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Pavlidou E, Mantzorou M, Tolia M, Antasouras G, Poutsidi A, Psara E, Poulios E, Fasoulas A, Vasios GK, Giaginis C. Childhood overweight and obesity and abnormal birth anthropometric measures are associated with a higher prevalence of childhood asthma in pre-school age. J Asthma 2022; 60:1316-1325. [PMID: 36332163 DOI: 10.1080/02770903.2022.2144354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Childhood asthma is one of the most common non-communicable diseases in the world. Several perinatal and postnatal factors have been associated with increased risk of developing childhood asthma. The present study aims to assess whether childhood overweight and obesity and abnormal birth anthropometric measures affect the risk of developing childhood asthma in preschool age. METHODS In this study, 5215 preschool children at the age of 2-5 years were enrolled after applying several inclusion and exclusion criteria and they examined whether they present asthma symptoms. Non-adjusted and adjusted statistical analysis was performed to assess whether perinatal and postnatal factors increase the risk of developing childhood asthma. RESULTS A prevalence of 4.5% of childhood asthma was recorded. Among children diagnosed with asthma, 19.4% were affected by overweight and 13.9% were obese. Childhood overweight/obesity was indepedently associated with a 76% higher risk of childhood asthma than normal weight. Abnormal birth anthropometric measures, i.e. birth weight, length, and head circumference, were independently associated with higher odds (87%, 29%, and 23%, respectively) of childhood asthma than normal ranges. CONCLUSIONS This is a cross-sectional, nationally representative study which supported evidence that childhood overweight/obesity and abnormal birth anthropometric measures may independently increase the risk of childhood asthma in preschool age. Emergent health policies and strategies are recommended to promote a healthy lifestyle, preventing childhood obesity at the early stages of life.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklio, Crete, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Antigoni Poutsidi
- Department of Surgery, School of Medicine, University of Thessaly, Larisa, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Aristeidis Fasoulas
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
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Arita Y, Kirk M, Gupta N, Antony R, Park HJ, Stecker MM, Peltier MR. Effect of 2,6-xylidine (DMA) on secretion of biomarkers for inflammation and neurodevelopment by the placenta. J Reprod Immunol 2021; 149:103458. [PMID: 34952372 DOI: 10.1016/j.jri.2021.103458] [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: 04/20/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Cigarette smoke enhances placental inflammation and interferes with steroidogenesis. However, the chemicals in the smoke responsible for these biological activities are unclear. 2,6 xylidine (also called 2,6 Dimethylaniline, DMA) is a component of cigarette smoke that has carcinogenic properties but its effects on the placenta are unknown. Therefore, we hypothesized that DMA may interfere with placental steroidogenesis or enhance placental inflammation. Placental explant cultures were treated with 0-50,000 nM DMA and concentrations of progesterone (P4), estradiol (E2), testosterone (T), IL-1β, TNF-α, IL-6, sgp130, HO-1, IL-10, 8-Isoprostane (8-IsoP), and BDNF in the conditioned medium were quantified. Since many environmental toxins enhance the proinflammatory host response to infection, we also performed experiments on placental cultures co-stimulated with 107 heat-killed E. coli. DMA alone significantly reduced P4 and T secretion but enhanced E2 secretion. The toxin also reduced placental secretion of IL-6, sgp130, and BDNF. For bacteria-stimulated cultures, DMA increased secretion of P4 and T, and proinflammatory cytokines (IL-1β, TNF-α) but had mixed effects on anti-inflammatory markers, increasing some (sgp130, IL-10) and reducing others (HO-1). However, DMA enhanced 8-IsoP levels by bacteria-stimulated placental cultures, suggesting that it increases oxidative stress by the tissues. These studies suggest that DMA affects secretion of biomarkers by the placenta and may promote inflammation. Further studies are needed to determine if these observed changes occur in vivo and the extent to which DMA exposure increases the risk of adverse pregnancy outcomes associated with smoking in pregnancy.
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Affiliation(s)
- Yuko Arita
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Michael Kirk
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Neha Gupta
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Ronny Antony
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Hyeon-Jeong Park
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States
| | - Mark M Stecker
- Fresno Institute of Neuroscience, Fresno, CA, United States
| | - Morgan R Peltier
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, NY, 11501, United States; Department of Psychiatry, Jersey Shore University Medical Center, Neptune, NJ, 07753, United States.
