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Elsiwi B, Eskenazi B, Bornman R, Obida M, Kim J, Moodie EE, Mann KK, Chevrier J. Maternal exposure to pyrethroid insecticides during pregnancy and respiratory allergy symptoms among children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE). ENVIRONMENTAL RESEARCH 2024; 242:117604. [PMID: 38000632 PMCID: PMC10962214 DOI: 10.1016/j.envres.2023.117604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Pyrethroid insecticides use for indoor residual spraying (IRS) in malaria-endemic areas results in high levels of exposure to local populations. Pyrethroids may cause asthma and respiratory allergies but no prior study has investigated this question in an IRS area. METHODS We measured maternal urinary concentrations of pyrethroid metabolites (cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA) in samples collected at delivery from 751 mothers participating in the Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE), a birth cohort study based in Limpopo, South Africa. At 3.5-year and 5-year follow-up visits, caregivers of 647 and 620 children, respectively, were queried about children's respiratory allergy symptoms based on validated instruments. We applied marginal structural models for repeated outcomes to estimate associations between biomarker concentrations and asthma diagnosis as well as respiratory allergy symptoms at ages 3.5 and 5 years. RESULTS We found that a10-fold increase in maternal urinary cis-DCCA, trans-DCCA and 3-PBA concentrations were associated with more than a doubling in the risk of doctor-diagnosed asthma (cis-DCCA: RR = 2.1, 95% CI = 1.3, 3.3; trans-DCCA: RR = 2.1, 95% CI = 1.1, 3.9; 3-PBA: RR = 2.4, 95% CI = 1.0, 5.8) and an about 80% increase in the risk of wheezing or whistling in the chest (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.0; trans-DCCA: RR = 1.7, 95% CI = 1.1, 2.6; 3-PBA: RR = 1.8, 95% CI = 1.0, 3.3) and suspected asthma (cis-DCCA: RR = 1.8, 95% CI = 1.1, 3.1; trans-DCCA: RR = 1.8, 95% CI = 1.1, 2.8). We also observed that higher concentrations of cis-DBCA and 3-PBA were related to increases in the risks of dry cough at night (RR = 3.5, 95% CI = 1.3, 9.5) and seasonal rhinoconjunctivitis (RR = 2.0, 95% CI = 1.1, 3.9), respectively. CONCLUSION Maternal exposure to pyrethroids may increase the risk of asthma and other respiratory allergy symptoms among preschool children from an IRS area.
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Affiliation(s)
- Basant Elsiwi
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California, Berkeley, USA
| | - Riana Bornman
- University of Pretoria Institute for Sustainable Malaria Control, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Muvhulawa Obida
- University of Pretoria Institute for Sustainable Malaria Control, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Joanne Kim
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Erica Em Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Koren K Mann
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
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Lewis G, Milnes L, Adams A, Schwarze J, Duff A. Influences on indoor environmental trigger remediation uptake for children and young people with asthma: A scoping review. Health Expect 2022; 26:87-97. [PMID: 36478049 PMCID: PMC9854302 DOI: 10.1111/hex.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/21/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Children and young people (CYP) with asthma can benefit from reduced exposure to indoor environmental allergens and triggers but may not consistently have avoidance strategies implemented. To inform future interventions to increase trigger and allergen avoidance and enhance asthma control, a greater understanding of the influences on avoidance behaviours is necessary. METHODS A systematic scoping review was selected to summarize evidence on what influences family uptake of indoor environmental asthma trigger avoidance strategies for CYP with asthma and identify research gaps. Primary studies of any design, including CYP (≤18 years) with asthma, and/or parent-carers, available in English and conducted since 1993, were eligible. Searches included nine databases, hand-searching reference lists and citation searching. FINDINGS Thirty-three articles were included and are summarized narratively due to heterogeneity. Influences appear complex and multifactorial and include barriers to strategy uptake, health beliefs and personal motivation. Research specifically related to family understanding of allergic sensitisation status and exposure risks, and how these may inform avoidance implementation is required. Patient and public involvement (PPI) was not reported in included articles, although two studies used participatory methods. CONCLUSION There is limited research on family asthma trigger management, particularly what influences current management behaviours. Variation in families' ability to identify important triggers, understand exposure risk and consistently reduce exposures warrants further exploratory research to explain how families reach avoidance decisions, and what future interventions should aim to address. Further PPI-informed research to address such gaps, could enable theory-based, person-centred interventions to improve the uptake of asthma trigger remediation. PATIENT OR PUBLIC CONTRIBUTION An asthma-specific PPI group contributed to the decision-making for the funding for the wider project this review sits within. The findings of this scoping review have informed the subsequent phases of the project, and this was discussed with PPI groups (both adult and CYP groups) when proposing the next phases of the project.
