooled dataset from 2007-2018 Medical Expenditure Panel Surveys (MEPS), regression discontinuity (D-RD) analyses estimated the association between Medicaid expansion and utilization of and expenditures for asthma-related prescription drugs among participants with asthma aged 26-64 with incomes below vs. at/above 138% of the federal poverty level (FPL). A sub-sample analysis was also conducted among participants with uncontrolled asthma. Utilization and expenditure outcomes were estimated using two-part models with logit as the first part and generalized linear models as the second part. RESULTS Utilization of and total cost for asthma-related prescription drugs increased by 1.89 fills (p < 0.001) and $306.59 (p < 0.001) among participants with asthma with income below 138% FPL after Medicaid expansion. The utilization and total cost of both short-acting bronchodilators and inhaled corticosteroids (ICSs) increased after Medicaid expansion among participants with asthma with incomes below 138% FPL. Among participants with uncontrolled asthma with incomes below 138% FPL, utilization and expenditures increased after Medicaid expansion for all asthma-related prescription drugs and short-acting bronchodilators. CONCLUSION Medicaid expansion was associated with increased utilization of and total expenditures for both quick-relief and preventive asthma medications among all low-income participants with asthma, but not with utilization of preventive medications among those with uncontrolled asthma.
Collapse
Affiliation(s)
- Lu Shi
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Tao Li
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Buthainah Ghanem
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, Chapman University, Irvine, CA, USA
| |
Collapse
|
29
|
Lewis K, Zettler-Greeley CM, Blake KV, Milkes A. A digital health application for managing pediatric asthma: Use and benefits. Inform Health Soc Care 2023; 48:370-386. [PMID: 37661853 DOI: 10.1080/17538157.2023.2250435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Childhood asthma is a common and serious chronic lung disease. Mobile health (mHealth) technologies may assist clinical providers, caregivers, and children in managing pediatric asthma. This study evaluated the Nemours app, an mHealth application. We examined: a) frequency of data access by providers and feature use by caregivers (parents/legal guardians) of 5-11-year-old children diagnosed with asthma and b) whether utilization was related to benefits. Nine providers (allergists/pulmonologists) and 80 patient-families (caregiver/child dyads) participated. Two-years of retrospective data were obtained for asthma control, in-person urgent healthcare utilization, and app utilization. Six-months of prospective data included asthma control, in-person urgent healthcare utilization, app utilization, surveys, and health literacy screeners. Providers (56%) accessed app data and caregivers (61%) utilized the app. Caregiver use of messaging feature predicted gains in health literacy scores (b = .44, p = .041), suggesting app use may offer some educational benefits. Implementation of strategies that support app engagement and utilization may help to maximize intended benefits.
Collapse
Affiliation(s)
- Kandia Lewis
- Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Florida, USA
| | - Amy Milkes
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Florida, USA
| |
Collapse
|
30
|
Murugan A, Kandaswamy S, Ray E, Gillespie S, Orenstein E. Effectiveness of a Vendor Predictive Model for the Risk of Pediatric Asthma Exacerbation: A Difference-in-Differences Analysis. Appl Clin Inform 2023; 14:932-943. [PMID: 37774752 PMCID: PMC10686758 DOI: 10.1055/a-2184-6481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/28/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Asthma is a common cause of morbidity and mortality in children. Predictive models may help providers tailor asthma therapies to an individual's exacerbation risk. The effectiveness of asthma risk scores on provider behavior and pediatric asthma outcomes remains unknown. OBJECTIVE Determine the impact of an electronic health record (EHR) vendor-released model on outcomes for children with asthma. METHODS The Epic Systems Risk of Pediatric Asthma Exacerbation model was implemented on February 24, 2021, for volunteer pediatric allergy and pulmonology providers as a noninterruptive risk score visible in the patient schedule view. Asthma hospitalizations, emergency department (ED) visits, or oral steroid courses within 90 days of the index visit were compared from February 24, 2019, to February 23, 2022, using a difference-in-differences design with a control group of visits to providers in the same departments. Volunteer providers were interviewed to identify barriers and facilitators to model use. RESULTS In the intervention group, asthma hospitalizations within 90 days decreased from 1.4% (54/3,842) to 0.7% (14/2,165) after implementation with no significant change in the control group (0.9% [171/19,865] preimplementation to 1.0% [105/10,743] post). ED visits in the intervention group decreased from 5.8% (222/3,842) to 5.5% (118/2,164) but increased from 5.5% (1,099/19,865) to 6.8% (727/10,743) in the control group. The adjusted difference-in-differences estimators for hospitalization, ED visit, and oral steroid outcomes were -0.9% (95% confidence interval [CI]: -1.6 to -0.3), -2.4% (-3.9 to -0.8), and -1.9% (-4.3 to 0.5). In qualitative analysis, providers understood the purpose of the model and felt it was useful to flag high exacerbation risk. Trust in the model was calibrated against providers' own clinical judgement. CONCLUSION This EHR vendor model implementation was associated with a significant decrease in asthma hospitalization and ED visits within 90 days of pediatric allergy and pulmonology clinic visits, but not oral steroid courses.
Collapse
Affiliation(s)
- Avinash Murugan
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, United States
| | - Swaminathan Kandaswamy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Edwin Ray
- Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Evan Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
- Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| |
Collapse
|
31
|
Freeman RE, Qi YS, Geller RJ, Cohen AR, Iyer SS, Waynik IY, Sullivan AF, Camargo CA. Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort. Clin Pediatr (Phila) 2023; 62:1067-1079. [PMID: 36715245 DOI: 10.1177/00099228221150608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Parental mental health conditions appear to contribute to the development of childhood respiratory illness. We investigated the relationship between parental mental health and childhood respiratory illness using data from a 17-center prospective cohort study of infants hospitalized with bronchiolitis between 2011 and 2014 (n = 921). Among 779 (84.6%) participants with self-reported parental mental health history data, 184 (23.6%) had parental history of depression and 155 (19.9%) had anxiety. Multivariable analyses found that both parental history of depression (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.01-1.99) and anxiety (HR 1.28, 95% CI 1.08-1.52) were associated with an increased risk of recurrent wheezing by age 3 years. However, only parental history of anxiety was associated with asthma by age 5 years (odds ratio 1.79, 95% CI 1.25-2.55). Further research on exposure severity, other early life stressors, and effective methods of parental psychosocial support is needed to develop targeted risk factor prevention strategies to reduce the burden of childhood respiratory illness.