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3
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Garcia-Garcia ML, Gonzalez-Carrasco E, Bracamonte T, Molinero M, Pozo F, Casas I, Calvo C. Impact of Prematurity and Severe Viral Bronchiolitis on Asthma Development at 6-9 Years. J Asthma Allergy 2020; 13:343-353. [PMID: 32982322 PMCID: PMC7509474 DOI: 10.2147/jaa.s258447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Premature birth is associated with increased susceptibility for viral infections and chronic airway morbidity. Preterm children, even moderate and late, may be at risk for short- and long-term respiratory morbidities. Objective Our main goal was to compare the burden of two conditions, severe bronchiolitis and prematurity (early and moderate-late), on asthma development at 6–9 years. Patients and Methods A retrospective cohort of all preterm (<37weeks gestational age) and full-term children hospitalized for bronchiolitis, with current age between 6 and 9 years, was created. A second cohort was made up of preterm children, without admission for bronchiolitis, randomly chosen from the hospital premature births database. Prevalence and risk factors for asthma were analysed. Parents completed the International Study of Asthma and Allergies in Childhood (ISAAC) Questionnaire for asthma symptoms for children 6–7 years. Lung function and aeroallergen sensitization were evaluated. Results Of the 480 selected children, 399 could be contacted and agreed to participate: 133 preterm and 114 full-term cases with admission for bronchiolitis and 146 preterm control children without admission for bronchiolitis. The frequency of current asthma at 6–9 years was higher in preterm cases (27%) compared with full-term-cases (15%) and preterm controls (14%) (p=0.04). Among hospitalized-bronchiolitis children, prematurity (p=0.04), rhinovirus infection (p=0.03), viral coinfection (p=0.04) and paternal asthma (p=0.003) were risk factors for asthma at 6–9 years. Among premature children, with and without bronchiolitis admission, the risk factors for asthma at 6–9 years were admission for bronchiolitis (p=0.03) and aeroallergen sensitisation (p=0.01). Moderate and late preterm children without admission for bronchiolitis showed similar prevalence of current asthma than full-term ones, previously admitted for bronchiolitis. Conclusion Preterm birth is an important early life risk factor for asthma in childhood. The addition of other risk factors, such as severe bronchiolitis, especially by rhinovirus or viral coinfections, are associated with even higher risk for subsequent asthma.
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Affiliation(s)
- Maria Luz Garcia-Garcia
- Pediatrics Department, Severo Ochoa University Hospital, Fundación IDIPHISA, Alfonso X El Sabio University Madrid, Spain. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Ersilia Gonzalez-Carrasco
- Department, Severo Ochoa University Hospital, Fundación IDIPHISA. Alfonso X El Sabio University, Madrid, Spain
| | - Teresa Bracamonte
- Pediatrics Department, Severo Ochoa University Hospital, Fundación IDIPHISA, Alfonso X El Sabio University Madrid, Spain. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Mar Molinero
- Respiratory Virus and Influenza Unit, National Microbiology Center (ISCIII), Madrid, Spain
| | - Francisco Pozo
- Respiratory Virus and Influenza Unit, National Microbiology Center (ISCIII), Madrid, Spain
| | - Inmaculada Casas
- Respiratory Virus and Influenza Unit, National Microbiology Center (ISCIII), Madrid, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Fundación IdiPaz, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain. TEDDY Network (European Network of Excellence for Pediatric Clinical Research), Italy. La Paz University Hospital, Madrid, Spain
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Yaacoby-Bianu K, Plonsky MT, Gur M, Bar-Yoseph R, Kugelman A, Bentur L. Effect of late preterm birth on lung clearance index and respiratory physiology in school-age children. Pediatr Pulmonol 2019; 54:1250-1256. [PMID: 31091024 DOI: 10.1002/ppul.24357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/06/2019] [Accepted: 04/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND We hypothesized that former late preterm (LP) children have abnormal pulmonary physiology parameters, including uneven ventilation distribution, due to premature disruption of normal lung development. METHODS A cross-sectional study evaluating former LP children at the age of 6 to 12 years as compared to term controls. Demographics and child's and family history of asthma/atopy/smoking were recorded. The outcome parameters were spirometry, multiple breath washout (MBW) measurement by lung clearance index (LCI), 6-minute walk test (6MWT), symptoms related to asthma and allergy, and Godin Leisure-Time Exercise Questionnaire. RESULTS Twenty-nine former LP were compared to 30 term-control children (mean age, 8.2 ± 1.7 and 8.8 ± 1.8 years, respectively). LP had reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) compared to term controls (FEV1 1.59 ± 0.48 vs 1.80 ± 0.39 L, P = 0.005 and FVC 1.73 ± 0.45 vs 1.99 ± 0.49 L, P = 0.009). There were no differences between the two groups regarding FEV1/FVC, forced expiratory flow between 25 and 75 (FEF25-75), LCI (7.10 ± 0.79 vs 6.96 ± 0.75, P = 0.50), 6MW distance, and weekly leisure-activity score. Former LP children had more episodes of wheezing and greater use of asthma medication. CONCLUSIONS This pilot study suggests that LP have lower pulmonary function tests (PFTs) but not ventilation inhomogeneity measured by LCI or functional disturbance. It is unclear if the differences in PFTs are due to late prematurity by itself or are the consequence of maternal and neonatal factors associated with LP. Further larger studies are required to assess the long-term respiratory consequences of LP birth.