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Affiliation(s)
- Grace Lewis
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Linda Milnes
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK
| | - Alexandra Adams
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
| | - Jürgen Schwarze
- Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Child Life and Health, Centre for Inflammation ResearchThe University of EdinburghEdinburghUnited Kingdom
| | - Alistair Duff
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK,Asthma UK Centre for Applied Research, USHER InstituteUniversity of EdinburghEdinburghUK,Paediatric Respiratory UnitLeeds Children's HospitalLeedsUK
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Zhang YF, Yang LD. Exercise training as an adjunctive therapy to montelukast in children with mild asthma: A randomized controlled trial. Medicine (Baltimore) 2019; 98:e14046. [PMID: 30633202 PMCID: PMC6336542 DOI: 10.1097/md.0000000000014046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study investigated the effectiveness and safety of exercise training (ET) as an adjunctive therapy to montelukast for children with mild asthma (MA). METHODS A total of 72 children, ages 4 to 12 years with MA were randomly assigned to a treatment group or a control group at a ratio of 1:1. The subjects in the treatment group received ET plus montelukast, while the participants in the control group received montelukast alone. The primary endpoint was lung function, as measured by forced expiratory volume in 1 second (FEV1) and ratio between FEV1 and forced vital capacity (FEV1/FVC). The secondary endpoints included the symptom improvements, as measured by clinical assessment score, and quality of life (QoL), as assessed with Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores. In addition, adverse events were also assessed during the period of this study. All outcomes were measured at baseline, at the end of 6-week treatment and 2-week follow-up after the treatment. RESULTS After 6-week treatment and 2-week follow-up, although ET plus montelukast did not show better effectiveness in improving lung function, as evaluated by the FEV1 (P > .05) and FEV1/FVC (P > .05) than montelukast alone, significant relief in clinical symptoms (P < .01), and improvement in QoL (P < .01) have achieved. Additionally, both groups had similar safety profile. CONCLUSION The results of this study showed that ET as an adjunctive therapy to montelukast may benefit for children with MA. Further studies are still needed to warrant the results of this study.
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O'Brien CE, Tsirilakis K, Santiago MT, Goldman DL, Vicencio AG. Heterogeneity of lower airway inflammation in children with severe-persistent asthma. Pediatr Pulmonol 2015; 50:1200-4. [PMID: 25739748 DOI: 10.1002/ppul.23165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/15/2015] [Accepted: 01/21/2015] [Indexed: 12/21/2022]
Abstract
RATIONALE The treatment of children with severe-persistent asthma remains problematic. Recent studies suggest that stratification of this cohort by inflammatory type may be useful in designing effective treatment strategies. In this study, we examined the inflammatory profile in bronchoalveolar lavage fluid from children with severe-persistent asthma and compared this profile with serum IgE levels. METHODS The inflammatory profile in the bronchoalveolar fluid from 32 children who met criteria for severe-persistent asthma as defined by the Severe Asthma Research Program (SARP) were analyzed retrospectively. Inflammatory patterns were classified as neutrophilic, eosinophilic, mixed, or pauci-granulocytic. Serum total IgE was measured prior to bronchoscopy and determined by ELISA at each hospital's lab by standard procedures. RESULTS The most common pattern of inflammation in this cohort was neutrophilic (37.5%) followed by eosinophilic (28.1%), mixed (21.9%), and pauci-granulocytic (11.1%). The odds ratio of an eosinophilic BAL pattern for patients with an elevated serum IgE was 4.67 (CI 0.78-28, P = 0.12). A correlation between serum IgE levels and BAL eosinophil percentages was present (P = 0.04). CONCLUSIONS To our knowledge, ours is one of few studies to systematically investigate the pattern of lower airway inflammation in children with severe-persistent asthma. Our results differ from a recent investigation in children, showing more heterogeneity and a greater proportion of neutrophilic inflammation. Further investigation is required to determine whether specific inflammatory patterns are associated with specific etiologies, and whether individualized therapy is warranted.
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Affiliation(s)
- Caitlin E O'Brien
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kalliope Tsirilakis
- Department of Pediatrics, Cohen Children's Medical Center of New York, Hofstra University School of Medicine, New Hyde Park, New York
| | - Maria Teresa Santiago
- Department of Pediatrics, Cohen Children's Medical Center of New York, Hofstra University School of Medicine, New Hyde Park, New York
| | - David L Goldman
- Divisions of Pediatrics and Microbiology, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | - Alfin G Vicencio
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
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Abstract
Control of asthma symptoms is fundamental to asthma management. New asthma guidelines suggest that asthma control, for most patients, can be achieved through education aimed at improving management. This includes providing written asthma management plans from health care providers; instructions on proper inhaler use; education about early signs and symptoms of asthma, and how to respond appropriately; medication regimens that prevent misuse of medications; follow-up medical care for long-term management of asthma after any hospitalization due to asthma; and assistance with assessing and reducing exposure to environmental risk factors in patients’ home, school, and work environments. The Shared Medical Appointment (SMA) is a group appointment model that has the potential to change the management of children with asthma for the better by offering benefits to both the health care provider and the patient. The SMA for children with asthma and their caregivers is an innovative 90-minute medical appointment in which 4 to 9 patients and their parents are seen at the same time in a supportive group setting. In addition to having concerns and questions about asthma addressed, the SMA provides education on medications, monitoring symptoms, and the demonstration and distribution of devices. Supportive materials are provided and discussed and education is emphasized through open group discussion and the participation of both caregiver and child. A brief, focused medical examination is also conducted. In this study, the charts of children with asthma who attended an SMA were reviewed for specific asthma-related clinical outcomes as defined by the National Heart, Lung, and Blood Institute’s, Expert Panel Review-3 (NHLBI-EPR-3) in the 4-month period prior to attending an SMA and during the 4-month period after attending an SMA. The results showed that asthma education provided in an SMA, as compared with a usual appointment, resulted in a significant positive impact on asthma-related outcomes in meeting NHLBI-EPR-3 guidelines for asthma management.
