1
|
Coelho C, Pinho J, Pinto M, Pedrosa C, Costa H, Romariz J, Carvalho MI. Pediatric asthma knowledge: Insights from a Portuguese central hospital study. Pediatr Pulmonol 2024. [PMID: 39073035 DOI: 10.1002/ppul.27196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 06/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. METHODS We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). RESULTS The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. CONCLUSION In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.
Collapse
Affiliation(s)
- Cristina Coelho
- Department of Immunology and Allergology, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Joana Pinho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Mariana Pinto
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Cláudia Pedrosa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Herculano Costa
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Jorge Romariz
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Maria I Carvalho
- Department of Pediatrics, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Pediatric Allergology and Pulmonology Unit, Unidade Local de Saúde Gaia e Espinho Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| |
Collapse
|
2
|
Assari S, Zare H. Household Income and Offspring Education Explain Blacks' Diminished Returns of Parental Education. OPEN JOURNAL OF PSYCHOLOGY 2024; 4:18-29. [PMID: 39091591 PMCID: PMC11292485 DOI: 10.31586/ojp.2024.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Background High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities' diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White families. This study explores the role of household income and offspring educational attainment as potential serial pathways that operate as mechanisms underlying diminished returns of parental education on offspring outcomes in Black families. Gender differences in these effects were also explored. Methods Utilizing data from the Future of Families and Child Wellbeing Study (FFCWS) over a 22-year follow-up period (seven waves), we examined the serial mediation by household income and offspring educational attainment in explaining the relationship between parental education and offspring outcomes namely depression, anxiety, criminal justice involvement, and welfare reliance [Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)]. We used structural equation modeling (SEM) with household income as the first mediator and young adult education as the second mediator. Multi-group models were used to explore gender differences in these paths. Results The study confirmed the role of our proposed serial mediators for Blacks' weaker effects of parental education on offspring outcomes. We observed weaker effects of first affects household income, with this effect being for Black families compared to White families, which then impacted educational attainment of the offspring. The findings indicate that household income plays a crucial mediating role, but its effect is weaker in Black families. Additionally, the educational attainment of offspring from highly educated Black parents is less effective in improving outcomes compared to their White peers, further contributing to diminished returns. Some gender differences were observed for the effects of educational attainment on economic and health outcomes of young adults. Conclusions The study underscores the need to reconsider traditional assumptions about the comparability of family conditions and outcomes across racial groups with similar levels of parental education. The findings highlight the importance of targeted policies and interventions aimed at enhancing the economic stability and educational outcomes of Black families to address these disparities. Policies should focus on promoting the economic well-being of highly educated Black parents and improving the educational outcomes of their children.
Collapse
Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA, United States
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- School of Business, University of Maryland Global Campus (UMGC), College Park, MD, United States
| |
Collapse
|
3
|
Konradsen JR, Selberg S, Ödling M, Sundbaum JK, Bossios A, Stridsman C. Treatable traits and exacerbation risk in patients with uncontrolled asthma prescribed GINA step 1-3 treatment: A nationwide asthma cohort study. Respirology 2024. [PMID: 38859634 DOI: 10.1111/resp.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Uncontrolled asthma in patients treated for mild/moderate disease could be caused by non-pulmonary treatable traits (TTs) that affect asthma control negatively. We aimed to identify demographic characteristics, behavioural (smoking) and extrapulmonary (obesity, comorbidities) TTs and the risk for future exacerbations among patients with uncontrolled asthma prescribed step 1-3 treatment according to the Global Initiative for Asthma (GINA). METHODS Twenty-eight thousand five hundred eighty-four asthma patients (≥18 y) with a registration in the Swedish National Airway Register between 2017 and 2019 were included (index-date). The database was linked to other national registers to obtain information on prescribed drugs 2-years pre-index and exacerbations 1-year post-index. Asthma treatment was classified into step 1-3 or 4-5, and uncontrolled asthma was defined based on symptom control, exacerbations and lung function. RESULTS GINA step 1-3 included 17,318 patients, of which 9586 (55%) were uncontrolled (UCA 1-3). In adjusted analyses, UCA 1-3 was associated with female sex (OR 1.34, 95% CI 1.27-1.41), older age (1.00, 1.00-1.00), primary education (1.30, 1.20-1.40) and secondary education (1.19, 1.12-1.26), and TTs such as smoking (1.25, 1.15-1.36), obesity (1.23, 1.15-1.32), cardiovascular disease (1.12, 1.06-1.20) and depression/anxiety (1.13, 1.06-1.21). Furthermore, UCA 1-3 was associated with future exacerbations; oral corticosteroids (1.90, 1.74-2.09) and asthma hospitalization (2.55, 2.17-3.00), respectively, also when adjusted for treatment step 4-5. CONCLUSION Over 50% of patients treated for mild/moderate asthma had an uncontrolled disease. Assessing and managing of TTs such as smoking, obesity and comorbidities should be conducted in a holistic manner, as these patients have an increased risk for future exacerbations.
