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Shepperd JA, Hunleth JM, Maki J, Prabakaran S, Pogge G, Webster G, Ruiz S, Waters EA. Interpersonal comparison among caregivers of children with asthma. Psychol Health 2024; 39:969-988. [PMID: 36147010 PMCID: PMC10030381 DOI: 10.1080/08870446.2022.2125514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Objective: We examined the extent to which caregivers of children with asthma used interpersonal comparisons-a novel comparison process that parallels social comparison and temporal comparison-to form judgments about their child. Methods & Measures: Using semi-structured interviews adapted from the McGill Illness Narrative Interview, we examined the interpersonal comparisons that caregivers of a child with asthma (n = 41) made regarding their child. Results: Interpersonal comparisons influenced caregiver thoughts, feelings, and behavior. They helped caregivers distinguish asthma from other breathing problems, evaluate the severity of the asthma, and understand their child's experience. However, they also created uncertainty by highlighting the complex, unpredictable nature of asthma. Interpersonal comparisons were a source of gratitude and hope, but also worry and frustration. Finally, interpersonal comparisons influenced caregivers' decisions and actions, resulting in decisions that aligned with and, at times, ran counter to biomedical models of asthma care. In some instances, caregivers used interpersonal comparisons to motivate their child's behavior. Conclusion: The interpersonal comparisons served as a source of information for caregivers trying to understand and manage their child's asthma. Investigating these comparisons also expands how we think about other comparison theories.
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Affiliation(s)
- James A. Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Jean M. Hunleth
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Julia Maki
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Sreekala Prabakaran
- Department of Pulmonology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory Webster
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Sienna Ruiz
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
| | - Erika A. Waters
- Department of Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO, USA
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2
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Chung HL. Diagnosis and management of asthma in infants and preschoolers. Clin Exp Pediatr 2022; 65:574-584. [PMID: 35436814 PMCID: PMC9742764 DOI: 10.3345/cep.2021.01746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/31/2022] [Indexed: 01/06/2023] Open
Abstract
Asthma is one of the most common chronic disease affecting children, and it often starts in infancy and preschool years. In previous birth cohorts, frequent wheezing in early life was associated with the development of asthma in later childhood and reduced lung function persisting into adulthood. Preschool wheezing is considered an umbrella term for distinctive diseases with different clinical features (phenotypes), each of which may be related to different underlying pathophysiologic mechanisms (endotypes). The classification of phenotypes of early wheezing is needed to identify children at high risk for developing asthma later who might benefit from early intervention. However, diagnosis of asthma in infants and preschoolers is particularly difficult because objective lung function tests cannot be performed and definitive biomarkers are lacking. Moreover, management of early asthma is challenging because of its different phenotypic presentations. Many prediction models and asthma guidelines have been developed to provide useful information for physicians to assess young children with recurrent wheezing and manage them appropriately. Many recent studies have investigated the application of personalized medicine for early asthma by identifying specific phenotypes and biomarkers. Further researches, including genetic and molecular studies, are needed to establish a clear definition of asthma and develop more targeted therapeutic approaches in this age group.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Daegu Catholic University, Daegu, Korea
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3
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Chan M, Gray M, Burns C, Owens L, Jaffe A, Homaira N. Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma. J Asthma Allergy 2021; 14:797-808. [PMID: 34262298 PMCID: PMC8274827 DOI: 10.2147/jaa.s311721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia. Methods A cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services. Results A total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up. Conclusion There are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.