Collapse
Affiliation(s)
- Rain E Freeman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Ying Shelly Qi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth J Geller
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ari R Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sujit S Iyer
- Department of Pediatric Emergency Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Ilana Y Waynik
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
32
|
Pattath P, Cornwell CR, Sircar K, Qin X. Assessing asthma self-management education among US children with current asthma, Asthma Call-back Survey (ACBS) 2015-2017. J Asthma 2023; 60:1918-1925. [PMID: 37026680 PMCID: PMC11295547 DOI: 10.1080/02770903.2023.2200842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/20/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Asthma self-management education (AS-ME) is an effective strategy to help children with asthma achieve better asthma control and outcome. The objective of this study is to assess the association between the prevalence of receiving AS-ME curriculum components and sociodemographic characteristics among children with current asthma. METHODS Behavioral Risk Factor Surveillance System, child Asthma Call-back Survey 2015-2017 aggregated data were used. Multivariable logistic regression models were used to assess associations of each AS-ME component question and sociodemographic characteristic, adjusting for sample weighting. RESULTS Among 3,213 children with current asthma, 52% of children reported ever being given an asthma action plan by a doctor or other healthcare professional. After adjusting for other variables, boys and Non-Hispanic Black children were more likely to report being given an action plan (APR= 1.15[95% CI 1.00-1.32] and APR= 1.28[95% CI 1.07-1.54] respectively). Non-Hispanic Black (APR = 2.15 [95% CI 1.30-3.55]), non-Hispanic, other race (APR = 1.95 [95% CI1.04-3.66]), and Hispanic children (APR = 1.84 [95% CI 1.18-2.89]) were more likely to report taking a course to learn how to manage asthma than non-Hispanic White children. Hispanic children (40.8%) were more likely to report being advised to change home environment compared to non-Hispanic Whites (31.5%) (APR =1.28 [95% CI 1.01-1.63). CONCLUSION The prevalence of some elements of asthma-self management education was relatively low and there were differences observed in the prevalence of receiving AS-ME by race/ethnicity, parental education, and income. Targeted implementation of asthma self-management components and interventions may improve asthma control and reduce asthma morbidity.
Collapse
Affiliation(s)
- Priyadarshini Pattath
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Cheryl R. Cornwell
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kanta Sircar
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoting Qin
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
33
|
Kaplan C, Kranidis A, Saint-Fleur AL, Christophides A, Kier C. Bridging the Gap from Acute to Chronic Care: Partnerships and Tools for Pediatric Asthma. Pediatr Rev 2023; 44:578-584. [PMID: 37777653 DOI: 10.1542/pir.2022-005599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Carl Kaplan
- Stony Brook Children's Hospital, Stony Brook, NY
| | | | | | | | | |
Collapse
|
34
|
Maue DK, Cater DT, Rogerson CM, Ealy A, Tori AJ, Abu-Sultaneh S. Outcomes of a respiratory therapist driven high flow nasal cannula management protocol for pediatric critical asthma patients. Pediatr Pulmonol 2023; 58:2881-2888. [PMID: 37606224 DOI: 10.1002/ppul.26606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION This study aimed to determine if a respiratory therapist (RT)-driven high flow nasal cannula (HFNC) protocol could decrease duration of HFNC use, pediatric intensive care unit (PICU) and hospital length of stay (LOS), and duration of continuous albuterol use in pediatric patients with critical asthma. METHODS This was a quality improvement project performed at a quaternary academic PICU. Patients admitted to the PICU between 2 and 18 years of age with a diagnosis of asthma requiring continuous albuterol and HFNC were included. Implementation of an RT-driven HFNC protocol [Plan-Do-Study-Act (PDSA) 1] occurred in October 2017. Additional interventions included weaning continuous albuterol and HFNC simultaneously (PDSA 2; March 2019), adjusting HFNC wean rate (PDSA 3; July 2020), and a HFNC holiday (PDSA 4; October 2021). HFNC duration was the primary outcome. Secondary outcomes included LOS data and continuous albuterol duration. Noninvasive ventilation (NIV), invasive mechanical ventilation (IMV), and 7-day PICU and hospital readmission rates were used as balancing measures. RESULTS A total of 410 patients were included. Patient demographics and adjunct therapy use did not differ among the groups. After PDSA 2, mean HFNC duration decreased (26.8-18.1 h). Mean PICU LOS decreased (41-31.8 h). Mean hospital LOS also decreased (86.5-68 h). These outcomes remained stable during PDSA 3 and 4. Continuous albuterol duration and NIV use were unchanged, while IMV use decreased. CONCLUSIONS An RT-driven HFNC protocol led to decreased length of HFNC and PICU and hospital LOS for pediatric patients with critical asthma without an increase in adverse events.
