The effect of the socioeconomic status on the measurement of asthma control

The relationship of gastroesophageal reflux disease and asthma control

Purpose

To study whether ACT responses are confounded by gastro-esophageal status (GERD), and if this is in concordance with the variation in Forced Expiratory Volume in 1 second (FEV1%) and Fractional Excretion of Nitric Oxide (FeNO).

Materials and Methods

This is a prospective cohort study (n = 307). Patients were surveyed for demographics data, and underwent ACT scoring, FEV1% and FeNO testing.

Results

Patients with GERD had mean ACT scores that were 4.1 (p < .001) lower than without-GERD group. Not-well-controlled asthmatics (FEV1% <80, high FeNO) with-GERD had mean ACT scores that were 2.9 (p < .001) for FEV1% <80 and 3.8 (p = .008) for high FeNO lower than without-GERD group respectively. Well-controlled asthmatics (FEV1% ≥80, low FeNO) with-GERD had mean ACT scores that were 5.2 (p < .001) for FEV1% ≥80 and 5.1 (p < .001) for low FeNO lower than without-GERD group respectively.

Conclusion

Our study demonstrates that symptoms of GERD can lead to an inaccurate perception of asthma control and ACT as compared to objective measures, such as FEV1% and FeNO. Hence, this can lead to mismanagement of asthma, especially when objective measures are not conducted along with ACT.

The influence of asthma on neuroinflammation and neurodevelopment: From epidemiology to basic models

Asthma is a highly heterogeneous inflammatory disease that can have a significant effect on both the respiratory system and central nervous system. Population based studies and animal models have found asthma to be comorbid with a number of neurological conditions, including depression, anxiety, and neurodevelopmental disorders. In addition, maternal asthma during pregnancy has been associated with neurodevelopmental disorders in the offspring, such as autism spectrum disorders and attention deficit hyperactivity disorder. In this article, we review the most current epidemiological studies of asthma that identify links to neurological conditions, both as it relates to individuals that suffer from asthma and the impacts asthma during pregnancy may have on offspring neurodevelopment. We also discuss the relevant animal models investigating these links, address the gaps in knowledge, and explore the potential future directions in this field.

Prediction of Asthma Exacerbations in Children

Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.

Multilevel Risk Factors for Sleep-Disordered Breathing-Related Symptom Burden in an Urban Pediatric Community-Based Sample

BACKGROUND

Pediatric sleep-disordered breathing (SDB) disproportionately affects children with low socioeconomic status (SES). The multilevel risk factors that drive these associations are not well understood.

RESEARCH QUESTION

What are the associations between SDB risk factors, including individual health conditions (obesity, asthma, and allergies), household SES (maternal education), indoor exposures (environmental tobacco smoke [ETS] and pests), and neighborhood characteristics (neighborhood disadvantage), and pediatric SDB symptoms?

STUDY DESIGN AND METHODS

Cross-sectional analyses were performed on 303 children (aged 6-12 years) enrolled in the Environmental Assessment of Sleep Youth study from 2018 to 2022. Exposures were determined by caregiver reports, assays of measured settled dust from the child's bedroom, and neighborhood-level Census data (deriving the Childhood Opportunity Index to characterize neighborhood disadvantage). The primary outcome was the SDB-related symptom burden assessed by the OSA-18 questionnaire total score. Using linear regression models, we calculated associations between exposures and SDB-related symptom burden, adjusting for sociodemographic factors, then health conditions, indoor environment, and neighborhood factors.

RESULTS

The sample included 303 children (39% Hispanic, Latino, Latina, or Spanish origin; 30% Black or African American; 22% White; and 11% other). Increasing OSA-18 total scores were associated with low household SES after adjustment for demographic factors, and with asthma, allergies, ETS, pests (mouse, cockroach, and rodents), and an indoor environmental index (sum of the presence of pests and ETS; 0-2) after adjusting for sociodemographic factors. Even after further adjusting for asthma, allergies, and neighborhood disadvantage, ETS and pest exposure were associated with OSA-18 (ETS: β = 12.80; 95% CI, 7.07-18.53, also adjusted for pest; pest exposure: β = 3.69; 95% CI, 0.44-6.94, also adjusted for ETS).

INTERPRETATION

In addition to associations with ETS, a novel association was observed for indoor pest exposure and SDB symptom burden. Strategies to reduce household exposure to ETS and indoor allergens should be tested as approaches for reducing sleep health disparities.