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Moore CM, Thornburg J, Secor EA, Hamlington KL, Schiltz AM, Freeman KL, Everman JL, Fingerlin TE, Liu AH, Seibold MA. Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295971. [PMID: 37790375 PMCID: PMC10543064 DOI: 10.1101/2023.09.22.23295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes. Objective Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes. Methods We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations. Results 81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels. Conclusions Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden. CLINICAL IMPLICATIONS In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures. CAPSULE SUMMARY Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.
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Wray JA, Sheehan BE, Rees VW, Cooper D, Morgan E, Plunk AD. A Qualitative Study of Unfairness and Distrust in Smoke-free Housing. Am J Health Behav 2021; 45:798-809. [PMID: 34702428 DOI: 10.5993/ajhb.45.5.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Whereas smoke-free housing (SFH) has the potential to protect residents from tobacco smoke, evidence suggests that SFH could lead to increased indoor smoking. In this study, we examine how perceptions of a residential smoking ban could be related to non-compliance. Methods: We conducted 8 focus group interviews of low-income housing residents living in Norfolk, Virginia (N=53). Interviews were semi-structured and based on a list of guided questions related to SFH compliance, developed in partnership with a standing community advisory board comprised of low-income housing residents. Results: Several themes emerged, including pervasive non-compliance, perceived unfairness and shame, barriers to compliance, and distrust of the housing authority. Smokers reported behavior primarily motivated by punishment avoidance, rather than out of any perceived obligation to comply with the ban. Conclusions: Results led us to consider Procedural Justice Theory as a conceptual framework, in which compliance is directly related to perceptions about the legitimacy of a rule or authority. When compliance is low due to a lack of perceived legitimacy, SFH should be adapted to promote changes in smoking behavior. We offer specific theory-supported adaptations to SFH focused on trust-building and improving perceived fairness.
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Affiliation(s)
- Jasilyn A. Wray
- Jasilyn A. Wray, Research Coordinator, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Brynn E. Sheehan
- Brynn E. Sheehan, Assistant Professor, Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Vaughan W. Rees
- Vaughan W. Rees, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Diane Cooper
- Diane Cooper, Community Advisory Board, Norfolk, VA, United States
| | - Emma Morgan
- Emma Morgan, Community Advisory Board, Norfolk, VA, United States
| | - Andrew D. Plunk
- Andrew D. Plunk, Associate Professor, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States;,
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Sismanlar Eyuboglu T, Aslan AT, Kose M, Pekcan S, Hangul M, Gulbahar O, Cingirt M, Bedir Demirdag T, Tezer H, Budakoglu II. Passive Smoking and Disease Severity in Childhood Pneumonia Under 5 Years of Age. J Trop Pediatr 2020; 66:412-418. [PMID: 31774539 DOI: 10.1093/tropej/fmz081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To objectively investigate the effect of passive smoking on pneumonia and disease severity in children aged less than 5 years by using cotinine as an indicator of passive smoking. METHODS Between December 2015 and April 2016, children aged less than 5 years with pneumonia and age-matched healthy controls were included in this study, which was conducted at three tertiary pediatric pulmonology centers. A questionnaire was given to the parents regarding demographic data and smoking status at home. Urinary cotinine/creatinine ratio (CCR) was measured. The data from the pneumonia and control groups, as well as children with mild and severe pneumonia within the pneumonia group, were compared. RESULTS A total of 227 subjects were included in the study; there were 74 children in the pneumonia group and 153 in the control group. The mean age of all the children was 33.4 ± 1.28 months. Of all subjects, 140 were male and 102 were exposed to passive smoking by their parents at home. There were statistically significant differences in age, number of people in the home, and mother's and father's age between the control and pneumonia groups (p < 0.05). No difference was found in the CCR in the control and pneumonia group (p > 0.05). Age and urinary CCR were significantly different between children with mild and severe pneumonia (p < 0.05). CONCLUSION We showed that passive smoking exposure was associated with the development of severe pneumonia in children. Further studies are needed to examine the underlying cause in detail.
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Affiliation(s)
- Tugba Sismanlar Eyuboglu
- Department of Pediatric Pulmonology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey 06080
| | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey 38030
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey 42090
| | - Melih Hangul
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey 38030
| | - Ozlem Gulbahar
- Department of Medical Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
| | - Mehmet Cingirt
- Department of Medical Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
| | - Tuga Bedir Demirdag
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
| | - Isıl Irem Budakoglu
- Department of Medical Education, Faculty of Medicine, Gazi University, Ankara, Turkey 06560
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Abstract
This article on exposome and asthma focuses on the interaction of patients and their environments in various parts of their growth, development, and stages of life. Indoor and outdoor environments play a role in pathogenesis via levels and duration of exposure, with genetic susceptibility as a crucial factor that alters the initiation and trajectory of common conditions such as asthma. Knowledge of environmental exposures globally and changes that are occurring is necessary to function effectively as medical professionals and health advocates.
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Affiliation(s)
- Ahila Subramanian
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA
| | - Sumita B Khatri
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA.
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Fagnano M, Thorsness S, Butz A, Halterman JS. Provider Counseling About Secondhand Smoke Exposure for Urban Children With Persistent or Poorly Controlled Asthma. J Pediatr Health Care 2018; 32:612-619. [PMID: 30064929 PMCID: PMC6341479 DOI: 10.1016/j.pedhc.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/08/2018] [Indexed: 11/21/2022]
Abstract
Urban children continue to be exposed to secondhand smoke (SHS), and this is particularly concerning for children with asthma. The objective of this study is to describe SHS exposure among urban children with asthma and assess SHS counseling delivered at primary care visits. We interviewed caregivers of 318 children (2-12 years) with persistent asthma at the time of a health care visit and reviewed medical records. We found that one third (32%) of children lived with a caregiver who smoked and that 15% lived with other smokers. Children whose caregivers smoked had the lowest prevalence of home smoking bans compared with homes with other smokers and no smokers (65% vs. 72% vs. 95%, respectively). Overall, 67% of caregivers received some SHS counseling. Providers most often counseled caregiver smokers; counseling occurred less frequently for caregivers in homes with other or no smokers. Further efforts to improve provider SHS counseling for all children with asthma are needed.
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Podlecka D, Malewska-Kaczmarek K, Jerzyńska J, Stelmach W, Stelmach I. Secondhand smoke exposure increased the need for inhaled corticosteroids in children with asthma. Ann Allergy Asthma Immunol 2018; 121:119-121. [PMID: 29709642 DOI: 10.1016/j.anai.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Kamila Malewska-Kaczmarek
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Wlodzimierz Stelmach
- Social Medicine Institute Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland.
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Oluwole O, Rennie DC, Senthilselvan A, Dyck R, Afanasieva A, Kirychuk S, Katselis G, Lawson JA. The association between endotoxin and beta-(1 → 3)-D-glucan in house dust with asthma severity among schoolchildren. Respir Med 2018; 138:38-46. [PMID: 29724391 DOI: 10.1016/j.rmed.2018.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/13/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Asthma severity can be affected by microbial exposures. However, less is known about the specific indoor agents aggravating the disease in children. We examined the associations between indoor endotoxin and beta-(1 → 3)-D-glucan exposures and asthma severity in children with asthma. METHODS A clinical cross-sectional study of schoolchildren (aged 7-17 years) was conducted in the province of Saskatchewan, Canada. Children with asthma (n = 116) were identified from 335 participants using a combination of survey responses and objective clinical assessments. We then ascertained asthma severity based on recommended guidelines (continuous daytime asthma symptoms, frequent nighttime asthma symptoms, and ≤ 60% predicted FEV1). Levels of indoor endotoxin and beta-(1 → 3)-D-glucan were measured in dust samples obtained from play area floors and child's mattresses. RESULTS The study population of 116 children with asthma was comprised of 75.9% mild asthma and 24.1% moderate/severe asthma. Higher mattress endotoxin concentration was associated with increased odds of moderate/severe asthma [adjusted odds ratio (aOR) = 11.40, 95% confidence interval (CI): 1.45-89.43] while higher beta-(1 → 3)-D-glucan concentration (aOR = 0.16, 95% CI: 0.03-0.89) and load (aOR = 0.10, 95% CI: 0.02-0.72) in play areas were inversely associated with moderate/severe asthma. Furthermore, higher mattress endotoxin concentration was associated with lower FVC (p = 0.01) and FEV1 (p = 0.03). These associations were not seen for beta-(1 → 3)-D-glucan. CONCLUSION Our results showed differential effects of microbial exposures on childhood asthma severity and further highlight domestic endotoxin exposure effects on respiratory health outcomes in children with asthma.