Collapse
Affiliation(s)
- Jon R Konradsen
- Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stina Selberg
- Department of Public Health and Clinical Medicine/The OLIN-Unit, Umeå University, Umeå, Sweden
| | - Maria Ödling
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Apostolos Bossios
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine/The OLIN-Unit, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
Yang-Huang J, McGrath JJ, Gauvin L, Nikiéma B, Spencer NJ, Awad YA, Clifford S, Markham W, Mensah F, Andersson White P, Ludvigsson J, Faresjö T, Duijts L, van Grieken A, Raat H. Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies. J Epidemiol Community Health 2024:jech-2023-220726. [PMID: 38849153 DOI: 10.1136/jech-2023-220726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/27/2023] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9-12 years in the UK, the Netherlands, Sweden, Australia, the USA and Canada. METHODS Data on 31 210 children were obtained from 7 prospective birth cohort studies across six countries. Asthma-related outcomes included ever asthma, wheezing/asthma attacks and medication control for asthma. Relative social inequalities were estimated using pooled risk ratios (RRs) adjusted for potential confounders (child age, sex, mother ethnic background and maternal age) for maternal education and household income. The Slope Index of Inequality (SII) was calculated for each cohort to evaluate absolute social inequalities. RESULTS Ever asthma prevalence ranged from 8.3% (Netherlands) to 29.1% (Australia). Wheezing/asthma attacks prevalence ranged from 3.9% (Quebec) to 16.8% (USA). Pooled RRs for low (vs high) maternal education and low (vs high) household income were: ever asthma (education 1.24, 95% CI 1.13 to 1.37; income 1.28, 95% CI 1.15 to 1.43), wheezing/asthma attacks (education 1.14, 95% CI 0.97 to 1.35; income 1.22, 95% CI 1.03 to 1.44) and asthma with medication control (education 1.16, 95% CI 0.97 to 1.40; income 1.25, 95% CI 1.01 to 1.55). SIIs supported the lower risk for children with more highly educated mothers and those from higher-income households in most cohorts, with few exceptions. CONCLUSIONS Social inequalities by household income on the risk of ever asthma, wheezing/asthma attacks, and medication control for asthma were evident; the associations were attenuated for maternal education. These findings support the need for prevention policies to address the relatively high risks of respiratory morbidity in children in families with low socioeconomic status.
Collapse
Affiliation(s)
- Junwen Yang-Huang
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Lise Gauvin
- Centre de recherche, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
- École de santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Beatrice Nikiéma
- Department of Program Development and Support, Cree Board of Health and Social Services of James Bay, Chisasibi, Quebec, Canada
| | - Nicholas James Spencer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Yara Abu Awad
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Susan Clifford
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wolfgang Markham
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pär Andersson White
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
5
|
DAMADOĞLU E, AKTAŞ ÖÖZTÜRK, GEMİCİOĞLU B, YILMAZ N, BOZKUŞ F, AYHAN V, KALPAKLIOĞLU AF, ERKEKOL FÖNER, HAVLUCU Y, EREL F, AYDIN Ö, EKİCİ A, BAÇÇIOĞLU A, BARIŞ SARGUN, BUHARİ GKÖYCÜ, CEYHAN B, GÖKSEL Ö, KÖSE M, DURSUN AB, YILDIZ F, YORGANCIOĞLU A, IŞIK SR, EDİGER D, OĞUZÜLGEN İK, DEMİR AU, KARAKAYA G, KALYONCU AF. Elderly and aged asthma have different characteristics: results of a multicenter study. Turk J Med Sci 2023; 54:309-315. [PMID: 38812643 PMCID: PMC11031165 DOI: 10.55730/1300-0144.5792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 02/15/2024] [Accepted: 11/18/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age. Materials and methods The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. Results A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. Conclusion The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease.
