Asthma, atopy, and lung function among racially diverse, poor inner-urban Minneapolis schoolchildren

A Review of Medication Use as an Indicator of Human Health Impact in Environmentally Stressed Areas

We reviewed from literature the feasibility of medication use as an indicator of health outcomes in environmentally stressed areas, especially where a paucity of typical epidemiological and other risk-based data are encountered. The majority of studies reported were about medication use as an indicator of adverse respiratory effects from air pollution in developed countries. Studies to a lesser extent pointed to medication use as indicator of health outcomes associated with other environmental health stressors such as water, noise pollution, and habitat conditions. The relationship between environmental stressors and medication use strongly suggests that medication use could be used to measure the impact of environmental stressors that otherwise could not be measured by epidemiological or other impact assessment studies, typically in settings where morbidity and mortality data might not be not accessible.

Ethnic differences in the effect of asthma on pulmonary function in children

RATIONALE

The impact of asthma on chronic lung function deficits is well known. However, there has been little study of ethnic differences in these asthma-associated deficits.

OBJECTIVES

To examine whether there are ethnic differences in the effects of asthma on children's lung function.

METHODS

We evaluated the impact of asthma on lung function in 3,245 Hispanic and non-Hispanic white school children (age 10-18 yr) in a longitudinal analysis of the Southern California Children's Health Study. Sex-specific mixed-effects regression spline models were fitted separately for each ethnic group.

MEASUREMENTS AND MAIN RESULTS

Large deficits in flows were observed among children with asthma diagnosed before age 4 years regardless of ethnicity. Hispanic girls with asthma had greater deficits in flows than non-Hispanic girls and were largest for maximal midexpiratory flow (-5.13% compared with -0.58%, respectively). A bigger impact of asthma in Hispanic girls was also found for FEV(1), FEF(75), and PEF (P value 0.04, 0.07, and 0.005, respectively). These ethnic differences were limited to girls diagnosed after age 4 years. In boys, asthma was also associated with greater deficits in flows among Hispanic than in non-Hispanic white children (differences that were not statistically significant). Ethnic differences in prevalence of pets and pests in the home, health insurance coverage, parental education, and smoking did not explain the pattern of lung function differences.

CONCLUSIONS

Larger asthma-associated lung function deficits in Hispanics, especially among girls, merit further investigation to determine public health implications and to identify causes amenable to intervention.

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Allergens in house dust are risk factors for asthma causation and exacerbation, and asthma interventions often focus on exposure reduction using methods that may not be sustainable over time in low-income communities. A randomized controlled trial with up to six home visits was used to evaluate the effectiveness of two interventions focused on reducing dust loading and allergen concentrations in 47 low-income inner-city households in Minneapolis, MN. The interventions, which included education and relatively inexpensive cleaning procedures, were developed using a community-based participatory consultation process with focus groups held in English, Somali, and Spanish to incorporate community feedback from participants into protocols and study design decisions. Change in levels of cat, cockroach, dust mite, and culturable fungi as well as overall dust loading were evaluated by measuring the difference in concentrations before and after the cleaning intervention, and mixed models were used to assess the effect of education and cleaning on baseline allergen levels during the final three home visits. The cleaning intervention significantly lowered dust loading in all households and culturable fungi levels in single family homes, reduced cat allergen concentrations in homes with cats, but had no significant effect on cockroach allergen levels. The cleaning intervention also modestly decreased the frequency of observed allergen concentrations above suggested health benchmarks for cat, cockroach, and fungi. The cleaning and education interventions had similar effects on baseline allergen levels measured during subsequent home visits; both interventions significantly reduced baseline levels of cat and fungal allergens observed in pre-cleaning samples, but had no significant effect on cockroach allergen levels. Overall, the cleaning intervention modestly reduced potential exposure to risk factors associated with asthma mortality and morbidity in a way that can be implemented by most homeowners or renters, independent of education, income, or the ability to speak English.

Major gene effect and additive familial pattern of inheritance of asthma exist among families of probands with sickle cell anemia and asthma

In the United States, sickle cell anemia (SCA) affects approximately 1 in 400 African-American newborns. Acute episodes of pain and acute chest syndrome (ACS) are the two leading causes of hospitalization. A relationship between the diagnosis of asthma and the incidence of pain and ACS has been established. We tested the hypothesis that a familial pattern of inheritance of asthma exists among first degree relatives of probands with SCA and asthma. Segregation analysis was performed in 104 families ascertained through affected probands. Of these, 19.7% (41/208) of the parents and 31.8% (28/88) of siblings of affected probands reported having been told by a doctor he or she had asthma at any age. Modes of inheritance were tested, using the Pedigree Analysis Package parameterized for the discrete trait of asthma affection status. A major effect was present and significant. Further tests were performed to determine whether transmission probabilities of the major effect followed Mendelian expectations. The additive mode of inheritance was the most parsimonious, while the residual heritability was found negligible. Our results support the hypothesis that a familial pattern of inheritance of asthma exists among first degree relatives of probands with SCA and asthma, suggesting that asthma is a co-morbid condition with SCA rather than a lung disease phenotype mimicking asthma.