Collapse
Affiliation(s)
- Danielle K Maue
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colin M Rogerson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aimee Ealy
- Department of Respiratory Care Services, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Alvaro J Tori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
35
|
Huang W, Schinasi LH, Kenyon CC, Auchincloss AH, Moore K, Melly S, Robinson LF, Forrest CB, De Roos AJ. Evaluation of evidence for interaction between PM2.5 and aeroallergens on childhood asthma exacerbation in Philadelphia, PA, 2011 to 2016. ENVIRONMENTAL RESEARCH 2023; 234:116395. [PMID: 37390950 DOI: 10.1016/j.envres.2023.116395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023]
Abstract
Fine particulate matter (PM2.5) and aeroallergens (i.e., pollen, molds) are known triggers of asthma exacerbation. Despite mechanistic evidence suggesting synergistic effects between PM2.5 and asthma exacerbation, little epidemiologic work has been performed in children, which has exhibited inconsistency. We conducted a time-series study to explore their interactions using electronic health records (EHR) data in Philadelphia, PA, for asthma diagnoses in outpatient, emergency department [ED], and inpatient settings. Daily asthma exacerbation cases (28,540 asthma exacerbation case encounters) were linked to daily ambient PM2.5 and daily aeroallergen levels during the aeroallergen season of a six-year period (mid-March to October 2011-2016). Asthma exacerbation counts were modeled using quasi-Poisson regression, where PM2.5 and aeroallergens were fitted with distributed lag non-linear functions (lagged from 0 to 14-days), respectively, when modeled as the primary exposure variables. Regression models were adjusted for mean daily temperature/relative humidity, long-term and seasonal trends, day-of-week, and major U.S. holidays. Increasing gradient of RR estimates were observed for only a few primary exposure risk factors [PM2.5 (90th vs. 5th percentile)/aeroallergens (90th percentile vs. 0)], across different levels of effect modifiers. For example, RRs for the association between late-season grass pollen (lag1) and asthma exacerbation were higher at higher levels of PM2.5, 5-days preceding the exacerbation event (low PM2.5: RR = 1.01, 95% CI: 0.93-1.09; medium PM2.5: 1.04, 95% CI: 0.96-1.12; high PM2.5: 1.09, 95% CI: 1.01-1.19). However, most of the highest RRs for aeroallergens were instead observed for days with low- or medium- PM2.5 levels; likewise, when PM2.5 was modeled as the primary exposure with aeroallergens as the effect modifier. Most of the RR estimates did not exhibit gradients that suggested synergism, and were of relatively high imprecision. Overall, our study suggested no evidence for interactions between PM2.5 and aeroallergens in their relationships with childhood asthma exacerbation.
Collapse
Affiliation(s)
- Wanyu Huang
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Chén C Kenyon
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, PA, USA; Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
36
|
Shehab N, Hossain J, Yousef E. Variation of asthma characteristics with atopic march, gastroesophageal reflux, and ENT pathologies. J Asthma 2023; 60:1661-1667. [PMID: 36755382 DOI: 10.1080/02770903.2023.2174030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Asthma is a significant cause of morbidity and mortality in the pediatric population. Atopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma, allergic rhinitis, and food allergies in the future. OBJECTIVE This study aimed to evaluate the severity differences between asthmatic children with and without atopic march in addition to characteristics of asthmatic patients with GER and ear-nose-and-throat (ENT) pathologies. METHODS A total of 616 pediatric asthmatic patients were enrolled. The study subjects were divided into two groups. Group A included asthmatic children with a history of AD. Group B had asthmatic children without a history of AD. Multiple factors were studied, including sex, race/ethnicity, family history of atopy, asthma severity, allergic rhinitis, food allergies, smoke exposure, ear-nose-and-throat (ENT) pathologies, gastroesophageal reflux (GER), frequency of systemic steroid use, and hospital admission rates. RESULTS Our results revealed that patients with atopic march are at risk of developing a higher severity of asthma, resulting in increased morbidity. In contrast, asthmatic patients without atopic march had a milder asthma severity, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march. CONCLUSION Our findings suggest that patients with atopic march should be expected to exhibit a more severe phenotype of asthma with increased asthma morbidity. Asthmatic patients without atopic march had a milder asthma phenotype, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march.
Collapse
Affiliation(s)
- Norane Shehab
- Department of Pediatrics, UF Health Jacksonville, Jacksonville, FL, USA
| | - Jobayer Hossain
- Department of Applied Economics and Statistics, Nemours Children's Health Delaware, Wilmington, DE, USA
| | - Ejaz Yousef
- Department of Pediatric Allergy and Immunology, Nemours Children's Health Jacksonville, Jacksonville, FL, USA
| |
Collapse
|
37
|
Wang YF, Xie B, Zou YX. Association between PFAS congeners exposure and asthma among US children in a nationally representative sample. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:5981-5990. [PMID: 37195568 DOI: 10.1007/s10653-023-01614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
Over the past few decades, contamination with perfluorinated and polyfluoroalkyl substances (PFAS) has gradually become a worldwide problem. Now that common PFAS such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are being phased out and replaced, people may be exposed to other PFAS congeners, and their potential hazards should be fully studied. We assessed the association of serum PFAS levels (as biomarkers of exposure) with asthma, including 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH), pefluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), using data from participants aged 3-11 from the 2013-2014 National Health and Nutrition Examination Surveys (n = 525), where PFAS was modeled as a binary variable.Me-PFOSA-AcOH (1.36; 95% CI 0.77, 2.38), PFDA (1.33; 95% CI 0.76, 2.33), and PFUnDA (1.89; 95% CI 0.83, 4.35) were nonsignificantly associated with increased odds of asthma. Age, sex, and race/ethnicity modified associations between serum PFUnDA, not other serum PFAS congeners exposure, and odds of asthma. Specifically, for male participants, the OR = 3.06 and 95% CI 1.23-7.62 for serum PFUnDA exposure; for participants aged 3-7 years old, the OR = 3.55 and 95% CI 1.04-12.10 for serum PFUnDA exposure; for non-Hispanic White participants, the OR = 3.44 and 95% CI 1.14-10.36 for serum PFUnDA exposure, all of which exhibited a significantly positive relationship. This cross-sectional study provides some evidence for associations between exposure to PFAS congeners and asthma in children. We believe this relationship deserves further exploration. More large-scale epidemiologic studies are needed to evaluate the association of serum PFAS congeners, especially for PFUnDA exposure, with asthma among children.