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Affiliation(s)
- Mei Chan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Christine Burns
- Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Louisa Owens
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
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4
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Shi M, Liang L, Wang Y, Yu Y. Risk factors associated with health-related quality of life in pediatric asthma. Sci Prog 2021; 104:368504211013657. [PMID: 33970048 PMCID: PMC10358580 DOI: 10.1177/00368504211013657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the quality of life (QOL) of children with asthma and analyze the related factors. A total of 360 children diagnosed with asthma were enrolled. We conducted the pediatric asthma quality of life questionnaire (PAQLQ). The differences in clinical characteristics between the two groups were compared. Clinical characteristics were compared between high and low QOL. More female was observed in low QOL group (p = 0.013). Patients with higher income (p = 0.003) were shown with higher QOL. Female patients presented significantly lower values for activity limitation (p = 0.016) and emotional function (p = 0.016) as compared to male patients. For patients who have low income, the QOL scores for dimensions of activity limitation was significantly worse than those have higher income (p = 0.001). Univariable results showed that gender (p = 0.013) and income (p = 0.001) were factors associated with QOL in asthma children. However, multivariate analysis suggested that only gender (OR = 0.558, p = 0.008) and income (OR = 1.762, p < 0.001) were the independent factors that affected the QOL levels. In this study, we found that the QOL dimensions of pediatric asthma differed between various subpopulations. For patients with risk factors of poor QOL, target intervention is advised in order to increase QOL.
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Affiliation(s)
- Miaomiao Shi
- Department of Respiratory Medicine, Anhui Provincial Children’s Hospital, Anhui, China
| | - Lei Liang
- Department of Respiratory Medicine, Anhui Provincial Children’s Hospital, Anhui, China
| | - Yu Wang
- Department of Respiratory Medicine, Anhui Provincial Children’s Hospital, Anhui, China
| | - Yangze Yu
- Department of Respiratory Medicine, Anhui Provincial Children’s Hospital, Anhui, China
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5
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Kowatsch T, Schachner T, Harperink S, Barata F, Dittler U, Xiao G, Stanger C, V Wangenheim F, Fleisch E, Oswald H, Möller A. Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study. J Med Internet Res 2021; 23:e25060. [PMID: 33484114 PMCID: PMC7929753 DOI: 10.2196/25060] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/19/2020] [Accepted: 01/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. OBJECTIVE With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent-delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. METHODS MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent-patient working alliance; (2) to offer hybrid (human- and conversational agent-supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. RESULTS Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. CONCLUSIONS This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a "team player" role but also show potential to improve health-relevant outcomes in chronic disease management.
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Affiliation(s)
- Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Theresa Schachner
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Samira Harperink
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Filipe Barata
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Ullrich Dittler
- Fakultät Digitale Medien, Campus Furtwangen, Hochschule Furtwangen University, Furtwangen, Germany
| | - Grace Xiao
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Florian V Wangenheim
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Helmut Oswald
- Department of Child and Adolescent Health, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Alexander Möller
- Division of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Clark H, Carpenter D, Walsh K, Davis SA, Garcia N, Sleath B. Medication Errors in Adolescents Using Asthma Controller Medications. Glob Pediatr Health 2020; 7:2333794X20981341. [PMID: 33403224 PMCID: PMC7739079 DOI: 10.1177/2333794x20981341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.
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Affiliation(s)
- Henry Clark
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Betsy Sleath
- University of North Carolina, Chapel Hill, NC, USA
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7
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Nassikas N, Spangler K, Fann N, Nolte CG, Dolwick P, Spero TL, Sheffield P, Wellenius GA. Ozone-related asthma emergency department visits in the US in a warming climate. ENVIRONMENTAL RESEARCH 2020; 183:109206. [PMID: 32035409 PMCID: PMC7167359 DOI: 10.1016/j.envres.2020.109206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
Ozone exposure is associated with higher risk of asthma-related emergency department visits. The meteorological conditions that govern ozone concentration are projected to be more favorable to ozone formation over much of the United States due to continued climate change, even as emissions of anthropogenic ozone precursors are expected to decrease by 2050. Our goal is to quantify the health benefits of a climate change mitigation scenario versus a "business-as-usual" scenario, defined by the United Nations Intergovernmental Panel on Climate Change Representative Concentration Pathways (RCPs) 4.5 and 8.5, respectively, using the health impact analytical program Benefits Mapping and Analysis Program - Community Edition (BenMAP - CE) to project the number of asthma ED visits in 2045-2055. We project an annual average of 3100 averted ozone-related asthma ED visits during the 2045-2055 period under RCP4.5 versus RCP8.5, with all other factors held constant, which translates to USD $1.7 million in averted costs annually. We identify counties with tens to hundreds of avoided ozone-related asthma ED visits under RCP4.5 versus RCP8.5. Overall, we project a heterogeneous distribution of ozone-related asthma ED visits at different spatial resolutions, specifically national, regional, and county levels, and a substantial net health and economic benefit of climate change mitigation.