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Affiliation(s)
- Oluwafemi Oluwole
- Department of Community Health and Epidemiology, University of Saskatchewan, 104 Clinic Place Saskatoon, SK, S7N 2Z4, Canada; Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada.
| | - Donna C Rennie
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada; College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | | | - Roland Dyck
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Anna Afanasieva
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada
| | - Shelley Kirychuk
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - George Katselis
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Joshua A Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, PO Box 23, Saskatoon, SK, S7N 2Z4, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Hatoun J, Davis-Plourde K, Penti B, Cabral H, Kazis L. Tobacco Control Laws and Pediatric Asthma. Pediatrics 2018; 141:S130-S136. [PMID: 29292313 DOI: 10.1542/peds.2017-1026p] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exposure to environmental tobacco smoke increases pediatric asthma severity. Strict, state-level tobacco control reduces smoking. The Child Asthma Call-Back Survey (Child ACBS) is a nationally representative survey of the guardians of children with asthma. The American Lung Association's annual State of Tobacco Control report grades tobacco control laws in each state including a tax grade (cigarette excise tax relative to the national mean), and a smoke-free air grade (number of locations where smoking is prohibited). METHODS We joined Child ACBS data from 2006 to 2010 with corresponding state and year tobacco grades. In the primary analysis, we investigated the effect of state tax grades on a child's asthma severity by using a logistic regression model adjusting for year. A secondary analysis assessed the impact of smoke-free air grades on in-home smoking. RESULTS Our analysis included 12 860 Child ACBS interviews from 35 states over 5 years, representing over 24 million individuals. We merged 112 unique State of Tobacco Control grades with patient data by state and year. A higher tax grade was associated with reduced severity (adjusted odds ratio = 1.40; P = .007, 95% confidence interval: 1.10-1.80). A better smoke-free air grade was not associated with decreased in-home smoking after adjusting for confounding by income and type of residence. CONCLUSIONS A stronger tobacco tax is associated with reduced asthma severity. Further study is needed to determine the effect of smoke-free air laws on in-home environmental. This work supports ongoing efforts to strengthen tobacco control through federal and state regulations.
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Affiliation(s)
- Jonathan Hatoun
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
| | | | - Brian Penti
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Howard Cabral
- School of Public Health, Boston University, Boston, Massachusetts; and
| | - Lewis Kazis
- School of Public Health, Boston University, Boston, Massachusetts; and
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Miadich SA, Everhart RS, Heron KE, Cobb CO. Medication use, sleep, and caregiver smoking status among urban children with asthma. J Asthma 2017; 55:588-595. [PMID: 28759271 DOI: 10.1080/02770903.2017.1350969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Children living in urban settings from low-income, minority families are at a high risk for experiencing asthma morbidity. Environmental tobacco smoke (ETS, i.e., secondhand) exposure, typically from caregiver smoking, has been associated with increased quick-relief medication use and child nocturnal awakenings due to increased asthma symptoms as well as worse sleep quality in children with asthma. This study investigated the moderating role of caregiver smoking status on the association between quick-relief medication use and child's sleep quality in urban children with persistent asthma. METHODS Fifty-four urban children with persistent asthma and their primary caregivers completed a baseline research session. Caregivers then completed ecological momentary assessment surveys via smartphones twice daily for two weeks in which smoking behaviors, child quick-relief medication use, and child's sleep quality were assessed. RESULTS Twenty caregivers (37%) reported smoking at least one day across the two-week period. The caregiver smoking status significantly moderated the association between quick-relief medication use and child's sleep quality after controlling for child age and monthly household income. The caregiver smoking status exacerbated the association between quick-relief medication use and child's sleep quality, such that more medication usage was associated with worse sleep quality. CONCLUSIONS Findings suggest that in urban families with a caregiver who smokes, more daily quick-relief medication use may put children at an increased risk for worse sleep quality. The effects of ETS exposure on child's sleep quality in addition to child asthma symptoms should be an integral part of discussions between pediatric healthcare providers and families of children with asthma.
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Affiliation(s)
- Samantha A Miadich
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Robin S Everhart
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Kristin E Heron
- b Department of Psychology , Old Dominion University , Norfolk , VA , USA
| | - Caroline O Cobb
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
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Hollenbach JP, Schifano ED, Hammel C, Cloutier MM. Exposure to secondhand smoke and asthma severity among children in Connecticut. PLoS One 2017; 12:e0174541. [PMID: 28362801 PMCID: PMC5375151 DOI: 10.1371/journal.pone.0174541] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether secondhand smoke (SHS) exposure is associated with greater asthma severity in children with physician-diagnosed asthma living in CT, and to examine whether area of residence, race/ethnicity or poverty moderate the association. METHODS A large childhood asthma database in CT (Easy Breathing) was linked by participant zip code to census data to classify participants by area of residence. Multinomial logistic regression models, adjusted for enrollment date, sex, age, race/ethnicity, area of residence, insurance type, family history of asthma, eczema, and exposure to dogs, cats, gas stove, rodents and cockroaches were used to examine the association between self-reported exposure to SHS and clinician-determined asthma severity (mild, moderate, and severe persistent vs. intermittent asthma). RESULTS Of the 30,163 children with asthma enrolled in Easy Breathing, between 6 months and 18 years old, living in 161 different towns in CT, exposure to SHS was associated with greater asthma severity (adjusted relative risk ratio (aRRR): 1.07 [1.00, 1.15] and aRRR: 1.11 [1.02, 1.22] for mild and moderate persistent asthma, respectively). The odds of Black and Puerto Rican/Hispanic children with asthma being exposed to SHS were twice that of Caucasian children. Though the odds of SHS exposure for publicly insured children with asthma were three times greater than the odds for privately insured children (OR: 3.02 [2.84,3,21]), SHS exposure was associated with persistent asthma only among privately insured children (adjusted odds ratio (aOR): 1.23 [1.11,1.37]). CONCLUSION This is the first large-scale pragmatic study to demonstrate that children exposed to SHS in Connecticut have greater asthma severity, clinically determined using a systematic approach, and varies by insurance status.
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Affiliation(s)
- Jessica P. Hollenbach
- Asthma Center, Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
- * E-mail:
| | - Elizabeth D. Schifano
- Department of Statistics, University of Connecticut, Storrs, Connecticut, United States of America
| | - Christopher Hammel
- University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
| | - Michelle M. Cloutier
- Asthma Center, Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
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Kuti BP, Omole KO, Kuti DK. Factors associated with childhood asthma control in a resource-poor center. J Family Med Prim Care 2017; 6:222-230. [PMID: 29302522 PMCID: PMC5749061 DOI: 10.4103/jfmpc.jfmpc_271_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. Methods: Over a 12-month study period, children aged 2–14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. Results: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P < 0.05). Low socioeconomic class (odds ratio [OR] =6.231; 95% confidence interval [CI] =1.022–8.496; P = 0.005) and poor parental asthma knowledge (OR = 7.607; 95% CI = 1.011–10.481; P = 0.007) independently predict suboptimal control. Conclusion: Approximately, one in five asthmatic children attending the WGH pediatric chest clinic who participated in the study had suboptimal asthma control during the study. More comprehensive parental/child asthma education and provision of affordable asthma care services may help improve asthma control among the children.
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Affiliation(s)
- Bankole Peter Kuti
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Ilesa, Nigeria.,Department of Paediatrics, Wesley Guild Hospital, Ilesa, Nigeria
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Abstract
Indoor environmental exposures, particularly allergens and pollutants, are major contributors to asthma morbidity in children; environmental control practices aimed at reducing these exposures are an integral component of asthma management. Some individually tailored environmental control practices that have been shown to reduce asthma symptoms and exacerbations are similar in efficacy and cost to controller medications. As a part of developing tailored strategies regarding environmental control measures, an environmental history can be obtained to evaluate the key indoor environmental exposures that are known to trigger asthma symptoms and exacerbations, including both indoor pollutants and allergens. An environmental history includes questions regarding the presence of pets or pests or evidence of pests in the home, as well as knowledge regarding whether the climatic characteristics in the community favor dust mites. In addition, the history focuses on sources of indoor air pollution, including the presence of smokers who live in the home or care for children and the use of gas stoves and appliances in the home. Serum allergen-specific immunoglobulin E antibody tests can be performed or the patient can be referred for allergy skin testing to identify indoor allergens that are most likely to be clinically relevant. Environmental control strategies are tailored to each potentially relevant indoor exposure and are based on knowledge of the sources and underlying characteristics of the exposure. Strategies include source removal, source control, and mitigation strategies, such as high-efficiency particulate air purifiers and allergen-proof mattress and pillow encasements, as well as education, which can be delivered by primary care pediatricians, allergists, pediatric pulmonologists, other health care workers, or community health workers trained in asthma environmental control and asthma education.