Collapse
Affiliation(s)
- Yi-Fan Wang
- Clinical School of Paediatrics, Tianjin Medical University, Tianjin, China
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Machang compus, 225 Machang Road, Hexi District, Tianjin, 300074, China
| | - Bin Xie
- Department of Biomedical Engineering, Tianjin Medical University, Tianjin, China
| | - Ying-Xue Zou
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Machang compus, 225 Machang Road, Hexi District, Tianjin, 300074, China.
| |
Collapse
|
38
|
Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
Collapse
Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| |
Collapse
|
39
|
van der Kamp M, Hengeveld V, Willard N, Thio B, de Graaf P, Geven I, Tabak M. Remote Patient Monitoring and Teleconsultation to Improve Health Outcomes and Reduce Health Care Utilization of Pediatric Asthma (ALPACA Study): Protocol for a Randomized Controlled Effectiveness Trial. JMIR Res Protoc 2023; 12:e45585. [PMID: 37399066 PMCID: PMC10365621 DOI: 10.2196/45585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Childhood asthma is imposing a great financial burden on the pediatric health care system. Asthma costs are directly related to the level of asthma control. A substantial part of these costs may be preventable by the timely and adequate assessment of asthma deterioration in daily life and proper asthma management. The use of eHealth technology may assist such timely and targeted medical anticipation. OBJECTIVE This paper describes the Ambulatory Pediatric Asthma Care (ALPACA) study protocol to investigate the effectiveness of an eHealth intervention consisting of remote patient monitoring and teleconsultation integrated into the daily clinical care of pediatric patients with asthma. This intervention aims to reduce health care utilization and costs and improve health outcomes compared to a control group that receives standard care. In addition, this study aims to improve future eHealth pediatric asthma care by gaining insights from home-monitoring data. METHODS This study is a prospective randomized controlled effectiveness trial. A total of 40 participants will be randomized to either 3 months of eHealth care (intervention group) or standard care (control group). The eHealth intervention consists of remote patient monitoring (spirometry, pulse oximetry, electronic medication adherence tracking, and asthma control questionnaire) and web-based teleconsultation (video sharing, messages). All participants will have a 3-month follow-up with standard care to evaluate whether the possible effects of eHealth care are longer lasting. During the entire study and follow-up period, all participants will use blinded observational home monitoring (sleep, cough/wheeze sounds, air quality in bedroom) as well. RESULTS This study was approved by the Medical Research Ethics Committees United. Enrollment began in February 2023, and the results of this study are expected to be submitted for publication in July 2024. CONCLUSIONS This study will contribute to the existing knowledge on the effectiveness of eHealth interventions that combine remote patient monitoring and teleconsultation for health care utilization, costs, and health outcomes. Furthermore, the observational home-monitoring data can contribute to improved identification of early signs of asthma deterioration in pediatric patients. Researchers and technology developers could use this study to guide and improve eHealth development, while health care professionals, health care institutions, and policy makers may employ our results to make informed decisions to steer toward high-quality, efficient pediatric asthma care. TRIAL REGISTRATION ClinicalTrials.gov NCT05517096; https://clinicaltrials.gov/ct2/show/NCT05517096. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45585.
Collapse
Affiliation(s)
- Mattienne van der Kamp
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
- Biomedical Signals and Systems Department, University of Twente, Enschede, Netherlands
| | - Vera Hengeveld
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Nico Willard
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Boony Thio
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Pascal de Graaf
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Inge Geven
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems Department, University of Twente, Enschede, Netherlands
| |
Collapse
|
40
|
Liu H, Zhang J, Liu L, Lian G, Shi R, Xu M, Yang J, Liu X. Global Disease Burden and Attributable Risk Factor Analysis of Asthma in 204 Countries and Territories From 1990 to 2019. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:473-495. [PMID: 37153981 PMCID: PMC10359648 DOI: 10.4168/aair.2023.15.4.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 07/21/2023]
Abstract
PURPOSE Asthma is a common chronic inflammatory respiratory tract disease with high morbidity and mortality. The global trends in asthma burden remain poorly understood, and asthma incidence has increased during the worldwide coronavirus disease 2019 (COVID-19) pandemic. This study aimed to provide a comprehensive view of the global distribution of asthma burden and its attributable risk factors from 1990 to 2019. METHODS Based on the Global Burden of Disease Study 2019 Database, asthma incidence, deaths, disability-adjusted life years (DALYs), the corresponding age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized DALY rate, and estimated annual percentage change were analyzed according to age, sex, sociodemographic index (SDI) quintiles, and locations. Risk factors contributing to asthma deaths and DALYs were also investigated. RESULTS Globally, the asthma incidence increased by 15%, but deaths and DALYs decreased. The corresponding ASIR, ASDR, and age-standardized DALY rate also decreased. The high SDI region had the highest ASIR, and the low SDI region had the highest ASDR. The ASDR and age-standardized DALY rate were negatively correlated with the SDI. The low-middle SDI region, particularly South Asia, showed the highest asthma-related deaths and DALYs. The incidence peak was under 9 years old, and more than 70% of all deaths occurred in the population over 60 years old. Smoking, occupational asthmagens, and a high body mass index were the main risk factors for asthma-related mortality and DALYs, and their distributions varied between sexes. CONCLUSIONS Globally, the asthma incidence has increased since 1990. The greatest asthma burden is borne by the low-middle SDI region. The 2 groups that need special attention are those under 9 years old and those over 60 years old. Targeted strategies are needed to reduce the asthma burden based on geographic and sex-age characteristics. Our findings also provide a platform for further investigation into the asthma burden in the era of COVID-19.