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Affiliation(s)
- Nicholas Nassikas
- Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University Alpert Medical School, Providence, RI, 02903, USA.
| | - Keith Spangler
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI, 02912, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02903, USA; Institute at Brown for Environment and Society, Brown University, Providence, RI, 02912, USA
| | - Neal Fann
- U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Research Triangle Park, NC, 27709, USA
| | - Christopher G Nolte
- U.S. Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, 27709, USA
| | - Patrick Dolwick
- U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Research Triangle Park, NC, 27709, USA
| | - Tanya L Spero
- U.S. Environmental Protection Agency, Office of Research and Development, Research Triangle Park, NC, 27709, USA
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02903, USA
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8
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Cag Y, Pacal Y, Gunduz M, Isik S, Kertmen BA, Toprak N, Ozaydin SE, Ozcetin M, Kut A. The effect of peripheral blood eosinophilia on inflammatory markers in asthmatic patients with lower respiratory tract infections. J Int Med Res 2019; 47:2452-2460. [PMID: 31006357 PMCID: PMC6567716 DOI: 10.1177/0300060519844859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the behaviour of the inflammatory marker neutrophil-to-lymphocyte ratio (NLR) in the presence of peripheral blood eosinophilia (PBE) in paediatric asthma patients with lower respiratory tract (LRT) infections. Methods This retrospective study enrolled consecutive patients aged ≥5 years who were diagnosed with asthma and whose haemogram values were available. The patients were further subdivided based on the presence or absence of LRT infections and allergies. NLR and C-reactive protein (CRP) were evaluated in relation to the presence or absence of PBE (≥4% eosinophils). Results A total of 991 patients were enrolled in the study. Patients with LRT infections had significantly higher leucocyte and neutrophil counts, a greater NLR and a higher level of CRP compared with patients without LRT infections. Overall, patients with PBE had significantly lower NLRs and CRP regardless of the presence or absence of an LRT infection. The PBE percentage showed moderate inverse correlations with NLR (r = −0.34) and CRP (r = −0.20). Conclusion The presence of PBE was significantly associated with lower NLR and CRP regardless of the presence or absence of an infectious condition.
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Affiliation(s)
- Yakup Cag
- 1 Department of Paediatrics, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Yakup Pacal
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Gunduz
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sakine Isik
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Birgul Altinsoy Kertmen
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Necmettin Toprak
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sadik Erhan Ozaydin
- 2 Department of Paediatric Pulmonology, Health Sciences Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozcetin
- 3 Department of Paediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arif Kut
- 4 Department of Paediatric Pulmonology, Medical Faculty, Maltepe University, Istanbul, Turkey
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Kaguelidou F, Durrieu G, Clavenna A. Pharmacoepidemiological research for the development and evaluation of drugs in pediatrics. Therapie 2019; 74:315-324. [PMID: 30773345 DOI: 10.1016/j.therap.2018.09.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 12/23/2022]
Abstract
New regulations have come into force in Europe and the US establishing the pediatric development as an integral part of the early development of medicinal products. Parallel to the advances in pediatric clinical research, it became obvious that all available sources and research tools to gather valuable information for the safe and efficacious prescription of medicines in children should be used. Real-life, pharmacoepidemiological studies provide information that contribute to the better knowledge of drug utilization, effects and safety in the pediatric population and thereby, a better prescribing in children. In this paper, we suggest some possible applications, provide examples of impact of pharmacoepidemiological and pharmacovigilance studies and expose future perspectives in pediatric pharmacoepidemiology.