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Wildhaber J, Carroll WD, Brand PLP. Global impact of asthma on children and adolescents' daily lives: the room to breathe survey. Pediatr Pulmonol 2012; 47:346-57. [PMID: 22028276 DOI: 10.1002/ppul.21557] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 06/08/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish children and adolescents' perspectives regarding their asthma and its impact upon their daily lives. DESIGN A 14-item questionnaire. SETTING Canada, Greece, Hungary, The Netherlands, the United Kingdom, and South Africa. PARTICIPANTS Children/adolescents (aged 8-15 years) with physician-diagnosed asthma. INTERVENTION Interviews were conducted by telephone (Canada, Greece, Hungary, The Netherlands, and the United Kingdom) or face-to-face (South Africa). OUTCOME MEASURES Asthma symptoms, impact on activities, and quality of life. RESULTS Of the 943 children/adolescents interviewed, 60% were male. Most (81%) described their asthma as "not too bad" or "I only get it every now and then," with only 4% reporting their asthma as being "very bad"; however, 92% experienced asthma-related coughing and 59% reported nocturnal awakening. Over half (57%) of children/adolescents believed they could predict when their asthma would make them ill; the most common initial symptoms being breathlessness (41%) and bad cough (33%). They considered the worst things about having asthma to be the symptoms of an asthma attack (32%) and not being able to play sport (25%). Almost half (47%) of children/adolescents felt that their asthma affected their ability to play sport or engage in physical activity. One in ten reported they had suffered asthma-related bullying. CONCLUSIONS Children/adolescents underestimate the severity of their asthma, and overestimate its control, indicating that they expect their illness to be symptomatic. Asthma has a substantial impact on their daily lives, particularly on physical activity and social functioning. Efforts are required to improve asthma control and expectations of health in children/adolescents.
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Friedman T. Diagnosing asthma in young children: current research & recommendations. J Pediatr Health Care 2010; 24:305-11. [PMID: 20804950 DOI: 10.1016/j.pedhc.2009.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/06/2009] [Accepted: 08/16/2009] [Indexed: 11/17/2022]
Abstract
Asthma is the leading pediatric chronic illness in the United States, and there has been a steady increase in the incidence of asthma in children younger than 6 years of age. Early intervention for asthma decreases morbidity, controls health care costs, and may even preserve lung function. Asthma is difficult to diagnose in young children and is under-diagnosed in this population. It is important for primary care nurse practitioners to diagnose asthma in young children in a timely manner so that therapy can be initiated. This article reviews current recommendations for diagnosing asthma in young children and highlights new and promising diagnostic tools for asthma.
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Affiliation(s)
- Tamar Friedman
- University of Pennsylvania, School of Nursing, 271 Linden Ln, Merion, PA 19006, USA.
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Pedersen S, Potter P, Dachev S, Bosheva M, Kaczmarek J, Springer E, Dunkel J, Engelstätter R. Efficacy and safety of three ciclesonide doses vs placebo in children with asthma: the RAINBOW study. Respir Med 2010; 104:1618-28. [PMID: 20619624 DOI: 10.1016/j.rmed.2010.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of three doses of ciclesonide (with or without spacer) in children with persistent asthma. PATIENTS AND METHODS This was a multicentre, double-blind, placebo-controlled, 12-week study of ciclesonide 40, 80 or 160 μg (once daily pm). Children (6-11 years) were randomised 1:1 to treatment via a metered dose inhaler (MDI) or MDI plus spacer. The primary variable was change from baseline in mean morning peak expiratory flow (PEF). Secondary variables included: time to first lack of efficacy (LOE), asthma control, forced expiratory volume in 1 s (FEV(1)), asthma symptom score and quality of life (QoL). Safety assessments included: adverse events (AEs), urinary cortisol excretion and body height. RESULTS In total, 1073 children received treatment. At endpoint, mean morning PEF significantly improved with all doses of ciclesonide vs. placebo. There was no difference over placebo in time to first LOE, but ciclesonide was superior to placebo on asthma control, symptom score, FEV(1) and QoL. There were no differences between the spacer or non-spacer subgroups. The incidences of AEs were comparable between treatment groups (approximately 35%) and there were no between-group differences in body height or urinary cortisol. CONCLUSIONS Ciclesonide 40-160 μg once daily is effective and well tolerated in children with persistent asthma; its efficacy and safety are unaffected by the use of a spacer. clinicaltrials.gov registration number: NCT00384189.
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Affiliation(s)
- Søren Pedersen
- University of Southern Denmark, Pediatric Research Unit, Kolding Hospital, Kolding, Denmark.
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