Collapse
Affiliation(s)
- Hailing Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Jing Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Li Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Guoli Lian
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Ruiming Shi
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Man Xu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Juan Yang
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, P. R. China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi'an Jiaotong University, Xi'an, P. R. China.
| | - Xiaohong Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China.
| |
Collapse
|
41
|
Brustad N, Bønnelykke K, Chawes B. Dietary prevention strategies for childhood asthma. Pediatr Allergy Immunol 2023; 34:e13984. [PMID: 37492917 DOI: 10.1111/pai.13984] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023]
Abstract
Asthma is the most common chronic disease in childhood and a rise in prevalence has been observed concomitantly with changing dietary habits in the Western world. This change has favored a more Westernized diet characterized by high intake of processed food and fat in contrast to a Mediterranean diet high in fruit, vegetable and fish intake. This has resulted in a decreased intake of several antioxidants and micronutrients including n-3 long-chained polyunsaturated fatty acids and vitamin D that are speculated to have anti-inflammatory effects and hold immunoregulatory properties. Several observational studies have investigated associations between dietary intake and wheeze and asthma but only few large well-conducted randomized controlled trials (RCTs) have been performed investigating the primary preventive effect of micronutrient supplementations. Currently, the recommendations from the Global Initiative for Asthma (GINA) for primary prevention of asthma in children do not include maternal dietary changes or supplementations during pregnancy, although the most recent report mentions both specific dietary patterns and micronutrients as potential protective supplementation regimes. This review will present the current literature and future research needs focusing on primary and secondary prevention of both early and late childhood asthma from dietary intake during pregnancy and early childhood to highlight potential preventive effects of specific dietary patterns and micronutrient supplements, which may facilitate the planning of future clinical trials in search of a preemptive strategy.
Collapse
Affiliation(s)
- Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
42
|
Miller RL, Schuh H, Chandran A, Aris IM, Bendixsen C, Blossom J, Breton C, Camargo CA, Canino G, Carroll KN, Commodore S, Cordero JF, Dabelea DM, Ferrara A, Fry RC, Ganiban JM, Gern JE, Gilliland FD, Gold DR, Habre R, Hare ME, Harte RN, Hartert T, Hasegawa K, Khurana Hershey GK, Jackson DJ, Joseph C, Kerver JM, Kim H, Litonjua AA, Marsit CJ, McEvoy C, Mendonça EA, Moore PE, Nkoy FL, O'Connor TG, Oken E, Ownby D, Perzanowski M, Rivera-Spoljaric K, Ryan PH, Singh AM, Stanford JB, Wright RJ, Wright RO, Zanobetti A, Zoratti E, Johnson CC. Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program. J Allergy Clin Immunol 2023; 152:84-93. [PMID: 36972767 PMCID: PMC10330473 DOI: 10.1016/j.jaci.2023.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Descriptive epidemiological data on incidence rates (IRs) of asthma with recurrent exacerbations (ARE) are sparse. OBJECTIVES This study hypothesized that IRs for ARE would vary by time, geography, age, and race and ethnicity, irrespective of parental asthma history. METHODS The investigators leveraged data from 17,246 children born after 1990 enrolled in 59 US with 1 Puerto Rican cohort in the Environmental Influences on Child Health Outcomes (ECHO) consortium to estimate IRs for ARE. RESULTS The overall crude IR for ARE was 6.07 per 1000 person-years (95% CI: 5.63-6.51) and was highest for children aged 2-4 years, for Hispanic Black and non-Hispanic Black children, and for those with a parental history of asthma. ARE IRs were higher for 2- to 4-year-olds in each race and ethnicity category and for both sexes. Multivariable analysis confirmed higher adjusted ARE IRs (aIRRs) for children born 2000-2009 compared with those born 1990-1999 and 2010-2017, 2-4 versus 10-19 years old (aIRR = 15.36; 95% CI: 12.09-19.52), and for males versus females (aIRR = 1.34; 95% CI 1.16-1.55). Black children (non-Hispanic and Hispanic) had higher rates than non-Hispanic White children (aIRR = 2.51; 95% CI 2.10-2.99; and aIRR = 2.04; 95% CI: 1.22-3.39, respectively). Children born in the Midwest, Northeast and South had higher rates than those born in the West (P < .01 for each comparison). Children with a parental history of asthma had rates nearly 3 times higher than those without such history (aIRR = 2.90; 95% CI: 2.43-3.46). CONCLUSIONS Factors associated with time, geography, age, race and ethnicity, sex, and parental history appear to influence the inception of ARE among children and adolescents.
Collapse
Affiliation(s)
| | - Holly Schuh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Izzuddin M Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | - Jeffrey Blossom
- Harvard University Center for Geographic Analysis, Cambridge, Mass
| | - Carrie Breton
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Carlos A Camargo
- Department of Epidemiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Glorisa Canino
- University of Puerto Rico Behavioral Sciences Research Institute, San Juan, Puerto Rico
| | | | | | - José F Cordero
- University of Georgia College of Public Health, Athens, Ga
| | - Dana M Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif
| | - Rebecca C Fry
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - James E Gern
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | - Frank D Gilliland
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Diane R Gold
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Rima Habre
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Marion E Hare
- University of Tennessee Health Science Center, Memphis, Tenn
| | | | - Tina Hartert
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Gurjit K Khurana Hershey
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | - Jean M Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Mich
| | | | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Carmen J Marsit
- Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Cindy McEvoy
- Oregon Health and Science University, Portland, Ore
| | - Eneida A Mendonça
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul E Moore
- Vanderbilt University School of Medicine, Nashville, Tenn
| | | | - Thomas G O'Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | | | | | - Patrick H Ryan
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Marie Singh
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | | | | | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | | | | |
Collapse
|
43
|
Ramsey RR, Plevinsky JM, Guilbert TW, Carmody JK, Hommel KA. Technology-Assisted Stepped-Care to Promote Adherence in Adolescents with Asthma: A Pilot Study. J Clin Psychol Med Settings 2023; 30:415-424. [PMID: 35986811 PMCID: PMC9391214 DOI: 10.1007/s10880-022-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
To examine the feasibility, acceptability, and preliminary efficacy of a technology-assisted stepped-care behavioral intervention to improve adherence in adolescents with asthma. Thirty adolescents (Mage = 14.66, 53% male) with moderate to severe-persistent asthma completed daily adherence monitoring and medication reminders via a mobile app (Step 1). Participants with < 68% adherence during Step 1 received a telehealth behavioral intervention (Step 2). Twenty-six of 30 participants (87%) completed Step 1. Step 2 was indicated for 18 participants and was completed by 17. Participants favorably rated their experience in the study. Improvements in adherence (40-58%, p = .048) and decreases in asthma composite severity scores (CASI 6.08-5.08, p = .023) were observed for the full sample. Technology-assisted stepped-care is feasible and acceptable. Participants demonstrated improved adherence and asthma composite severity scores once they received the appropriate step of the intervention. Future studies should include a control group, a longer time-frame and an intermediate intervention step.