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Affiliation(s)
- Karin Yaacoby-Bianu
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moran T Plonsky
- Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Amir Kugelman
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatal Intensive Care, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Zhang J, Ma C, Yang A, Zhang R, Gong J, Mo F. Is preterm birth associated with asthma among children from birth to 17 years old? -A study based on 2011-2012 US National Survey of Children's Health. Ital J Pediatr 2018; 44:151. [PMID: 30579359 PMCID: PMC6303925 DOI: 10.1186/s13052-018-0583-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Preterm birth can interrupt lung development in utero and is associated with early life factors, which adversely affects the developing respiratory system. Studies on preterm birth and asthma risk are comparatively sparse and the results are not consistent. METHODS Multivariate analyses were performed on a cross-sectional data from the National Survey of Children's Health (NSCH) collected in 2011 to 2012. The NSCH was a nationally representative telephone survey sponsored by the Maternal and Child Health Bureau and conducted by the National Center for Health Statistics. A cross-sectional analysis using data from the US on 90,721 children was conducted to examine the relationship between preterm birth and asthma risk. RESULTS A total of 90,721 children under 17 years were included and 12% of the children were reported as preterm birth. The prevalence of diagnosed asthma was 15%, with a male to female ratio of 1.26:1. Children who were born preterm were 1.64 times (95% confidence interval: 1.45-1.84) more likely to develop asthma compared with those who were born term after controlling for confounders. Similarly, children who were low birth weight were 1.43 times (95% confidence interval: 1.25-1.63) more likely for asthma, and the odds ratio increased to 1.77 for those both preborn and low birth weight. Child's gender, race/ethnicity, age, family structure, family income levels, and household smoking were significantly associated with the odds of reported asthma. CONCLUSIONS Preterm birth was associated with increased risk of asthma among US children, supporting the notion that preterm birth may play a critical role in asthma development.
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Affiliation(s)
- Jie Zhang
- Department of Ship Hygiene, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433 China
- School of Public Health, Brown University, Providence, RI USA
| | - Chenchao Ma
- Department of thoracic surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Aimin Yang
- School of Public Health, Brown University, Providence, RI USA
| | - Rongqiang Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiannan Gong
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Fengfeng Mo
- Department of Ship Hygiene, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433 China
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Jackson WM, O’Shea TM, Allred EN, Laughon MM, Gower WA, Leviton A. Risk factors for chronic lung disease and asthma differ among children born extremely preterm. Pediatr Pulmonol 2018; 53:1533-1540. [PMID: 30160065 PMCID: PMC6716602 DOI: 10.1002/ppul.24148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the hypothesis that chronic lung disease of prematurity (CLD) is a risk factor for asthma in children born extremely preterm, and the hypothesis that the risk factors for CLD are similar to those for asthma. METHODS A retrospective analysis was performed using data collected prospectively from 882 children born before the 28th week of gestation between 2002 and 2004 who returned for follow-up at ages 12 and 24 months and 10 years. We created time-oriented logistic regression models to compare risk factors for CLD, defined as need for supplemental oxygen at 36 weeks postmenstrual age, and parent-reported asthma at 10 years of age. RESULTS CLD diagnosed during neonatal admission was associated with bronchodilator use at 12 months and 24 months (P < 0.001), but not with an asthma diagnosis at 10 years (Odds Ratio 1.3; 95% confidence interval 0.98-1.8). While risk factors for CLD include lower gestational age (OR 2.7; 1.5-4.7) and fetal growth restriction (OR 2.3; 1.4-3.7), risk factors for asthma include mother's eligibility for public insurance (Medicaid) (OR 1.8; 1.1-2.8), and higher weight gain velocity during the first year (OR 1.5; 1.02-2.2) and between the 2nd and 10th year (OR 1.7; 1.2-2.4). CONCLUSIONS Among children born extremely preterm, the diagnosis of CLD and its antecedents were associated with transient preschool wheezing, but not with asthma. Post-NICU factors, such as growth velocity and socioeconomic disadvantage, appear to have stronger associations with asthma than exposures during NICU admission.