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13
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Alicea-Alvarez N, Foppiano Palacios C, Ortiz M, Huang D, Reeves K. Path to health asthma study: A survey of pediatric asthma in an urban community. J Asthma 2016; 54:273-278. [PMID: 27485682 DOI: 10.1080/02770903.2016.1216564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Minority children with asthma who live in low-income urban communities bear a disproportionate burden of the disease. This study explores the perceived health care needs related to asthma care, identifies asthma triggers, potential barriers to care, and assesses the need for additional community resources. METHODS We conducted a cross-sectional survey of Hispanic and African American adults (n = 53) who take care of a child with asthma and live in an urban community of North Philadelphia. Input from community leaders was obtained in the development the survey tool resulting in a unique 'community-centric' questionnaire. The survey was also available in Spanish. All surveys were conducted in the community setting. RESULTS Variables were used to measure asthma severity and triggers. Children were categorized with intermittent (n = 24, 45.3%), mild persistent (n = 13, 24.5%), or moderate-to-severe persistent asthma (n = 16, 30.2%). Most children with persistent asthma were enrolled under Medicaid or CHIP (n = 24, p = 0.011) and reflected a low-income socioeconomic status. Persistent asthma was found to be associated with most triggers: pets, dust mites, mice, mold, and cockroaches. There was no significant association between environmental tobacco smoke and persistent asthma. Children with persistent asthma and 2 or more triggers were more likely to be hospitalized and go to the Emergency Department. CONCLUSION Urban minority children living in low-income communities face neighborhood-specific asthma triggers and challenges to care. Studies conducted in urban neighborhoods, with collaboration from community members, will highlight the need of comprehensive services to account for community-centric social determinants.
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Affiliation(s)
| | - Carlo Foppiano Palacios
- b Internal Medicine/Pediatrics, University of Maryland Medical Center , Baltimore , MD , USA
| | - Melanie Ortiz
- c Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
| | - Diana Huang
- c Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
| | - Kathleen Reeves
- d Office of Health Equity, Diversity and Inclusion Director, Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
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Difficult-to-control asthma: epidemiology and its link with environmental factors. Curr Opin Allergy Clin Immunol 2016; 15:397-401. [PMID: 26226354 DOI: 10.1097/aci.0000000000000195] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW The aim of the present review was to discuss the epidemiology of inadequate asthma control with an examination of contributing environmental factors. RECENT FINDINGS Despite advances in asthma therapies, a proportion of patients with asthma continue to have difficulty in gaining adequate asthma control. Asthma severity and control in childhood are of particular importance as they translate to asthma morbidity in adulthood. Children with comorbid severe allergic rhinitis were more likely to have uncontrolled asthma. Recent data suggest that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen exposure. Tobacco smoke exposure, even passive exposure, leads to increased asthma symptoms and decreased response to inhaled corticosteroids. Efforts to ban smoking in public places have resulted in promising asthma results for entire populations. Energy-saving efforts to tighten a home's air leaks can lead to increased indoor pollutant levels and, therefore, must be accompanied by efforts to reduce, filter, or exchange indoor pollutants. Obesity is independently associated with decreased asthma control. Furthermore, the detrimental effects of pollutant exposure are enhanced in an overweight individual with asthma. SUMMARY Lack of asthma control can be because of a complex web of factors including adherence, intrinsic factors, and environmental exposures. Further research into intervention strategies is needed to achieve improved rates of asthma control.
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Asthma in Urban Children: Epidemiology, Environmental Risk Factors, and the Public Health Domain. Curr Allergy Asthma Rep 2016; 16:33. [DOI: 10.1007/s11882-016-0609-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang Z, May SM, Charoenlap S, Pyle R, Ott NL, Mohammed K, Joshi AY. Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2015; 115:396-401.e2. [DOI: 10.1016/j.anai.2015.08.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/25/2015] [Accepted: 08/03/2015] [Indexed: 01/29/2023]
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Secondhand Smoke Exposure and Illness Severity among Children Hospitalized with Pneumonia. J Pediatr 2015; 167:869-874.e1. [PMID: 26231828 PMCID: PMC4586387 DOI: 10.1016/j.jpeds.2015.06.049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/22/2015] [Accepted: 06/24/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the relationship between secondhand smoke (SHS) exposure and disease severity among children hospitalized with community-acquired pneumonia (CAP). STUDY DESIGN Children hospitalized with clinical and radiographic CAP were enrolled between January 1, 2010, and June 30, 2012 at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community study. Household SHS exposure was defined based on the number of smokers in the child's home. Outcomes included hospital length of stay, intensive care unit admission, and mechanical ventilation. Proportional hazards and logistic regression models were used to assess associations between SHS exposure and outcomes. All models were adjusted for age, sex, race/ethnicity, household education level, government insurance, comorbidities, enrollment site, year, and season. RESULTS Of the 2219 children included in the study, SHS exposure was reported in 785 (35.4%), including 325 (14.8%) with ≥2 smokers in the home. Compared with nonexposed children, the children exposed to ≥2 smokers had longer length of stay (median, 70.4 hours vs 64.4 hours; adjusted hazard ratio, 0.85; 95% CI, 0.75-0.97) and were more likely to receive intensive care (25.2% vs 20.9%; aOR, 1.44; 95% CI, 1.05-1.96), but not mechanical ventilation. Outcomes in children exposed to only 1 household smoker were similar to those in nonexposed children. CONCLUSION Children hospitalized with CAP from households with ≥2 smokers had a longer length of stay and were more likely to require intensive care compared with children from households with no smokers, suggesting that they experienced greater pneumonia severity.
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Abstract
Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma.
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Affiliation(s)
- Jessica P Hollenbach
- Department of Pediatrics, Asthma Center, The Children's Center for Community Research, CT Children's Medical Center, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, USA
| | - Michelle M Cloutier
- Department of Pediatrics, Asthma Center, The Children's Center for Community Research, Connecticut Children's Medical Center, University of Connecticut Health Center, 282 Washington Street, Hartford, CT 06106, USA.
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Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:6-20. [PMID: 25303775 PMCID: PMC4286274 DOI: 10.1289/ehp.1307922] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 10/09/2014] [Indexed: 05/18/2023]
Abstract
BACKGROUND Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma. OBJECTIVES In this review we provide an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma. METHODS Peer-reviewed articles published from 2000 to 2013 on indoor exposures and exacerbation of asthma were identified through PubMed, from reference lists, and from authors' files. Articles that focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence. RESULTS Sixty-nine eligible articles were included. Major changed conclusions include a causal relationship with exacerbation for indoor dampness or dampness-related agents (in children); associations with exacerbation for dampness or dampness-related agents (in adults), endotoxin, and environmental tobacco smoke (in preschool children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, nitrogen dioxide, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents. DISCUSSION This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until all available evidence is examined more thoroughly. CONCLUSION Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in nonsensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.
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Costa LD, Costa PS, Camargos PA. Exacerbation of asthma and airway infection: is the virus the villain? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [PMCID: PMC7185549 DOI: 10.1016/j.jpedp.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objetivo Rever a literatura disponível sobre a relação entre infecção viral aguda do trato respiratório e o desencadeamento de exacerbações da asma, identificando os vírus mais prevalentes, os métodos de detecção, bem como os aspectos preventivos e terapêuticos. Fonte dos dados Foi realizada uma busca nas bases de dados PubMed, SciELO e Lilacs utilizando os descritores: asma, exacerbação, vírus, criança e infecção respiratória aguda, entre os anos de 2002 e 2013. Síntese dos dados Foram selecionados 42 artigos originais que tratavam da identificação de vírus respiratórios durante episódios de exacerbação da asma, em sua maioria estudos transversais. Houve ampla variação na metodologia dos trabalhos avaliados, principalmente em relação à idade das crianças e métodos de coleta e detecção viral. Os resultados apontam que, em até 92,2% das exacerbações, um agente viral foi potencialmente o principal fator desencadeante, sendo o rinovírus humano o mais identificado. O padrão de circulação viral pode ter sido responsável pela sazonalidade das exacerbações. A associação entre infecção viral e inflamação alérgica parece ser determinante para levar ao descontrole clínico‐funcional da asma, porém poucos estudos avaliaram outros fatores desencadeantes em associação com a infecção viral. Conclusões Os vírus respiratórios estão presentes na maioria das crianças asmáticas durante os episódios de exacerbação. Os mecanismos fisiopatológicos envolvidos ainda não estão totalmente estabelecidos e o sinergismo entre a inflamação alérgica e infecção viral parece determinar o descontrole da doença. O papel dos outros agentes desencadeantes e protetores não estão claramente determinados.