Collapse
Affiliation(s)
- Ebru DAMADOĞLU
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge ÖZTÜRK AKTAŞ
- Division of Immunology and Allergic Diseases Ankara City Hospital, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Bilun GEMİCİOĞLU
- Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medine, İstanbul University-Cerrahpaşa, İstanbul,
Turkiye
| | - Nafiye YILMAZ
- Department of Chest Diseases, Faculty of Medicine, Ataturk University, Erzurum,
Turkiye
| | - Fulşen BOZKUŞ
- Department of Chest Diseases, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş,
Turkiye
| | - Vehbi AYHAN
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize,
Turkiye
| | - Ayse Füsun KALPAKLIOĞLU
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkiye
| | - Ferda ÖNER ERKEKOL
- Department of Allergy and Immunology, Medicana International Ankara Hospital, Ankara,
Turkiye
| | - Yavuz HAVLUCU
- Department of Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa,
Turkiye
| | - Fuat EREL
- Department of Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir,
Turkiye
| | - Ömür AYDIN
- Division of Immunology and Allergy, Department of Chest Disease, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Aydanur EKİCİ
- Department of Chest Diseases, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkiye
| | - Ayşe BAÇÇIOĞLU
- Division of Allergy and Immunology, Department of Chest Diseases, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkiye
| | - Serap ARGUN BARIŞ
- Department of Chest Diseases, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkiye
| | - Gözde KÖYCÜ BUHARİ
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Berrin CEYHAN
- Department of Chest Diseases, Faculty of Medicine, Marmara University, İstanbul,
Turkiye
| | - Özlem GÖKSEL
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir,
Turkiye
| | - Mehmet KÖSE
- Department of Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir,
Turkiye
| | - Adile Berna DURSUN
- Department of Chest Diseases, Faculty of Medicine, Lokman Hekim University, Ankara,
Turkiye
| | - Füsun YILDIZ
- Department of Pulmonary Diseases, Faculty of Medicine, Cyprus International University, Northern Cyprus,
Turkiye
| | - Arzu YORGANCIOĞLU
- Department of Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa,
Turkiye
| | | | - Dane EDİGER
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Bursa Uludağ University, Bursa,
Turkiye
| | | | - Ahmet Uğur DEMİR
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Gül KARAKAYA
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ali Fuat KALYONCU
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| |
Collapse
|
6
|
Håkansson KEJ, Guerrero SC, Backer V, Ulrik CS, Rastogi D. Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort. Respir Res 2023; 24:173. [PMID: 37370052 PMCID: PMC10304602 DOI: 10.1186/s12931-023-02482-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood. METHODS A Danish nationwide cohort of children and adolescents aged 2-17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2-11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care. The population is chosen due to detailed medical records in the setting of universal health care. RESULTS The cohort comprised of 29,851 children and adolescents (59% boys), with a median age of 9 years. While 17% of children were on high dose ICS, 22% were on daily ICS below GINA low dose cut-off. Prevalence of severe asthma (3.0-6.5%) was lower than poor asthma control (6.4-25%); both declined from childhood to adolescence. Exacerbations occurred in 7.1-9.0% of children, with median number of exacerbations being 1 (IQR 1-1). Despite being classified as having mild-to-moderate asthma, 15% had poor asthma control and 3.8% experienced exacerbation(s), respectively. While 61% of children with severe asthma and 58% with exacerbation-prone disease were in specialist care, only 24% with uncontrolled disease were receiving specialist care. Of children and adolescents using high-dose ICS, 71% were managed in primary care, while the use of additional controllers was more common in specialist care. CONCLUSIONS Throughout childhood and adolescence, there was a high prevalence of severe asthma and poor control, although their prevalence declined with age. We demonstrate a large unmet need for specialist care among children with at-risk asthma, particularly among those with poorly controlled asthma, even in a system with free-to-access, tax-funded healthcare.