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Affiliation(s)
- Wesley M. Jackson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth N. Allred
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Matthew M. Laughon
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - W. Adam Gower
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Alan Leviton
- Departments of Neurology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts
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Wi C, Krusemark EA, Voge G, Sohn S, Liu H, Ryu E, Park MA, Castro‐Rodriguez JA, Juhn YJ. Usefulness of asthma predictive index in ascertaining asthma status of children using medical records: An explorative study. Allergy 2018; 73:1276-1283. [PMID: 29319899 DOI: 10.1111/all.13403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frequent wheezing in original asthma predictive index (API) was defined by parental report of recurrent wheezing within 1 year during the first 3 years of life. The nature of frequent wheezing in children, particularly aged over 3 years, has not been studied. We aimed to assess the frequency and interval of wheezing to define frequent wheezing in ascertaining asthma for children using medical records. METHODS Among children who participated in a previous study (n = 427), all wheezing episodes documented in medical records were collected for children who had ≥2 wheezing episodes PLUS met one major criterion or two minor criteria of API. We compared the distribution of known risk factors for asthma between subjects having two consecutive wheezing episodes with shorter interval (≤1 year) compared to those with longer interval (1 to 3 years). RESULTS A total of 62 children met API at median age of 2.3 years. During follow-up period (median age: 11.3 years), a total of 198 wheezing episodes were observed. 81% of wheezing intervals were within 3 years from the earlier wheezing episode, including 60% within 1 year. Children who met API based on 1-year interval (n = 40) vs 1- to 3-year interval (n = 13) appeared to be similar in regard to the known risk factors for asthma. CONCLUSIONS Our exploratory study finding suggests that children who had frequent wheezing episodes with longer interval (<3 years) need to be considered to be determined as asthma cases when API is applied to retrospective medical records. Prospective studies with a larger sample size need to replicate this finding.
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Affiliation(s)
- C.‐I. Wi
- Department of Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA
- Asthma Epidemiology Research Unit Mayo Clinic Rochester MN USA
| | - E. A. Krusemark
- Department of Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA
- Asthma Epidemiology Research Unit Mayo Clinic Rochester MN USA
| | - G. Voge
- Department of Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA
- Asthma Epidemiology Research Unit Mayo Clinic Rochester MN USA
- Division of Neonatology Children's Hospitals and Clinics of Minnesota Minneapolis MN USA
| | - S. Sohn
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
| | - H. Liu
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
| | - E. Ryu
- Asthma Epidemiology Research Unit Mayo Clinic Rochester MN USA
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
| | - M. A. Park
- Division of Allergic Diseases Mayo Clinic Rochester MN USA
| | - J. A. Castro‐Rodriguez
- Division of Pediatrics School of Medicine Pontificia Universidad Catolica de Chile Santiago Chile
| | - Y. J. Juhn
- Asthma Epidemiology Research Unit Mayo Clinic Rochester MN USA
- Department of Pediatric and Adolescent Medicine/Internal Medicine Mayo Clinic Rochester MN USA
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Sohn S, Wi CI, Wu ST, Liu H, Ryu E, Krusemark E, Seabright A, Voge GA, Juhn YJ. Ascertainment of asthma prognosis using natural language processing from electronic medical records. J Allergy Clin Immunol 2018; 141:2292-2294.e3. [PMID: 29438770 PMCID: PMC5994178 DOI: 10.1016/j.jaci.2017.12.1003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/08/2017] [Accepted: 12/13/2017] [Indexed: 01/10/2023]
Abstract
NLP algorithm successfully determined asthma prognosis (i.e., no remission, long-term remission, and intermittent remission) by taking into account asthma symptoms documented in EMR, and addressed the limitations of billing code- based asthma outcome assessment.
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Affiliation(s)
- Sunghwan Sohn
- Department of Health Science Research, Mayo Clinic, Rochester, Minn
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Stephen T Wu
- Oregon Health & Science University, Portland, Ore
| | - Hongfang Liu
- Department of Health Science Research, Mayo Clinic, Rochester, Minn
| | - Euijung Ryu
- Department of Health Science Research, Mayo Clinic, Rochester, Minn
| | - Elizabeth Krusemark
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | | | - Gretchen A Voge
- Division of Neonatology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn.