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Affiliation(s)
- Lusmaia D.C. Costa
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil
- Autor para correspondência.
| | - Paulo Sucasas Costa
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, GO, Brasil
| | - Paulo A.M. Camargos
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
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Costa LDC, Costa PS, Camargos PAM. Exacerbation of asthma and airway infection: is the virus the villain? J Pediatr (Rio J) 2014; 90:542-55. [PMID: 25261603 PMCID: PMC7094671 DOI: 10.1016/j.jped.2014.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review the available literature on the association between acute viral respiratory tract infection and the onset of asthma exacerbations, identifying the most prevalent viruses, detection methods, as well as preventive and therapeutic aspects. SOURCES A search was conducted in PubMed, Lilacs, and SciELO databases, between the years 2002 and 2013, using the following descriptors: asthma exacerbation, virus, child, and acute respiratory infection. SUMMARY OF THE FINDINGS A total of 42 original articles addressing the identification of respiratory viruses during episodes of asthma exacerbation were selected, mostly cross-sectional studies. There was a wide variation in the methodology of the assessed studies, particularly in relation to the children's age and methods of collection and viral detection. The results indicate that, in up to 92.2% of exacerbations, a viral agent was potentially the main triggering factor, and human rhinovirus was the most frequently identified factor. The pattern of viral circulation may have been responsible for the seasonality of exacerbations. The association between viral infections and allergic inflammation appears to be crucial for the clinical and functional uncontrolled asthma, but few studies have evaluated other triggering factors in association with viral infection. CONCLUSIONS Respiratory viruses are present in the majority of asthmatic children during episodes of exacerbation. The involved physiopathological mechanisms are yet to be fully established, and the synergism between allergic inflammation and viral infection appears to determine uncontrolled disease. The role of other triggering and protective agents is yet to be clearly determined.
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Affiliation(s)
- Lusmaia D C Costa
- Department of Pediatrics, School of Medicine, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
| | - Paulo Sucasas Costa
- Department of Pediatrics, School of Medicine, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Paulo A M Camargos
- Department of Pediatrics, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Schwartz J, Bottorff JL, Richardson CG. Secondhand smoke exposure, restless sleep, and sleep duration in adolescents. SLEEP DISORDERS 2014; 2014:374732. [PMID: 24808961 PMCID: PMC3997916 DOI: 10.1155/2014/374732] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/10/2013] [Accepted: 03/18/2014] [Indexed: 11/24/2022]
Abstract
Purpose. To examine whether secondhand smoke (SHS) exposure is associated with restless sleep and/or nighttime sleep duration among adolescents. Methods. Data were analyzed from 1,592 adolescents who completed an internet-delivered survey as part of the British Columbia Adolescent Substance Use Survey cohort study. Ordinal logistic and linear regression models were used to examine associations between frequency of SHS exposure in the past month and frequency of restless sleep and nighttime sleep duration, respectively. Results. SHS exposure was significantly positively associated with restless sleep and significantly negatively associated with sleep duration. In fully adjusted models, compared with students who reported never being exposed to SHS in the past month, students who reported a low, medium, or high frequency of SHS exposure were 1.53, 1.76, and 2.51 times as likely, respectively, to report more frequent restless sleep (OR = 1.53, 95% CI 1.08-2.16; OR = 1.76, 95% CI 1.22-2.53; OR = 2.51, 95% CI 1.59-3.98). With regard to sleep duration, as frequency of SHS exposure increased by one category, nighttime sleep duration during the week and weekend decreased by 4 minutes (B = -0.06, 95% CI = -0.01- - 0.11) and 6 minutes (B = -0.09, 95% CI = -0.03- - 0.14), respectively. Conclusions. This study suggests that frequency of SHS exposure has a significant dose-response relationship with restless sleep and sleep duration in adolescents.
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Affiliation(s)
- Jennifer Schwartz
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Joan L. Bottorff
- School of Nursing, University of British Columbia, 3333 University Way, Kelowna, BC, Canada V6T 1Z3
| | - Chris G. Richardson
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
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Dick S, Doust E, Cowie H, Ayres JG, Turner S. Associations between environmental exposures and asthma control and exacerbations in young children: a systematic review. BMJ Open 2014; 4:e003827. [PMID: 24523420 PMCID: PMC3927936 DOI: 10.1136/bmjopen-2013-003827] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To complete a systematic review of the literature describing associations between all environmental exposures and asthma symptoms and exacerbations in children up to mean age of 9 years. DESIGN Systematic review. SETTING Reference lists of identified studies and reviews were searched for all articles published until November 2013 in electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Controls Trials Register). PARTICIPANTS Studies were selected which examined a link between exposure to environmental factors and asthma symptoms and exacerbations where the study participants were children with a mean age of ≤9 years. PRIMARY AND SECONDARY OUTCOME MEASURES Indices of asthma symptoms, control and exacerbations. RESULTS A total of 27 studies were identified including eight where inhaled allergens and four where environmental tobacco smoke (ETS) were the exposures of interest. There was evidence that exposure to allergen, ETS, poor air quality and unflued heaters had a modest magnitude of effect (ORs between 2 and 3). There was also evidence of interactions observed between exposures such as allergen and ETS. CONCLUSIONS Exposure to inhaled allergens, ETS, unflued heaters and poor air quality has an important effect on exacerbations in young children with asthma and should be minimised or, ideally, avoided. Better understanding of the effect of exposure to damp housing, air conditioning and dietary factors plus interactions between environmental exposures associated with exacerbations is required.
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Affiliation(s)
- Smita Dick
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Emma Doust
- Institute of Occupational Medicine, Edinburgh, UK
| | - Hilary Cowie
- Institute of Occupational Medicine, Edinburgh, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
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McCarville M, Sohn MW, Oh E, Weiss K, Gupta R. Environmental tobacco smoke and asthma exacerbations and severity: the difference between measured and reported exposure. Arch Dis Child 2013; 98:510-4. [PMID: 23606711 DOI: 10.1136/archdischild-2012-303109] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of measured versus reported environmental tobacco smoke (ETS) exposure on asthma severity and exacerbations in an urban paediatric population. DESIGN We analysed cross-sectional data from the Chicago Initiative to Raise Asthma Health Equity study that followed a cohort of 561 children aged 8-14 with physician-diagnosed asthma between 2003 and 2005. Participant sociodemographic data and asthma symptoms were gathered by parental survey; exposures to ETS were determined by salivary cotinine levels and parent report. Multivariable negative binomial and ordered logistic regressions were used to assess associations between ETS and asthma outcomes. RESULTS Among 466 children included in our analysis, 58% had moderate or severe persistent asthma; 32% had >2 exacerbations requiring a hospitalisation or an emergency room visit or same day care in the previous year. Half of caregivers reported that at least one household member smoked. In multivariable analyses, salivary cotinine was significantly associated with frequently reported exacerbations in the previous year (adjusted incidence rate ratio=1.39, 95% CI 1.09 to 1.79), but not significantly associated with asthma severity. Reported household smoking was not significantly associated with either asthma severity or frequency of exacerbations. CONCLUSIONS Salivary cotinine was more predictive of asthma exacerbation frequency but caregiver- reported household smoking was not. Use of a nicotine biomarker may be important in both the clinical and research settings to accurately identify an important risk factor for asthma exacerbations.
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Affiliation(s)
- Megan McCarville
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Room 1410, Chicago, IL 60612, USA.
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Wong GWK, Kwon N, Hong JG, Hsu JY, Gunasekera KD. Pediatric asthma control in Asia: phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey. Allergy 2013; 68:524-30. [PMID: 23414255 DOI: 10.1111/all.12117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We conducted Phase 2 of the Asthma Insights and Reality in the Asia-Pacific (AIRIAP 2) survey in 2006 to determine the level of asthma control in this region and the validity of the Asthma Control Test (ACT) and childhood ACT (C-ACT) in relation to asthma control. METHODS Pediatric participants (0 to <16 years; N = 988) with diagnosed asthma and current asthma symptoms or taking anti-asthma medications were recruited from 12 geographic areas in Asia. The survey consisted of the AIRIAP 2 questionnaire (asthma symptoms, use of urgent healthcare services and anti-asthma medication) and the ACT or C-ACT (English or Chinese translations only), both administered in the participant's preferred language. A symptom control index based on the Global Initiative for Asthma criteria (except lung function) was used to classify asthma control status. RESULTS Most participants had inadequately controlled asthma ('uncontrolled' = 53.4%, 528/988; 'partly controlled' = 44.0%, 435/988). Only 2.5% (25/988) had 'controlled' asthma. Demand for urgent healthcare services (51.7%, 511/988) and use of short-acting beta-agonists (55.2%, 545/988) was high. The optimal ACT and C-ACT cutoff score for detecting uncontrolled asthma (compared with controlled or partly controlled asthma) was determined to be ≤19 (receiver operating characteristic analysis) with good agreement between the ACT and C-ACT and the symptom control index. CONCLUSIONS Findings from this survey show that asthma control is suboptimal in many children in the Asia-Pacific region. Practical tools, such as the ACT or C-ACT, may help clinicians assess asthma control and facilitate adjustment of asthma medication.