Collapse
Affiliation(s)
- Kjell Erik Julius Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Silvia Cabrera Guerrero
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
| |
Collapse
|
7
|
Kunøe A, Sevelsted A, Chawes BLK, Stokholm J, Krakauer M, Bønnelykke K, Bisgaard H. Height and bone mineral content after inhaled corticosteroid use in the first 6 years of life. Thorax 2022; 77:745-751. [PMID: 35046091 DOI: 10.1136/thoraxjnl-2020-216755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infants and young children might be particularly susceptible to the potential side effects from inhaled corticosteroid (ICS) on height and bone mineral content (BMC), but this has rarely been studied in long-term prospective studies. METHODS Children from two Copenhagen Prospective Studies on Asthma in Childhood cohorts were included. ICS use was registered prospectively from birth to age 6 and the cumulative dose was calculated. Primary outcomes were height and BMC from dual-energy X-ray absorptiometry (DXA) scans at age 6. RESULTS At age 6, a total of 930 children (84%) from the cohorts had a valid height measurement and 792 (71%) had a DXA scan. 291 children (31%) received a cumulated ICS dose equivalent to or above 10 weeks of standard treatment before age 6. We found an inverse association between ICS use and height, -0.26 cm (95% CI: -0.45 to -0.07) per 1 year standard treatment from 0 to 6 years of age, p=0.006. This effect was mainly driven by children with ongoing treatment between age 5 and 6 years (-0.31 cm (95% CI: -0.52 to -0.1), p=0.004), while there was no significant association in children who stopped treatment at least 1 year before age 6 (-0.09 cm (95% CI: -0.46 to 0.28), p=0.64). There was no association between ICS use and BMC at age 6. CONCLUSIONS ICS use in early childhood was associated with reduced height at age 6 years but only in children with continued treatment in the sixth year of life.
Collapse
Affiliation(s)
- Asja Kunøe
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Astrid Sevelsted
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo L K Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Pediatrics, Næstved Hospital, Næstved, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Gentofte, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| |
Collapse
|
8
|
Ji X, Yao Y, Zheng P, Hao C. The relationship of domestic pet ownership with the risk of childhood asthma: A systematic review and meta-analysis. Front Pediatr 2022; 10:953330. [PMID: 35935350 PMCID: PMC9352935 DOI: 10.3389/fped.2022.953330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The relationship between pet ownership and childhood asthma remains controversial. In recent years, there have been increasing studies with large sample size. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between pet ownership and childhood asthma. METHOD Relevant research was retrieved from PubMed, Cochrane, EMBASE, and Web of science. The retrieval was as of October 1, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Stata 15.0 was used to conduct the meta-analysis. RESULTS A total of 60 studies with large sample size published between 1995 and 2021 were included in this systematic review and meta-analysis, which included 18 cohort studies and 42 case-control studies covering 27 countries and 1,871,295 children. As shown by meta-analysis results, cat ownership (OR = 1.18, 95%CI: 1.05∼1.33) and dog ownership (OR = 1.12, 95%CI: 1.0 0∼1.24) have a significant bearing on the occurrence of childhood asthma. Pet ownership was also positively correlated with the occurrence of severe childhood asthma (OR = 1.15, 95%CI: 1.11∼1.20). CONCLUSION Pet ownership, especially cats and dogs, is associated with the occurrence of asthma in children.