Collapse
Affiliation(s)
- Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC: 7035, Cincinnati, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jill M Plevinsky
- Division of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Theresa W Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Julia K Carmody
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, USA
- Department of Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC: 7035, Cincinnati, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| |
Collapse
|
44
|
Fitzpatrick AM, Diani B, Kavalieratos D, Corace EA, Mason C, Van Dresser M, Grunwell JR. Poorer Caregiver Mental and Social Health Is Associated With Worse Respiratory Outcomes in Preschool Children With Recurrent Wheezing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1814-1822. [PMID: 36868472 PMCID: PMC10258161 DOI: 10.1016/j.jaip.2023.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Mental and social health in caregivers of preschool children has been inadequately studied, but it may influence respiratory symptom recognition and management. OBJECTIVE To identify preschool caregivers at highest risk for poor mental and social health outcomes on the basis of patient-reported outcome measures. METHODS Female caregivers 18 to 50 years old (N = 129) with a preschool child aged 12 to 59 months with recurrent wheezing and at least 1 exacerbation in the previous year completed 8 validated patient-reported outcome measures of mental and social health. k-means cluster analysis was performed using the T score for each instrument. Caregiver/child dyads were followed for 6 months. Primary outcomes included caregiver quality of life and wheezing episodes in their preschool children. RESULTS Three clusters of caregivers were identified: low risk (n = 38), moderate risk (n = 56), and high risk (n = 35). The high-risk cluster had the lowest life satisfaction, meaning and purpose, and emotional support and the highest social isolation, depression, anger, perceived stress, and anxiety that persisted for more than 6 months. This cluster had the poorest quality of life and marked disparities in social determinants of health. Preschool children from caregivers in the high-risk cluster had more frequent respiratory symptoms and a higher occurrence of any wheezing episode, but a lower outpatient physician utilization for wheezing management. CONCLUSIONS Caregiver mental and social health is associated with respiratory outcomes in preschool children. Routine assessment of mental and social health in caregivers is warranted to promote health equity and improve wheezing outcomes in preschool children.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Badiallo Diani
- Department of Biomedical Engineering, Emory University, Atlanta, Ga; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Dio Kavalieratos
- Department of Family and Preventative Medicine, Emory University, Atlanta, Ga
| | | | | | | | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| |
Collapse
|
45
|
Wu TD, Zaeh S, Eakin MN, Koehler K, Davis MF, Wohn C, Diibor I, Psoter KJ, Cronister C, Connolly F, Stein M, McCormack MC. Association of School Infrastructure on Health and Achievement Among Children With Asthma. Acad Pediatr 2023; 23:814-820. [PMID: 36272721 PMCID: PMC10113606 DOI: 10.1016/j.acap.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine whether school infrastructure is associated with health and academic outcomes among elementary school children with asthma. METHODS We conducted a retrospective cohort study of linked medical, academic, and facilities data from a large mid-Atlantic school district of the United States. All K-5 students with asthma who were enrolled under the state's Children's Health Insurance Program were included. We estimated associations of the infrastructure quality of the student's school, as assessed by an engineering firm in Summer 2011 and represented by the Facility Condition Index (FCI), with asthma health outcomes, absenteeism, and standardized test scores in math and reading in the 2 academic years thereafter. RESULTS A total of 6558 students were identified, the majority non-Hispanic Black, across 130 schools. Most schools (97/130, 75%) were in very poor or worse condition. In cluster-adjusted models accounting for demographics, grade, school-specific area deprivation, and inhaled corticosteroid use, a one standard deviation increase in FCI, corresponding to greater infrastructure deficiency, was associated with higher rates of asthma-related hospitalizations (incidence rate ratio [IRR] 1.16; 95% confidence interval [CI] 1.03, 1.32), more absenteeism (IRR 1.05; 95% CI 1.01, 1.08), and lower scores in math (mean difference [MD] -3.3; 95% CI -5.5, -1.2) and reading (MD -3.0; 95% CI -5.1, -0.9). There were no differences in rates of asthma-related emergency visits or steroid prescriptions. CONCLUSIONS Children with asthma attending schools with poorer infrastructure had worse health and academic outcomes. Public policy emphasizing reinvestment in school infrastructure may be a potential means of addressing asthma disparities.
Collapse
Affiliation(s)
- Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine (TD Wu), Baylor College of Medicine, Houston, Tex; Center for Innovations in Quality, Effectiveness, and Safety (TD Wu), Michael E DeBakey VA Medical Center, Houston, Tex; Division of Pulmonary and Critical Care Medicine (TD Wu, MN Eakin, and M McCormack), Johns Hopkins School of Medicine, Baltimore, Md
| | - Sandra Zaeh
- Yale University School of Medicine (S Zaeh), New Haven, Conn
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine (TD Wu, MN Eakin, and M McCormack), Johns Hopkins School of Medicine, Baltimore, Md
| | - Kirsten Koehler
- Department of Environmental Health and Engineering (K Koehler, MF Davis), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Meghan F Davis
- Department of Environmental Health and Engineering (K Koehler, MF Davis), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Department of Molecular and Comparative Pathobiology (MF Davis), Johns Hopkins School of Medicine, Baltimore, Md; Division of Infectious Diseases (MF Davis), Johns Hopkins School of Medicine, Baltimore, Md
| | - Chris Wohn
- Office of Achievement and Accountability (C Wohn, I Diibor), Baltimore City Public Schools, Baltimore Md
| | - Ike Diibor
- Office of Achievement and Accountability (C Wohn, I Diibor), Baltimore City Public Schools, Baltimore Md
| | - Kevin J Psoter
- Division of General Pediatrics (KJ Psoter, Johns Hopkins School of Medicine, Baltimore, Md
| | - Curt Cronister
- Baltimore Education Research Consortium (C Cronister, F Connolly, and M Stein), Baltimore Md
| | - Faith Connolly
- Baltimore Education Research Consortium (C Cronister, F Connolly, and M Stein), Baltimore Md
| | - Marc Stein
- Baltimore Education Research Consortium (C Cronister, F Connolly, and M Stein), Baltimore Md; Department of Advanced Studies in Education (M Stein), Johns Hopkins School of Education, Baltimore, Md
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine (TD Wu, MN Eakin, and M McCormack), Johns Hopkins School of Medicine, Baltimore, Md.