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Affiliation(s)
- G. W. K. Wong
- Department of Paediatrics and School of Public Health; The Chinese University of Hong Kong; Shatin; New Territories; Hong Kong
| | | | - J. G. Hong
- Shanghai First People's Hospital; Shanghai Jiaotong University; Shanghai; China
| | - J.-Y. Hsu
- Taichung Veterans General Hospital; Taichung; Taiwan
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Kit BK, Simon AE, Brody DJ, Akinbami LJ. US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma. Pediatrics 2013; 131:407-14. [PMID: 23400612 DOI: 10.1542/peds.2012-2328] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine exposure to tobacco smoke products (TSPs), environmental tobacco smoke (ETS), and in-home smoke among youth with asthma in the United States. METHODS Nationally representative, cross-sectional data from 2250 youth aged 4 to 19 years with current asthma in the 1988-1994, 1999-2004, and 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes were use of TSPs (serum cotinine level >10 ng/mL or self-reported recent use of cigarettes, cigars, or pipes) and, among non-TSP users, ETS exposure (serum cotinine ≥0.05 ng/mL) and in-home smoke exposure (reported). Multiple logistic regression analyses assessed the associations between the outcomes and age, gender, race/ethnicity, and family income. RESULTS Among adolescents (aged 12-19 years) with asthma in 2005-2010, 17.3% reported TSP use. Among youth (aged 4-19 years) with asthma who did not use TSPs, 53.2% were exposed to ETS and 17.6% had in-home smoke exposure. Among low-income youth, 70.1% and 28.1% had exposure to ETS and in-home smoke, respectively. After controlling for sociodemographic factors, higher prevalence of exposure to ETS and in-home smoke persisted among low-income youth. Between 1988-1994 and 2005-2010, there was a decline in ETS and in-home smoke exposure (both P < .001). CONCLUSIONS ETS exposure among youth with asthma declined between 1988-1994 and 2005-2010, but a majority remained exposed in 2005-2010, with higher exposure among low-income youth. More than 1 in 6 youth with asthma in 2005-2010 were exposed to in-home smoke and a similar portion of adolescents used TSPs.
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Affiliation(s)
- Brian K Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
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Blaakman S, Tremblay PJ, Halterman JS, Fagnano M, Borrelli B. Implementation of a community-based secondhand smoke reduction intervention for caregivers of urban children with asthma: process evaluation, successes and challenges. HEALTH EDUCATION RESEARCH 2013; 28:141-52. [PMID: 22717938 PMCID: PMC3549585 DOI: 10.1093/her/cys070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 04/27/2012] [Indexed: 05/24/2023]
Abstract
Many children, including those with asthma, remain exposed to secondhand smoke. This manuscript evaluates the process of implementing a secondhand smoke reduction counseling intervention using motivational interviewing (MI) for caregivers of urban children with asthma, including reach, dose delivered, dose received and fidelity. Challenges, strategies and successes in applying MI are highlighted. Data for 140 children (3-10 years) enrolled in the School Based Asthma Therapy trial, randomized to the treatment condition and living with one or more smoker, were analyzed. Summary statistics describe the sample, process measures related to intervention implementation, and primary caregiver (PCG) satisfaction with the intervention. The full intervention was completed by 79% of PCGs, but only 17% of other smoking caregivers. Nearly all (98%) PCGs were satisfied with the care study nurses provided and felt the program might be helpful to others. Despite challenges, this intervention was feasible and well received reaching caregivers who were not actively seeking treatment for smoking cessation or secondhand smoke reduction. Anticipating the strategies required to implement such an intervention may help promote participant engagement and retention to enhance the program's ultimate success.
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Affiliation(s)
- Susan Blaakman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children’s Hospital at Strong, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA, University of Rochester School of Nursing, Box SON, Helen Wood Hall, Rochester, NY 14642, USA and Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903 USA
| | - Paul J. Tremblay
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children’s Hospital at Strong, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA, University of Rochester School of Nursing, Box SON, Helen Wood Hall, Rochester, NY 14642, USA and Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903 USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children’s Hospital at Strong, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA, University of Rochester School of Nursing, Box SON, Helen Wood Hall, Rochester, NY 14642, USA and Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903 USA
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children’s Hospital at Strong, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA, University of Rochester School of Nursing, Box SON, Helen Wood Hall, Rochester, NY 14642, USA and Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903 USA
| | - Belinda Borrelli
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children’s Hospital at Strong, Box 777, 601 Elmwood Avenue, Rochester, NY 14642, USA, University of Rochester School of Nursing, Box SON, Helen Wood Hall, Rochester, NY 14642, USA and Center for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University School of Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903 USA
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Akinbami LJ, Kit BK, Simon AE. Impact of environmental tobacco smoke on children with asthma, United States, 2003-2010. Acad Pediatr 2013; 13:508-16. [PMID: 24021528 PMCID: PMC4756763 DOI: 10.1016/j.acap.2013.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Given widespread interventions to reduce environmental tobacco smoke (ETS) exposure and improve asthma control, we sought to assess the current impact of ETS exposure on children with asthma. METHODS We analyzed 2003-2010 data for nonsmoking children aged 6 to 19 years with asthma from the National Health and Nutrition Examination Survey. Outcomes (sleep disturbance, missed school days, health care visits, activity limitation, and wheezing with exercise) were compared between ETS exposed children (serum cotinine levels 0.05 to 10 ng/mL) and unexposed children (<0.05 ng/mL) using ordinal regression adjusted for demographic characteristics. We also assessed whether associations were observable with low ETS exposure levels (0.05 to 1.0 ng/mL). RESULTS Overall, 53.3% of children aged 6 to 19 years with asthma were ETS exposed. Age-stratified models showed associations between ETS exposure and most adverse outcomes among 6- to 11-year-olds, but not 12- to 19-year-olds. Even ETS exposure associated with low serum cotinine levels was associated with adverse outcomes for 6- to 11-year-olds. Race-stratified models for children aged 6 to 19 years showed an association between ETS exposure and missing school, health care visits, and activity limitation due to wheezing among non-Hispanic white children, and disturbed sleep among non-Hispanic white and Mexican children. Among non-Hispanic black children, there was no elevated risk between ETS exposure and the assessed outcomes: non-Hispanic black children had high rates of adverse outcomes regardless of ETS exposure. CONCLUSIONS Among children with asthma 6 to 11 years of age, ETS exposure was associated with most adverse outcomes. Even ETS exposure resulting in low serum cotinine levels was associated with risks for young children with asthma.
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Affiliation(s)
- Lara J. Akinbami
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention Hyattsville, MD
,United States Public Health Service, Rockville, MD
| | - Brian K. Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
,United States Public Health Service, Rockville, MD
| | - Alan E. Simon
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention Hyattsville, MD
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Correia-Deur JEDM, Claudio L, Imazawa AT, Eluf-Neto J. Variations in peak expiratory flow measurements associated to air pollution and allergic sensitization in children in Sao Paulo, Brazil. Am J Ind Med 2012; 55:1087-98. [PMID: 22544523 DOI: 10.1002/ajim.22060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the last 20 years, there has been an increase in the incidence of allergic respiratory diseases worldwide and exposure to air pollution has been discussed as one of the factors associated with this increase. The objective of this study was to investigate the effects of air pollution on peak expiratory flow (PEF) and FEV1 in children with and without allergic sensitization. METHODS Ninety-six children were followed from April to July, 2004 with spirometry measurements. They were tested for allergic sensitization (IgE, skin prick test, eosinophilia) and asked about allergic symptoms. Air pollution, temperature, and relative humidity data were available. RESULTS Decrements in PEF were observed with previous 24-hr average exposure to air pollution, as well as with 3-10-day average exposure and were associated mainly with PM(10), NO(2), and O(3) in all three categories of allergic sensitization. Even though allergic sensitized children tended to present larger decrements in the PEF measurements they were not statistically different from the non-allergic sensitized. Decrements in FEV1 were observed mainly with previous 24-hr average exposure and 3-day moving average. CONCLUSIONS Decrements in PEF associated with air pollution were observed in children independent from their allergic sensitization status. Their daily exposure to air pollution can be responsible for a chronic inflammatory process that might impair their lung growth and later their lung function in adulthood.
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Hoskins G, Williams B, Jackson C, Norman P, Donnan P. Patient, practice and organisational influences on asthma control: observational data from a national study on primary care in the United Kingdom. Int J Nurs Stud 2012; 49:596-609. [PMID: 22079260 DOI: 10.1016/j.ijnurstu.2011.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 10/10/2011] [Accepted: 10/19/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. OBJECTIVE This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. DESIGN, SETTING AND PARTICIPANTS Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. METHOD Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. RESULTS Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [-0.155 (-0.275; -0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR<80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (-0.007; 0.777)], and gender [0.314 (0.281; 0.347)]. Pattern of medication use, smoking history, age, body mass index (BMI), and health service resource use were also significant factors for predicting control. CONCLUSIONS Targeting of health service resource requires knowledge of the factors associated with poor control of asthma symptoms. In the UK the contribution of local and regional structures appears minimal in explaining variation in asthma outcomes. However, unexplained variation in the data suggests other unrecorded factors may play a part. While patient personal characteristics (including self-management plan use, inhaler technique, medication compliance) appear to be the predominant influence the complex nature of the disease means that some, perhaps more subtle, influences are affecting the variability at all levels and this variance needs to be explored. Further research in other international contexts is required to identify the likely applicability of these findings to other health care systems.