Collapse
Affiliation(s)
- Xiaoyi Ji
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China.,Department of Pediatric, Jiaxing Maternal and Child Health Hospital, Jiaxing, China
| | - Yuan Yao
- Department of Radiology, Jiaxing Maternal and Child Health Hospital, Jiaxing, China
| | - Ping Zheng
- Department of Pediatric, Jiaxing Maternal and Child Health Hospital, Jiaxing, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| |
Collapse
|
9
|
Håkansson KEJ, Backer V, Suppli Ulrik C. Socioeconomic biases in asthma control and specialist referral of possible severe asthma. Eur Respir J 2021; 58:13993003.00741-2021. [PMID: 33986027 DOI: 10.1183/13993003.00741-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS). METHODS Asthma patients fulfilling the following: aged 18-45 and redeeming ≥2 prescriptions of ICS during 2014-18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals). RESULTS Of 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51-0.85)), 36-45 versus 18-25 years), male sex (OR 0.75 (0.64-0.87)), residence outside the Capital Region (OR 0.70 (0.59-0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59-0.95)).Having completed higher education increased odds of specialist referral (OR 1.28 (1.03-1.59)), when compared to patients with basic education. CONCLUSION Even in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.
Collapse
Affiliation(s)
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Almomani BA, Al-Qawasmeh BS, Al-Shatnawi SF, Awad S, Alzoubi SA. Predictors of proper inhaler technique and asthma control in pediatric patients with asthma. Pediatr Pulmonol 2021; 56:866-874. [PMID: 33497530 DOI: 10.1002/ppul.25263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/12/2020] [Accepted: 01/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improper use of asthma inhalers is one of the potential factors of poor asthma control among children. This study aimed to assess the proper handling of asthma inhalers and asthma control in addition to factors influencing them among pediatric patients who self-administer their inhalers. METHODS A cross-sectional study was conducted in Jordan from February 2019 to February 2020. All eligible pediatric patients with asthma attending outpatient settings were approached. The inhalation technique was assessed according to a standard checklist, and asthma control was assessed using the Asthma Control Test. RESULTS A total of 150 patients were included in this study. A metered dose inhaler (MDI) was the most commonly used inhaler device (89.4%) which was used appropriately by only 13.4% of participants. Whereas, appropriate use of Turbohaler and Diskus was reported by 38.5% and 28.9%, respectively. The higher level of parental knowledge was associated with higher number of correct MDI steps (OR = 1.066; 95% CI = 1.010-1.125; p = .020) and less reported errors in critical steps (OR = 0.949; 95% CI = 0.900-0.999; p = .047). Higher level of both parental education and pediatric average stigma score (less stigmatized) were associated with better asthma control ([OR = 5.181; 95% CI = 1.238-21.677; p = .024], [OR = 2.825; 95% CI = 1.420-5.619; p = .003], respectively). CONCLUSION Continuous education on appropriate inhaler self-administration for asthmatic children is highly recommended. Clinical pharmacists play a major role toward improving the administration of inhalers through patient training and counseling.
Collapse
Affiliation(s)
- Basima A Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Batool S Al-Qawasmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah F Al-Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah Awad
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sirin A Alzoubi
- Department of Pediatrics, Princess Rahma Teaching Hospital, Irbid, Jordan
| |
Collapse
|
11
|
Ilmarinen P, Stridsman C, Bashir M, Tuomisto LE, Vähätalo I, Goksör E, Kankaanranta H, Backman H, Langhammer A, Piirilä P, Rönmark E, Lundbäck B, Nwaru BI, Wennergren G. Level of education and asthma control in adult-onset asthma. J Asthma 2021; 59:840-849. [PMID: 33497270 DOI: 10.1080/02770903.2021.1871742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Education in itself and as a proxy for socioeconomic status, may influence asthma control, but remains poorly studied in adult-onset asthma. Our aim was to study the association between the level of education and asthma control in adult-onset asthma. METHODS Subjects with current asthma with onset >15 years were examined within the Obstructive Lung Disease in Northern Sweden study (OLIN, n = 593), Seinäjoki Adult Asthma Study (SAAS, n = 200), and West Sweden Asthma Study (WSAS, n = 301) in 2009-2014 in a cross-sectional setting. Educational level was classified as primary, secondary and tertiary. Uncontrolled asthma was defined as Asthma Control Test (ACT) score ≤19. Altogether, 896 subjects with complete data on ACT and education were included (OLIN n = 511, SAAS n = 200 and WSAS n = 185). RESULTS In each cohort and in pooled data of all cohorts, median ACT score was lower among those with primary education than in those with secondary and tertiary education. Uncontrolled asthma was most common among those with primary education, especially among daily ICS users (42.6% primary, 28.6% secondary and 24.2% tertiary; p = 0.001). In adjusted analysis, primary education was associated with uncontrolled asthma in daily ICS users (OR 1.92, 95% CI 1.15-3.20). When stratified by atopy, the association between primary education and uncontrolled asthma was seen in non-atopic (OR 3.42, 95% CI 1.30-8.96) but not in atopic subjects. CONCLUSIONS In high-income Nordic countries, lower educational level was a risk factor for uncontrolled asthma in subjects with adult-onset asthma. Educational level should be considered in the management of adult-onset asthma.