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Affiliation(s)
- Florentia Kaguelidou
- CIC Inserm 1426, Department of pediatric pharmacology and pharmacogenetics, clinical investigations center, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; UMR-1123, ECEVE, Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Department of pediatric pharmacology and pharmacogenetics, hôpital Robert-Debré, AP-HP, 75019 Paris, France.
| | - Geneviève Durrieu
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France
| | - Antonio Clavenna
- Laboratory for mother and child health, department of public health, IRCCS, Istituto di ricerche farmacologiche Mario Negri, 20156 Milan, Italy
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Papadopoulos NG, Čustović A, Cabana MD, Dell SD, Deschildre A, Hedlin G, Hossny E, Le Souëf P, Matricardi PM, Nieto A, Phipatanakul W, Pitrez PM, Pohunek P, Gavornikova M, Jaumont X, Price DB. Pediatric asthma: An unmet need for more effective, focused treatments. Pediatr Allergy Immunol 2019; 30:7-16. [PMID: 30312503 PMCID: PMC7380053 DOI: 10.1111/pai.12990] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite remarkable advances in our understanding of asthma, there are still several unmet needs associated with the management of pediatric asthma. METHODS A two-day, face-to-face meeting was held in London, United Kingdom, on October 28 and 29, 2017, involving a group of international expert clinicians and scientists in asthma management to discuss the challenges and unmet needs that remain to be addressed in pediatric asthma. RESULTS These unmet needs include a lack of clinical efficacy and safety evidence, and limited availability of non-steroid-based alternative therapies in patients <6 years of age. An increased focus on children is needed in the context of clinical practice guidelines for asthma; current pediatric practice relies mostly on extrapolations from adult recommendations. Furthermore, no uniform definition of pediatric asthma exists, which hampers timely and robust diagnosis of the condition in affected patients. CONCLUSIONS There is a need for a uniform definition of pediatric asthma, clearly distinguishable from adult asthma. Furthermore, guidelines which provide specific treatment recommendations for the management of pediatric asthma are also needed. Clinical trials and real-world evidence studies assessing anti-immunoglobulin E (IgE) therapies and other monoclonal antibodies in children <6 years of age with asthma may provide further information regarding the most appropriate treatment options in these vulnerable patients. Early intervention with anti-IgE and non-steroid-based alternative therapies may delay disease progression, leading to improved clinical outcomes.
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Affiliation(s)
- Nikolaos G. Papadopoulos
- Division of Infection, Inflammation & Respiratory MedicineThe University of ManchesterManchesterUK
- The Allergy Department, 2nd Pediatric Clinic, National & KapodistrianUniversity of AthensAthensGreece
| | - Adnan Čustović
- Department of PaediatricsImperial College LondonLondonUK
| | - Michael D. Cabana
- Departments of Pediatrics and Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCalifornia
| | - Sharon D. Dell
- Division of Respiratory Medicine, Department of Pediatrics, Child Health Evaluative Sciences, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Antoine Deschildre
- CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de FlandreCHRU de Lille and Université Nord de FranceLilleFrance
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Lung and Allergy UnitKarolinska University HospitalStockholmSweden
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Elham Hossny
- Pediatric Allergy and Immunology UnitChildren's Hospital Ain Shams UniversityCairoEgypt
| | - Peter Le Souëf
- School of Paediatrics and Faculty of Child Health and Medical SciencesUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Paolo M. Matricardi
- Department of Pediatric Pneumology & ImmunologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy UnitChildren's Hospital La FeValenciaSpain
| | - Wanda Phipatanakul
- Pediatric Allergy and ImmunologyBoston Children’s HospitalBostonMassachusetts
| | - Paulo M. Pitrez
- School of MedicinePontifícia Universidade Católica do Rio Grande do Sul (PUCRS)Porto AlegreBrazil
| | - Petr Pohunek
- Pediatric Department, 2nd Faculty of MedicineCharles University Prague, and University Hospital MotolPragueCzech Republic
| | | | | | - David B. Price
- Observational and Pragmatic Research InstituteSingaporeSingapore
- University of AberdeenAberdeenUK
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11
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Osokogu OU, Verhamme K, Sturkenboom M, Kaguelidou F. Pharmacoepidemiology in pediatrics: Needs, challenges and future directions for research. Therapie 2018; 73:151-156. [PMID: 29580613 DOI: 10.1016/j.therap.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022]
Abstract
Despite international initiatives to promote clinical research in pediatrics, there are still many gaps of knowledge in the use of drugs to treat this specific population. When important information cannot be derived only from clinical trials, use of available observational research tools is required. In this paper, we provide an overview of the particular interest of pharmacoepidemiological research into the evaluation of drug effects in children and adolescents. We also sought to underline the unique challenges and specific needs regarding this research. Implementation of innovative methodologies and expansion of database networks to perform necessary studies could further improve performances of observational research.