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Affiliation(s)
- Gaylor Hoskins
- NMAHP Research Unit, School of Nursing, University of Stirling, Scotland, United Kingdom.
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Herzog R, Cunningham-Rundles S. Pediatric asthma: natural history, assessment, and treatment. ACTA ACUST UNITED AC 2012; 78:645-60. [PMID: 21913196 DOI: 10.1002/msj.20285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Wheezing and childhood asthma are not synonymous but rather comprise a heterogeneous group of conditions that have different outcomes over the course of childhood. Most infants who wheeze have a transient condition associated with diminished airway function at birth and have no increased risk of asthma later in life. However, children with persistent wheezing throughout childhood and frequent exacerbations represent the main challenge today. Studying the natural history of asthma is important for the understanding and accurate prediction of the clinical course of different phenotypes. To date, a great improvement has been achieved in reducing the frequency of asthma symptoms. However, neither decreased environmental exposure nor controller treatment, as recommended by the recent National Asthma Education And Prevention Program, can halt the progression of asthma in childhood or the development of persistent wheezing phenotype. This review focuses on the recent studies that led to the current understanding of asthma phenotypes in childhood and the recommended treatments.
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Affiliation(s)
- Ronit Herzog
- Department of Pediatrics, Division of Allergy, Immunology and Pulmonology, Weill Medical College of Cornell University, New York, NY, USA.
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Household smoking behavior: effects on indoor air quality and health of urban children with asthma. Matern Child Health J 2011; 15:460-8. [PMID: 20401688 DOI: 10.1007/s10995-010-0606-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of the study was to examine the association between biomarkers and environmental measures of second hand smoke (SHS) with caregiver, i.e. parent or legal guardian, report of household smoking behavior and morbidity measures among children with asthma. Baseline data were drawn from a longitudinal intervention for 126 inner city children with asthma, residing with a smoker. Most children met criteria for moderate to severe persistent asthma (63%) versus mild intermittent (20%) or mild persistent (17%). Household smoking behavior and asthma morbidity were compared with child urine cotinine and indoor measures of air quality including fine particulate matter (PM(2.5)) and air nicotine (AN). Kruskal-Wallis, Wilcoxon rank-sum and Spearman rho correlation tests were used to determine the level of association between biomarkers of SHS exposure and household smoking behavior and asthma morbidity. Most children had uncontrolled asthma (62%). The primary household smoker was the child's caregiver (86/126, 68%) of which 66 (77%) were the child's mother. Significantly higher mean PM(2.5), AN and cotinine concentrations were detected in households where the caregiver was the smoker (caregiver smoker: PM(2.5) μg/m(3): 44.16, AN: 1.79 μg/m(3), cotinine: 27.39 ng/ml; caregiver non-smoker: PM(2.5): 28.88 μg/m(3), AN: 0.71 μg/m(3), cotinine:10.78 ng/ml, all P ≤ 0.01). Urine cotinine concentrations trended higher in children who reported 5 or more symptom days within the past 2 weeks (>5 days/past 2 weeks, cotinine: 28.1 ng/ml vs. <5 days/past 2 weeks, cotinine: 16.2 ng/ml; P = 0.08). However, environmental measures of SHS exposures were not associated with asthma symptoms. Urban children with persistent asthma, residing with a smoker are exposed to high levels of SHS predominantly from their primary caregiver. Because cotinine was more strongly associated with asthma symptoms than environmental measures of SHS exposure and is independent of the site of exposure, it remains the gold standard for SHS exposure assessment in children with asthma.
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Abstract
PURPOSE OF REVIEW Indoor pollutants and allergens cause asthma symptoms and exacerbations and influence the risk of developing asthma. We review recent studies regarding the effects of the indoor environment on childhood asthma. RECENT FINDINGS Exposure to some indoor allergens and second hand smoke are causally related to the development of asthma in children. Many recent studies have demonstrated an association between exposure to indoor pollutants and allergens and airways inflammation, asthma symptoms, and increased healthcare utilization among individuals with established asthma. Genetic polymorphisms conferring susceptibility to some indoor exposures have also been identified, and recent findings support the notion that environmental exposures may influence gene expression through epigenetic modification. Recent studies also support the efficacy of multifaceted environmental interventions in childhood asthma. SUMMARY Studies have provided significant evidence of the association between many indoor pollutants and allergens and asthma morbidity, and have also demonstrated the efficacy of multifaceted indoor environmental interventions in childhood asthma. There is also a growing body of evidence suggesting that some indoor pollutants and allergens may increase the risk of developing asthma. Future studies should examine mechanisms whereby environmental exposures may influence asthma pathogenesis and expand the current knowledge of susceptibility factors for indoor exposures.
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Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, Wang H, Borrelli B. Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial. ACTA ACUST UNITED AC 2011; 165:262-8. [PMID: 21383275 DOI: 10.1001/archpediatrics.2011.1] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. DESIGN Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. SETTING Rochester, New York. PARTICIPANTS Children aged 3 to 10 years with persistent asthma. INTERVENTIONS Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. MAIN OUTCOME MEASURE Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. RESULTS We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference = 0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P < .01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk = 0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n = 285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference = 0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52). CONCLUSIONS The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642, USA.
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Butz AM, Halterman JS, Bellin M, Tsoukleris M, Donithan M, Kub J, Thompson RE, Land CL, Walker J, Bollinger ME. Factors associated with second-hand smoke exposure in young inner-city children with asthma. J Asthma 2011; 48:449-57. [PMID: 21545248 DOI: 10.3109/02770903.2011.576742] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma. METHODS We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment (N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity. RESULTS Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (β = 0.23; p < .001, R(2) = 0.35). CONCLUSION Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Fagnano M, Bayer AL, Isensee CA, Hernandez T, Halterman JS. Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma. Acad Pediatr 2011; 11:493-9. [PMID: 21816697 PMCID: PMC3481184 DOI: 10.1016/j.acap.2011.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe nocturnal asthma symptoms among urban children with asthma and assess the burden of sleep difficulties between children with varying levels of nocturnal symptoms. METHODS We analyzed baseline data from 287 urban children with persistent asthma (aged 4-10 years) enrolled in the School-Based Asthma Therapy trial; Rochester, New York. Caregivers reported on nocturnal asthma symptoms (number of nights/2 weeks with wheezing or coughing), parent quality of life (Juniper's Pediatric Asthma Caregivers Quality of Life Questionnaire), and sleep quality by using the validated Children's Sleep Habits Questionnaire. We used bivariate and multivariate statistics to compare nocturnal asthma symptoms with sleep quality/quantity and quality of life. RESULTS Most children (mean age, 7.5 years) were black (62%); 74% had Medicaid. Forty-one percent of children had intermittent nocturnal asthma symptoms, 23% mild persistent, and 36% moderate to severe. Children's average total sleep quality score was 51 (range, 33-99) which is above the clinically significant cutoff of 41, indicating pervasive sleep disturbances among this population. Sleep scores were worse for children with more nocturnal asthma symptoms compared with those with milder symptoms on total score, as well as several subscales, including night wakings, parasomnias, and sleep disordered breathing (all P < .03). Parents of children with more nocturnal asthma symptoms reported their child having fewer nights with enough sleep in the past week (P = .018) and worse parent quality of life (P < .001). CONCLUSIONS Nocturnal asthma symptoms are prevalent in this population and are associated with poor sleep quality and worse parent quality of life. These findings have potential implications for understanding the disease burden of pediatric asthma.
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Affiliation(s)
- Maria Fagnano
- Department of Pediatrics and the Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Newcomb P, Hunt A, Rast P, Cauble D, Rowe N, Li J. Acute effects of walking environment and GSTM1 variants in children with asthma. Biol Res Nurs 2010; 14:55-64. [PMID: 21196426 DOI: 10.1177/1099800410389167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exercise in air polluted by traffic emissions may aggravate airway inflammation in children with asthma, particularly those who produce decreased glutathione-S transferase (GST) as a result of GSTM1 gene deletion. OBJECTIVES This pilot crossover study investigated whether children with asthma experience more airway changes when exercising outdoors near roadways than when exercising indoors. It also examined differences in risk between children with and without GSTM1 deletion. METHOD Children between the ages of 5 and 12 years were assigned to groups and walked daily for 1 week in each exercise condition. Airway inflammation indicated by exhaled nitric oxide (eNO) and pulmonary functions measured as forced expiratory volume in 1 s (FEV1) and mid-expiratory flow rate were measured at baseline and at three intervals during the walking program. Independent variables of interest included walking condition (place), time of walking, genotype, and particulate matter (PM) exposure. RESULTS A linear mixed models approach was used to investigate the contributions of targeted variables to respiratory outcomes. Results indicated that walking location and ambient level of ultrafine particulates during walking influenced function of small airways. Absence of one or both alleles for the GSTM1 gene did not influence airway function acutely. DISCUSSION Mid-expiratory flow (FEF(25-75)) may be more informative than FEV1 in studies of acute lung function changes in children with asthma. Further study of the effects of varied environmental conditions on lower airway function of children is needed to optimize exercise experiences for urban children with asthma.