| |
Collapse
|
46
|
Fitzpatrick AM, Grunwell JR, Cottrill KA, Mutic AD, Mauger DT. Blood Eosinophils for Prediction of Exacerbation in Preschool Children With Recurrent Wheezing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1485-1493.e8. [PMID: 36738927 PMCID: PMC10164693 DOI: 10.1016/j.jaip.2023.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although clinical features of type 2 inflammation have been associated with poorer longitudinal outcomes in preschool children with recurrent wheezing, it remains difficult to predict which children are at highest risk for poor outcomes during a routine clinical encounter. OBJECTIVE We tested the hypothesis that prespecified cut points of blood eosinophil counts would predict exacerbation and treatment response outcomes in preschool children with recurrent wheezing and that prediction could be improved with the addition of a second biomarker. METHODS Data from 3 clinical trials of 1,074 preschool children aged 12 to 71 months with recurrent wheezing were merged. The primary outcome was the occurrence of any exacerbation during follow-up. Secondary outcomes included the annualized rate of wheezing exacerbations and the occurrence of any exacerbation requiring hospitalization. Exploratory analyses focused on exacerbation outcomes, offline exhaled nitric oxide concentrations, and caregiver-reported asthma control scores after inhaled corticosteroid treatment initiation. RESULTS Each blood eosinophil cut point was associated with increased odds of exacerbation, higher exacerbation rates, and greater hospitalization occurrence in preschool children with recurrent wheezing. However, outcome detection was improved in children with more elevated blood eosinophil counts. Addition of a second biomarker of type 2 inflammation improved outcome detection and was further associated with an improved response to initiation of daily inhaled corticosteroids in exploratory analyses. However, the specificity of blood eosinophils was poor. CONCLUSIONS Although validation studies are warranted, blood eosinophil cut points may be useful for clinical assessment and future studies of exacerbation and treatment response in preschool children with recurrent wheezing.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - David T Mauger
- Department of Statistics, Pennsylvania State University, Hershey, Pa
| |
Collapse
|
47
|
Herrin MA, Sherris AR, Dearborn LC, Loftus CT, Szpiro AA, Moore PE, Adgent MA, Barrett ES, Nguyen RHN, Carroll KN, Karr CJ. Association between maternal occupational exposure to cleaning chemicals during pregnancy and childhood wheeze and asthma. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1166174. [PMID: 38045485 PMCID: PMC10691794 DOI: 10.3389/fepid.2023.1166174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Asthma is a leading cause of childhood morbidity in the U.S. and a significant public health concern. The prenatal period is a critical window during which environmental influences, including maternal occupational exposures, can shape child respiratory health. Cleaning chemicals are commonly encountered in occupational settings, yet few studies have examined the potential link between prenatal occupational exposures to cleaning chemicals and risk of childhood wheeze and asthma. Methods We evaluated the potential influence of maternal occupational exposure to cleaning chemicals during pregnancy on pediatric asthma and wheeze at child age 4-6 years in 453 mother-child pairs from two longitudinal pregnancy cohorts, TIDES and GAPPS, part of the ECHO prenatal and early childhood pathways to health (ECHO-PATHWAYS) consortium. Maternal occupational exposure to cleaning chemicals was defined based on reported occupation and frequency of occupational use of chemicals during pregnancy. Child current wheeze and asthma outcomes were defined by parental responses to a widely-used, standardized respiratory outcomes questionnaire administered at child age 4-6 years. Multivariable Poisson regression with robust standard errors was used to estimate relative risk (RR) of asthma in models adjusted for confounding. Effect modification by child sex was assessed using product interaction terms. Results Overall, 116 mothers (25.6%) reported occupational exposure to cleaning chemicals during pregnancy, 11.7% of children had current wheeze, and 10.2% had current asthma. We did not identify associations between prenatal exposure to cleaning chemicals and current wheeze [RRadjusted 1.03, 95% confidence interval (CI): 0.56, 1.90] or current asthma (RRadjusted 0.89, CI: 0.46, 1.74) in the overall sample. Analyses of effect modification suggested an adverse association among females for current wheeze (RR 1.82, CI: 0.76, 4.37), compared to males (RR 0.68, CI: 0.29, 1.58), though the interaction p-value was >0.05. Conclusion We did not observe evidence of associations between maternal prenatal occupational exposure to cleaning chemicals and childhood wheeze or asthma in the multi-site ECHO-PATHWAYS consortium. We leveraged longitudinal U.S. pregnancy cohorts with rich data characterization to expand on limited and mixed literature. Ongoing research is needed to more precisely characterize maternal occupational chemical exposures and impacts on child health in larger studies.