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Affiliation(s)
- Osemeke U Osokogu
- Department of medical informatics, Erasmus university medical center, 3015 GE Rotterdam, The Netherlands
| | - Katia Verhamme
- Department of medical informatics, Erasmus university medical center, 3015 GE Rotterdam, The Netherlands
| | - Miriam Sturkenboom
- Department of medical informatics, Erasmus university medical center, 3015 GE Rotterdam, The Netherlands
| | - Florentia Kaguelidou
- Inserm, CIC 1426, 75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, EA 08, 75010 Paris, France; Robert-Debré hospital, department of pediatric pharmacology and pharmacogenetics, AP-HP, 75019 Paris, France.
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12
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Ioniuc I, Miron I, Ignat A, Lupu VV, Gavrilovici C, Starcea M, Mitrofan EC, Murgu A. Different evolution in the treatment of a severe persistent asthma in 2 twins: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e8820. [PMID: 29245242 PMCID: PMC5728857 DOI: 10.1097/md.0000000000008820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
RATIONALE Asthma is a multifactorial disease with complex genetic inheritance. In children under the age of 5 years, the diagnosis of asthma is a challenge. PATIENT CONCERN We present the case of twin sisters under the same treatment for persistent asthma, but with different evolution over the time. DIAGNOSES One of the sister is diagnosed with severe persistent bronchial asthma associated with bronchiectasis and dyslipidemia and the other one only with mild persistent asthma. INTERVENTIONS At each admission the treatment for the exacerbations and the underlying respiratory infections was represented by antibiotics, short-acting β2 agonists, and, sometimes, oxygen and systemic corticosteroids. As chronic treatment, they received in the last period inhaled corticosteroids associated with long-acting β2 agonist. OUTCOMES Until the age of 6.5 years, they had similar diagnoses and treatment; from this point one was asymptomatic, with normal pulmonary function tests. The other one had a more complicated evolution which led to a severe crisis by the age of 10 years old. LESSONS Although asthma is a multifactorial disease with complex genetic inheritance, the genetics has its limits. Our twins had a similar onset with the same genetic inheritance, with the same risk factors, with the same comorbidities and with the same treatment. In this context, different evolutions of severe persistent asthma require more extensive genetic investigations. PATIENT CONCERN We present the case of twin sisters under the same treatment for persistent asthma, but with different evolution over the time.
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Affiliation(s)
- Ileana Ioniuc
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | - Ingrith Miron
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | - Ancuta Ignat
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | - Vasile Valeriu Lupu
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | | | - Magdalena Starcea
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
| | | | - Alina Murgu
- Pediatrics Department, University of Medicine and Pharmacy “Grigore T. Popa”
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13
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Dragicevic S, Milosevic K, Nestorovic B, Nikolic A. Influence of the Polymorphism C-509T in the TGFB1 Gene Promoter on the Response to Montelukast. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2017; 30:239-245. [PMID: 35923018 DOI: 10.1089/ped.2017.0770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Transforming growth factor beta 1 (TGFB1) is a multifunctional cytokine with a key role in asthma airway inflammation and remodeling. Since elevated levels of this cytokine in airways might be associated with response to asthma therapy, the aim of this study was to investigate whether the presence of the polymorphism C-509T in the promoter of the TGFB1 gene is associated with response to montelukast. A group of 102 asthmatic patients was genotyped for the presence of the C-509T polymorphism by DNA sequencing and subjected to induced sputum sampling. Cells from sputum samples and BEAS 2B cells were treated with montelukast and endogenous TGFB1 expression was measured by quantitative real-time polymerase chain reaction. The promoter activity was analyzed by luciferase assays in BEAS 2B cells transfected with constructs carrying variants -509C and -509T of the TGFB1 gene promoter. After treatment with montelukast, the decrease in TGFB1 gene expression was greater for the -509TT genotype (58.9%) than for the -509CC and -509CT genotypes (49.6% and 31.8%, respectively) (P = 0.071). In BEAS 2B cells, expression of endogenous TGFB1 was reduced by about 27% after montelukast treatment, while luciferase activity of both promoter variants was increased after montelukast treatment (-509C allele: 48.3%, P = 0.060; and -509T allele: 100.5%, P = 0.062). A more intensive response was registered in the promoter containing the -509T allele, which had 135% higher activity than the -509C variant (P = 0.035). This study showed that the presence of the -509T allele in the TGFB1 promoter might modulate effects of montelukast on TGFB1 gene expression, but future studies are necessary, taking into consideration other genetic and nongenetic factors. It is of potential importance for clinical management of asthma to clarify the influence of the C-509T polymorphism on the response to treatment with montelukast.