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Affiliation(s)
- Patricia Newcomb
- College of Nursing, University of Texas at Arlington, Arlington, TX 76019, USA.
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Halterman JS, Conn KM, Hernandez T, Tanski SE. Parent knowledge, attitudes, and household practices regarding SHS exposure: a case-control study of urban children with and without asthma. Clin Pediatr (Phila) 2010; 49:782-9. [PMID: 20522612 DOI: 10.1177/0009922810368290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impoverished children suffer disproportionately from asthma and are more likely than other children to be exposed to secondhand smoke (SHS). We conducted a case-control study to describe and compare knowledge, attitudes, and household practices regarding SHS exposure among parents of young urban children with and without asthma (response rate, 76%). Overall, 39% of children lived with > or =1 smoker (cases, 36%; controls, 43%). The majority of parents (78%) felt that cigarette smoking is very dangerous and agreed that smoke harms the health of children (97%). Cases were more likely than controls to report that smoking in a car affects children's health (54% vs 42%) and that smoking in front of children is never allowed in their home (88% vs 79%). Additionally, more cases reported a home smoking ban (81% vs 70%). Our findings suggest that parents of children with asthma have somewhat better knowledge, attitudes, and practices regarding SHS; however, gaps remain, and many urban children continue to be exposed.
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Affiliation(s)
- Jill S Halterman
- University of Rochester School of Medicine, Golisano Children's Hospital at Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Halterman JS, Borrelli B, Conn KM, Tremblay P, Blaakman S. Motivation to quit smoking among parents of urban children with asthma. PATIENT EDUCATION AND COUNSELING 2010; 79:152-155. [PMID: 19796913 PMCID: PMC2856779 DOI: 10.1016/j.pec.2009.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/27/2009] [Accepted: 09/03/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify factors associated with motivation to quit smoking among parents of urban children with asthma. METHODS We analyzed data from parents who smoke and had a child enrolled in the School-Based Asthma Therapy (SBAT) trial. We assessed asthma symptoms, children's cotinine, and parent smoking behaviors. Motivation to quit smoking was assessed by a 10-point continuous measure (1, not at all motivated; 10, very motivated). RESULTS 209 parents smoked (39% of sample), and children's mean cotinine was 2.48 ng/ml. Motivation to quit was on average 6.9, and 47% of parents scored >or=8 on the scale. Parents who believed their child's asthma was not under good control, and parents who strongly agreed their child's asthma symptoms would decrease if they stop smoking had higher motivation to quit compared to their counterparts (p<.05). In a multivariate analysis, parents who believed their child's asthma was not under control had more than twice the odds of reporting high motivation to quit. CONCLUSION Parents' perception of the risks of smoking to their child with asthma is associated with motivation to quit. PRACTICE IMPLICATIONS Raising awareness about the effect of smoking and quitting on children's asthma might increase motivation to quit among parents.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children's Hospital at Strong, Rochester, NY 14642, USA.
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Yolton K, Xu Y, Khoury J, Succop P, Lanphear B, Beebe DW, Owens J. Associations between secondhand smoke exposure and sleep patterns in children. Pediatrics 2010; 125:e261-8. [PMID: 20083521 PMCID: PMC4900537 DOI: 10.1542/peds.2009-0690] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate the relationship between exposure to secondhand smoke (SHS) and child sleep patterns among a group of children with asthma who were exposed regularly to tobacco smoke at home. METHODS We studied 219 children who were enrolled in an asthma intervention trial and were exposed regularly to SHS. Serum cotinine levels were used to measure exposure to tobacco smoke, and sleep patterns were assessed through parent reports using the Children's Sleep Habits Questionnaire. Covariates in adjusted analyses included gender, age, race, maternal marital status, education, and income, prenatal tobacco exposure, maternal depression, Home Observation for Measurement of the Environment total score, household density, asthma severity, and use of asthma medications. RESULTS Exposure to SHS was associated with sleep problems, including longer sleep-onset delay (P = .004), sleep-disordered breathing (P = .02), parasomnias (P = .002), daytime sleepiness (P = .022), and overall sleep disturbance (P = .0002). CONCLUSIONS We conclude that exposure to SHS is associated with increased sleep problems among children with asthma.
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Affiliation(s)
- Kimberly Yolton
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, 3333 Burnet Ave, ML 7035, Cincinnati, OH 45229-3039, USA.
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati, Ohio
| | - Jane Khoury
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati, Ohio
| | - Paul Succop
- University of Cincinnati, Department of Environmental Health, Cincinnati, Ohio
| | - Bruce Lanphear
- Simon Frasier University and British Columbia Children's Hospital, British Columbia, Vancouver
| | - Dean W. Beebe
- Cincinnati Children's Hospital Medical Center, Department of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio
| | - Judith Owens
- Brown University, Department of Pediatrics, Providence, Rhode Island
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Jones SE, Wheeler LS, Smith AM, McManus T. Adherence to National Asthma Education and Prevention Program's "How Asthma-Friendly Is Your School?" recommendations. J Sch Nurs 2010; 25:382-94. [PMID: 19770490 DOI: 10.1177/1059840509343292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School health policies and programs provide the framework for a safe and supportive environment for students with asthma. School Health Policies and Programs Study 2006 data were examined to assess whether schools nationwide have policies and programs consistent with the "How Asthma-Friendly Is Your School?" checklist from the National Asthma Education and Prevention Program. Adherence to some of the recommendations on the checklist was high. For example, 80% or more of schools allowed students to carry and self-administer asthma medications, and obtained and kept asthma action plans. For other recommendations, however, far fewer schools had the recommended polices or programs; most notably, less than one third of schools had a full-time Registered Nurse. Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home.
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Liles S, Hovell MF, Matt GE, Zakarian JM, Jones JA. Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships. Nicotine Tob Res 2009; 11:1395-406. [PMID: 19875763 PMCID: PMC2784488 DOI: 10.1093/ntr/ntp149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/07/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a randomized trial of a 6-month, 14-session counseling intervention to decrease their children's secondhand smoke exposure (SHSe) and eliminate smoking. METHODS Measures were taken at baseline and at 3, 6, 12, and 18 months on 150 mothers who exposed their children (aged <4 years) to > or = 10 cigarettes/week in the home. Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels. RESULTS There were few quits longer than 6 months. Mothers in the counseling group reported more 24-hr quits (p = .019) and more 7-day quits (p = .029) than controls. Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study. Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts. DISCUSSION Results confirm that attempts to quit smoking predict additional quit attempts. This suggests that practice may be necessary for many people to quit smoking permanently. Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures. Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials.
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Affiliation(s)
- Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA
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Lawson JA, Dosman JA, Rennie DC, Beach J, Newman SC, Senthilselvan A. Relationship between indoor environment and asthma and wheeze severity among rural children and adolescents. J Agromedicine 2009; 14:277-85. [PMID: 19437289 DOI: 10.1080/10599240902772910] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have examined the associations between environmental characteristics and asthma severity among children in a rural setting. The authors studied these associations using a number of asthma severity indicators. They conducted a case-control study of 6- to 18-year-old children and adolescents in Humboldt, Saskatchewan, and the surrounding area. Only cases representing subjects reporting wheeze in the past 12 months or doctor-diagnosed asthma were used for the present analysis (n = 98). Data were collected by questionnaire, while vacuumed dust (mattress and play area floor) was used for the quantification of endotoxin exposure, and saliva was used for the measurement of cotinine to assess tobacco smoke exposure. Severity indicators included wheeze frequency, breathing medication use, sleep disruption from wheeze, and school absenteeism, all in the past 12 months. A majority of cases were male (62.3%). Wheezing 1 to 3 times was reported by 40.8% of cases, whereas 17.3% wheezed 4 or more times in the past 12 months. Short-acting beta agonist medications or inhaled corticosteroids alone were used by 24.5% of the cases, whereas 33.7% of the cases used multiple or additional breathing medications. Sleep disruption was reported by 28.6% of the cases, whereas 12.2% reported at least one school absence. High tobacco smoke exposure was associated with increased wheeze frequency. There was an inverse association between play area endotoxin concentration and school absenteeism, with some indication of interaction with tobacco smoke exposure. House-cleaning behaviors and changes in health behaviors resulting from the child's respiratory condition were different between those with and without report of sleep disruption due to wheeze. Several environmental variables were associated with severity indicators. However, the associations were not consistent between indicators, suggesting that other factors or changes in behavior resulting from the disease should be considered when assessing these associations.