Collapse
Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Muwada Bashir
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Emma Goksör
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Arnulf Langhammer
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| |
Collapse
|
12
|
Gentile DA, Morphew T, Elliott J, Presto AA, Skoner DP. Asthma prevalence and control among schoolchildren residing near outdoor air pollution sites. J Asthma 2020; 59:12-22. [PMID: 33104451 DOI: 10.1080/02770903.2020.1840584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Outdoor air pollution (OAP) contributes to poor asthma outcomes and remains a public health concern in Pittsburgh. The purpose of this study was to determine the prevalence of childhood asthma and its rate of control among Pittsburgh schoolchildren residing near OAP sites. METHODS Participants were recruited from schools near OAP sites. Asthma prevalence and control were assessed using a validated survey. Demographics and socioeconomic status were collected by survey, BMI was calculated, secondhand smoke (SHS) exposure was assessed by salivary cotinine levels, and OAP was assessed by mobile platform monitoring. Multivariate analysis adjusted for confounders. RESULTS In 1202 Pittsburgh elementary school students surveyed, 50.9% were female, average age was 8.5 years (SD = 1.9), 52.2% were African American and 60.6% had public health insurance. SHS exposure was relatively high at 33.9%, 17.1% of students were obese, and 70% had exposure to particulate matter (PM2.5) greater than the World Health Organization standard of 10 μg/m3. Overall prevalence of asthma was 22.5% with PM2.5, nitric oxide (NOx), sulfur (S), and zinc (Zn) significantly related to odds of asthma. Among the 270 children previously diagnosed with asthma, 59.3% were not well controlled with PM2.5, black carbon, and silicon (Si) significantly related to odds of uncontrolled asthma. CONCLUSIONS These results demonstrate that asthma prevalence and poor disease control are significantly elevated in Pittsburgh schoolchildren exposed to high levels of OAP. Future efforts need to focus on primary prevention of asthma by reducing exposure to OAP in at risk populations.
Collapse
Affiliation(s)
- Deborah A Gentile
- Division of Clinical Research, Allergy and Asthma Wellness Centers, Butler, PA, USA
| | | | | | - Albert A Presto
- Center for Atmospheric Particle Studies, Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - David P Skoner
- Division of Pediatric Allergy/Immunology, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
13
|
Abstract
Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients’ concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.
Collapse
Affiliation(s)
- Mary B Bridgeman
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, 5751Rutgers, The State University of New Jersey, NJ, USA
| | - Lori A Wilken
- Pharmacy Practice, 14681University of Illinois at Chicago College of Pharmacy, IL, USA
| |
Collapse
|
14
|
Oluwole O, Rennie DC, Lawson JA. Clinical and complete remission of asthma among schoolchildren. Ann Allergy Asthma Immunol 2020; 125:214-215. [PMID: 32442597 DOI: 10.1016/j.anai.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Oluwafemi Oluwole
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Donna C Rennie
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joshua A Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|