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9
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Automated chart review utilizing natural language processing algorithm for asthma predictive index. BMC Pulm Med 2018; 18:34. [PMID: 29439692 PMCID: PMC5812028 DOI: 10.1186/s12890-018-0593-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Thus far, no algorithms have been developed to automatically extract patients who meet Asthma Predictive Index (API) criteria from the Electronic health records (EHR) yet. Our objective is to develop and validate a natural language processing (NLP) algorithm to identify patients that meet API criteria. METHODS This is a cross-sectional study nested in a birth cohort study in Olmsted County, MN. Asthma status ascertained by manual chart review based on API criteria served as gold standard. NLP-API was developed on a training cohort (n = 87) and validated on a test cohort (n = 427). Criterion validity was measured by sensitivity, specificity, positive predictive value and negative predictive value of the NLP algorithm against manual chart review for asthma status. Construct validity was determined by associations of asthma status defined by NLP-API with known risk factors for asthma. RESULTS Among the eligible 427 subjects of the test cohort, 48% were males and 74% were White. Median age was 5.3 years (interquartile range 3.6-6.8). 35 (8%) had a history of asthma by NLP-API vs. 36 (8%) by abstractor with 31 by both approaches. NLP-API predicted asthma status with sensitivity 86%, specificity 98%, positive predictive value 88%, negative predictive value 98%. Asthma status by both NLP and manual chart review were significantly associated with the known asthma risk factors, such as history of allergic rhinitis, eczema, family history of asthma, and maternal history of smoking during pregnancy (p value < 0.05). Maternal smoking [odds ratio: 4.4, 95% confidence interval 1.8-10.7] was associated with asthma status determined by NLP-API and abstractor, and the effect sizes were similar between the reviews with 4.4 vs 4.2 respectively. CONCLUSION NLP-API was able to ascertain asthma status in children mining from EHR and has a potential to enhance asthma care and research through population management and large-scale studies when identifying children who meet API criteria.
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Wi CI, Sohn S, Rolfes MC, Seabright A, Ryu E, Voge G, Bachman KA, Park MA, Kita H, Croghan IT, Liu H, Juhn YJ. Application of a Natural Language Processing Algorithm to Asthma Ascertainment. An Automated Chart Review. Am J Respir Crit Care Med 2017; 196:430-437. [PMID: 28375665 DOI: 10.1164/rccm.201610-2006oc] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Difficulty of asthma ascertainment and its associated methodologic heterogeneity have created significant barriers to asthma care and research. OBJECTIVES We evaluated the validity of an existing natural language processing (NLP) algorithm for asthma criteria to enable an automated chart review using electronic medical records (EMRs). METHODS The study was designed as a retrospective birth cohort study using a random sample of 500 subjects from the 1997-2007 Mayo Birth Cohort who were born at Mayo Clinic and enrolled in primary pediatric care at Mayo Clinic Rochester. Performance of NLP-based asthma ascertainment using predetermined asthma criteria was assessed by determining both criterion validity (chart review of EMRs by abstractor as a gold standard) and construct validity (association with known risk factors for asthma, such as allergic rhinitis). MEASUREMENTS AND MAIN RESULTS After excluding three subjects whose respiratory symptoms could be attributed to other conditions (e.g., tracheomalacia), among the remaining eligible 497 subjects, 51% were male, 77% white persons, and the median age at last follow-up date was 11.5 years. The asthma prevalence was 31% in the study cohort. Sensitivity, specificity, positive predictive value, and negative predictive value for NLP algorithm in predicting asthma status were 97%, 95%, 90%, and 98%, respectively. The risk factors for asthma (e.g., allergic rhinitis) that were identified either by NLP or the abstractor were the same. CONCLUSIONS Asthma ascertainment through NLP should be considered in the era of EMRs because it can enable large-scale clinical studies in a more time-efficient manner and improve the recognition and care of childhood asthma in practice.
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Affiliation(s)
- Chung-Il Wi
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
| | - Sunghwan Sohn
- 3 Division of Biomedical Statistics and Informatics, and
| | - Mary C Rolfes
- 2 Asthma Epidemiology Research Unit.,4 Mayo Medical School, Rochester, Minnesota
| | | | - Euijung Ryu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Gretchen Voge
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit.,5 Division of Neonatology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; and
| | - Kay A Bachman
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Miguel A Park
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Hirohito Kita
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Ivana T Croghan
- 7 Department of Medicine Research, Mayo Clinic, Rochester, Minnesota
| | - Hongfang Liu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Young J Juhn
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
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Bellanti JA, Settipane RA. Can the burden of disease due to food allergy be prevented? Allergy Asthma Proc 2017; 38:85-87. [PMID: 28234045 DOI: 10.2500/aap.2017.38.4040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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