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Affiliation(s)
- Joshua A Lawson
- Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
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Halterman JS, Borrelli B, Fisher S, Szilagyi P, Yoos L. Improving care for urban children with asthma: design and methods of the School-Based Asthma Therapy (SBAT) trial. J Asthma 2008; 45:279-86. [PMID: 18446591 DOI: 10.1080/02770900701854908] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The School Based Asthma Therapy (SBAT) trial builds on a pilot study in which we found that school-based administration of preventive asthma medications for inner-city children reduced asthma symptoms. However, the beneficial effects of this program were seen only among children not exposed to environmental tobacco smoke (ETS). The current study is designed to establish whether this intervention can be enhanced by more stringent adherence to asthma guidelines through the addition of symptom-based medication dose adjustments, and whether smoke-exposed children benefit from the intervention when it is combined with an ETS reduction program. The intervention consists of both administration of preventive asthma medications in school (with dose adjustments according to NHLBI guidelines) and a home-based ETS reduction program utilizing motivational interviewing principles. This paper describes the methodology, conceptual framework, and lessons learned from the SBAT trial. Results of this study will help to determine whether this type of comprehensive school-based program can serve as a model to improve care for urban children and reduce disparities.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Golisano Children's Hospital at Strong, Rochester, New York 14642, USA. jill
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Marschan E, Kuitunen M, Kukkonen K, Poussa T, Sarnesto A, Haahtela T, Korpela R, Savilahti E, Vaarala O. Probiotics in infancy induce protective immune profiles that are characteristic for chronic low-grade inflammation. Clin Exp Allergy 2008; 38:611-8. [PMID: 18266878 DOI: 10.1111/j.1365-2222.2008.02942.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Probiotics are widely studied both in the treatment and prevention of allergic diseases, but their mode of action is poorly known. OBJECTIVE Our aim was to examine the effect of probiotic bacteria on in vivo cytokine, antibody, and inflammatory responses in allergy-prone infants. METHODS In a randomized double-blind study, probiotic bacteria or placebo were given for 1 month before delivery to mothers and for 6 months to infants with a family history of allergy. Plasma samples were analysed for C-reactive protein (CRP), total IgA and IgE, food-specific IgA, IgG, and IgE, IL-2, IL-4, IL-6, IL-10, TNF-alpha, and IFN-gamma. We analysed the associations of immunological and inflammatory parameters at age 6 months with probiotic treatment and allergic phenotype at 2 years. RESULTS Infants receiving probiotic bacteria had higher plasma levels of CRP (P=0.008), total IgA (P=0.016), total IgE (P=0.047), and IL-10 (P=0.002) than infants in the placebo group. Increased plasma CRP level at age 6 months was associated with a decreased risk of eczema [odds ratio (OR) 0.41 [95% confidence interval (CI) 0.17-0.99], P=0.046], and with a decreased risk of allergic disease [OR 0.38 (95% CI 0.16-0.87), P=0.023] at age 2 years, when adjusted with probiotic use. CONCLUSION The association of CRP with a decreased risk of eczema at 2 years of age in allergy-prone children supports the view that chronic, low-grade inflammation protects from eczema. Probiotic-induced low-grade inflammation was characterized by elevation of IgE, IgA, and IL-10, the changes typically observed in helminth infection-associated induction of regulatory mechanisms. The findings emphasize the role of chronic microbial exposure as an immune modulator protecting from allergy.
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Affiliation(s)
- E Marschan
- The Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
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Abstract
Involuntary exposure to environmental tobacco smoke (ETS) is a serious and entirely preventable public health hazard. It has become clear that ETS adversely affects the health of all who breathe its toxins. Independent of active smoking, ETS exposure is a modifiable risk factor for chronic obstructive pulmonary disease. The expanding body of research presented in this article provides evidence that the damaging consequences of ETS reach far beyond the lungs. Having been determined the third leading cause of preventable death in this country, this is a problem that must be addressed aggressively.
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Affiliation(s)
- Jane Z Reardon
- Department of Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Vargas PA, Brenner B, Clark S, Boudreaux ED, Camargo CA. Exposure to environmental tobacco smoke among children presenting to the emergency department with acute asthma: a multicenter study. Pediatr Pulmonol 2007; 42:646-55. [PMID: 17534978 DOI: 10.1002/ppul.20637] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Environmental tobacco smoke (ETS) exposure has been associated with increased use of the emergency department (ED) for acute asthma care. The purpose of this study was to determine the prevalence of ETS exposure among children presenting to the ED for acute asthma care and whether ETS exposure affects acute asthma severity or response to therapy. We conducted a multi-center study of children 2-11 years with physician-diagnosed acute asthma presenting to 44 EDs in 18 states. Chi-square test, Student's t-test, Wilcoxon rank sum test, and logistic regression were used for the analyses. The study population included 954 children. Thirty-six percent (95% CI, 33-39%) of caregivers reported that their child was exposed to ETS. Among exposed children, 35% were exposed 1-6 days/week, and 65% were exposed daily. Compared to unexposed children, ETS-exposed children were older at asthma diagnosis, older at ED presentation, and were less likely to be Hispanic. Indicators of chronic asthma severity were higher among unexposed children (i.e., total number of medications, use of controller medications, use of beta(2) agonists, number of urgent clinic visits, and lifetime hospitalizations). There was a weak association between ETS and acute asthma severity. Response to therapy (including ED disposition) did not differ between groups. On multivariate analysis, ETS-exposed children were more likely to be older, female, non-Hispanic, have lower household income, not use controller medications, and have a pet at home (all P < 0.05). Our study showed that the prevalence of ETS exposure among children presenting to the ED with acute asthma differs across demographic factors. There were no significant differences in acute asthma symptoms or response to ED therapy between ETS-exposed and unexposed children. Lower use of controller medications and less frequent urgent clinic visits among ETS-exposed children suggest inadequate asthma care or milder disease. The weak association between ETS exposure and acute asthma severity might reflect confounding by psychological factors and/or chronic asthma severity. The frequency of ETS exposure suggests that the ED may be an appropriate venue to engage caregivers of children with asthma in asthma education and smoking cessation efforts.
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Affiliation(s)
- Perla A Vargas
- University of Arkansas for Medical Sciences, Little Rock, AR 72202-3591, USA.
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Koinis-Mitchell D, McQuaid EL, Seifer R, Kopel SJ, Esteban C, Canino G, Garcia-Coll C, Klein R, Fritz GK. Multiple urban and asthma-related risks and their association with asthma morbidity in children. J Pediatr Psychol 2007; 32:582-95. [PMID: 17218338 PMCID: PMC3274817 DOI: 10.1093/jpepsy/jsl050] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether a multi-dimensional cumulative risk index (CRI) is a stronger predictor of asthma morbidity in urban, school-aged children with asthma, than poverty or severity alone. METHODS A total of 163 children with asthma, ages 7-15 years (42% female; 69% ethnic minority) and their primary caregivers completed interview-based questionnaires, focusing on potential cultural, contextual, and asthma-specific risks that can impact asthma morbidity. RESULTS Higher levels of cumulative risks were associated with more asthma morbidity, after controlling for poverty level or asthma severity. Analyses by ethnic group and subgroup also supported the relationship between the CRI and specific indices of asthma morbidity. CONCLUSIONS This study demonstrates the utility of multiple-dimensional risk models for predicting variations in asthma morbidity in urban children. Research efforts with urban families who have children with asthma need to consider the context of urban poverty as it relates to children's cultural backgrounds and specific asthma outcomes.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Child and Family Psychiatry, Bradley/Hasbro Research Center, Brown Medical School, 1 Hoppin Street, Coro West, 2nd Floor, Providence, RI 02903, USA.
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Halterman JS, Fagnano M, Conn KM, Lynch KA, DelBalso MA, Chin NP. Barriers to reducing ETS in the homes of inner-city children with asthma. J Asthma 2007; 44:83-8. [PMID: 17454320 DOI: 10.1080/02770900601180545] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study assessed knowledge regarding the harm of environmental tobacco smoke (ETS) exposure and barriers to reducing ETS from the point-of-view of urban parents of asthmatic children. We conducted in-depth interviews with 15 mothers of children with asthma. All parents had good knowledge regarding the harmful effects of ETS. While all children of smoking parents were exposed to ETS, parents described using various strategies to keep ETS away from children. Many parents experienced significant stress in their lives and used smoking to relieve their stress. Barriers to a smoke-free home included stress, addiction, and the use of ineffective strategies to reduce ETS exposure.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, New York 14642, USA.
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