Collapse
Affiliation(s)
- Melissa A Herrin
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Allison R Sherris
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Logan C Dearborn
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States
| | - Paul E Moore
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Margaret A Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kecia N Carroll
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
48
|
Nieto-Cid M, Garriga-Baraut T, Plaza-Martín AM, Tortajada-Girbés M, Torres-Borrego J, Lozano-Blasco J, Moreno-Galarraga L, Del Mar Folqué-Giménez M, Bosque-García M, Gaboli M, López-Neyra A, Rivas-Juesas C, Caballero-Rabasco MA, Freixa-Benavente A, Valdesoiro-Navarrete L, de Mir-Messa I, Ballester-Asensio E, Penín-Antón M, Romero-García R, Navarro-Morón J, Valenzuela-Soria A, Sánchez-Mateos M, Batlles-Garrido J, Sanz-Santiago V, de Atauri ÁGD, Andrés-Martín A, Campos-Alonso E, Gómez-Pastrana D, Vázquez-Rodríguez E, Martínez-Pardo L, Del Río-Camacho G, Mazón-Ramos Á, Nieto-García A. Cost-effectiveness of omalizumab for the treatment of severe pediatric allergic asthma-Results of a real-life study in Spain. Pediatr Allergy Immunol 2023; 34:e13942. [PMID: 37102393 DOI: 10.1111/pai.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Severe pediatric allergic asthma (SPAA) induces a huge economic burden in terms of direct, indirect, and intangible costs. The use of omalizumab for the treatment of these patients has produced a significant improvement in several clinical outcomes, but at the same time, the cost for the management of the disease has also increased. The aim of this report was to evaluate whether the use of omalizumab is cost-effective. METHODS A sample of 426 children with SPAA from the ANCHORS (Asthma iN CHildren: Omalizumab in Real-life in Spain) study was used to calculate the incremental cost-effectiveness ratio (ICER) for the avoidance of moderate-to-severe exacerbations (MSE) and also for the improvement in childhood Asthma Control Test (c-ACT) or the Asthma Control Questionnaire (ACQ5). We retrospectively collected data on health encounters and drug consumption before and up to 6 years after the beginning of the treatment with omalizumab. RESULTS The ICER per avoided MSE was €2107 after 1 year, and it consistently decreased to €656 in those followed up to 6 years. Similarly, the ICER for the minimally important difference in control tests showed a decrease from €2059 to €380 per each 0.5 points of improvement in ACQ5 and from €3141 to €2322 per each 3 points improvement in c-ACT, at years 1 and 6, respectively. CONCLUSION The use of OMZ is a cost-effective option for most children with uncontrolled SPAA, especially those who have frequent exacerbations; the costs are progressively reduced in successive years of treatment.
Collapse
Affiliation(s)
- María Nieto-Cid
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain
- Allergy Service, Hospital Universitario de La Plana, Villarreal, Spain
| | - Teresa Garriga-Baraut
- Pediatric Allergy Unit, Hospital Universitari Vall d'Hebron. Grup d'Investigació "Creixement i Desenvolupament", Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain
| | - Ana Mª Plaza-Martín
- Allergy and Clinical Immunology Department, Hospital Materno-Infantil Sant Joan de Déu, Barcelona, Spain
| | - Miguel Tortajada-Girbés
- Pediatric Allergy and Pneumology Unit, Hospital Universitari Dr. Peset, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Torres-Borrego
- Pediatric Allergy and Pulmonology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jaime Lozano-Blasco
- Allergy and Clinical Immunology Department, Hospital Materno-Infantil Sant Joan de Déu, Barcelona, Spain
| | - Laura Moreno-Galarraga
- Pediatric Pulmonology Unit, Complejo Hospitalario de Navarra. IdiSNA Health Research Institute, Pamplona, Spain
| | - Mª Del Mar Folqué-Giménez
- Allergy and Clinical Immunology Department, Hospital Materno-Infantil Sant Joan de Déu, Barcelona, Spain
| | - Montse Bosque-García
- Pediatric Allergy and Pulmonology Unit, Hospital de Sabadell - Corporació Universitaria Parc Taulí, Sabadell, Spain
| | - Mirella Gaboli
- Pediatric Pulmonology and Allergy Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Andrea Freixa-Benavente
- Pediatric Allergy Unit, Hospital Universitari Vall d'Hebron. Grup d'Investigació "Creixement i Desenvolupament", Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain
| | - Laura Valdesoiro-Navarrete
- Pediatric Allergy and Pulmonology Unit, Hospital de Sabadell - Corporació Universitaria Parc Taulí, Sabadell, Spain
| | - Inés de Mir-Messa
- Pediatric Allergy Unit, Hospital Universitari Vall d'Hebron. Grup d'Investigació "Creixement i Desenvolupament", Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR), Barcelona, Spain
| | - Esther Ballester-Asensio
- Pediatric Allergy and Pneumology Unit, Hospital Universitari Dr. Peset, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - María Penín-Antón
- Pediatrics Service, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Raquel Romero-García
- Pediatric Pulmonology and Allergy Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | | | - José Batlles-Garrido
- Pediatric Pulmonology and Allergy Unit, Hospital Universitario Torrecárdenas, Almería, Spain
| | | | | | | | | | - David Gómez-Pastrana
- Pediatrics Service, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | | | | - Ángel Mazón-Ramos
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain
| | - Antonio Nieto-García
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain
| |
Collapse
|
49
|
Brar S, Dixon SN, Paterson JM, Dirk J, Hahn E, Kim SJ, Ng V, Solomon M, Vasilevska-Ristovska J, Banh T, Nathan PC, Parekh RS, Chanchlani R. Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study. Pediatr Nephrol 2023; 38:801-810. [PMID: 35849223 DOI: 10.1007/s00467-022-05635-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation. METHODS In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used. RESULTS Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively. CONCLUSIONS Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Sandeep Brar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie N Dixon
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - J Michael Paterson
- ICES Central, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jade Dirk
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Emma Hahn
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - S Joseph Kim
- ICES Western, London, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Ng
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Melinda Solomon
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul C Nathan
- ICES Central, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan S Parekh
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Academics, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
- Division of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
50
|
Noah TL, Tolleson-Rinehart S, Esther CR, Peterson-Carmichael SL, Davis SD, Moore PE. The future of pediatric pulmonology: A survey of division directors, assessment of current research funding, and discussion of workforce trends. Pediatr Pulmonol 2023; 58:653-661. [PMID: 33325144 DOI: 10.1002/ppul.25228] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles R Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul E Moore
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|