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Affiliation(s)
- Sandra Dragicevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Katarina Milosevic
- Department of Pulmonology and Allergology, University Children's Hospital, Belgrade, Serbia
| | - Branimir Nestorovic
- Department of Pulmonology and Allergology, University Children's Hospital, Belgrade, Serbia
| | - Aleksandra Nikolic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
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14
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Maas BM, Wang J, Cooner F, Green D, Yuan Y, Yao L, Burckart GJ. Bone Mineral Density to Assess Pediatric Bone Health in Drug Development. Ther Innov Regul Sci 2017; 51:756-760. [PMID: 30227097 DOI: 10.1177/2168479017709047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pediatric bone health is an important part of the safety assessment of inhaled corticosteroids and certain other drugs. Current regulatory guidance for assessment of bone health for intranasal and inhaled corticosteroid drugs is a single 1-year study of linear growth. OBJECTIVE The objective of this study was to assess whether a significant change in bone mineral density (BMD) could be observed during a 12-month period in pediatric patients being treated for asthma with an inhaled corticosteroid using a previously conducted study. METHODS The publicly available information from the Childhood Asthma Management Program (CAMP) study was used to assess whether a statistically significant difference in BMD could be detected over a 1-year period. Patients who were at Tanner stage ≥2 were excluded from analysis as is stated in the present FDA Guidance on growth studies with inhaled corticosteroids, and children with any use of oral corticosteroids were also excluded. A comparison in BMD change over time (bone mineral accretion [BMA]) between baseline and 12 months of follow-up was made for the placebo and inhaled budesonide groups using multiple regression analysis to account for age, race, and gender as covariates. RESULTS From the original 1041 patients in the CAMP study, 74 patients met the criteria for evaluation, with 42 patients receiving budesonide and 32 placebo patients. Children randomized to budesonide had a lower mean BMA than those receiving placebo (0.021 ± 0.023 [SD] g/cm2/y vs 0.036 ± 0.025 [SD] g/cm2/y). CONCLUSION In a select pediatric patient population, a significant change in BMA can be observed over 12 months on an inhaled corticosteroid. Based on this post hoc analysis, measurement of BMA as an assessment of pediatric bone health may be considered for certain drugs, especially when there is a potential signal of bone toxicity from animal or human data. The clinical relevance of this finding is presently unknown, and more data on the relationship between changes in BMA and clinical pediatric bone health outcomes are needed.
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Affiliation(s)
- Brian M Maas
- 1 University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jian Wang
- 2 Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Freda Cooner
- 3 Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Dionna Green
- 4 Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, USA
| | - Ye Yuan
- 5 University of Florida, Gainesville, FL, USA
| | - Lynne Yao
- 2 Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gilbert J Burckart
- 4 Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, USA
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15
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O'Leary F, Pegiazoglou I, Marshall T, Thosar D, Deck M, Peat J, Ging J, Selvadurai H. Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre-school wheeze action plans. J Paediatr Child Health 2016; 52:872-6. [PMID: 27603035 DOI: 10.1111/jpc.13343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/11/2016] [Accepted: 03/12/2016] [Indexed: 11/28/2022]
Abstract
AIM To measure the long-term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre-school wheeze action plan in our population. METHODS A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record. RESULTS Two thousand three hundred and forty-two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1-15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P < 0.001. These results justified the design of the electronic pre-school wheeze action plan. CONCLUSIONS The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan.
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Affiliation(s)
- Fenton O'Leary
- Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia. .,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Ioannis Pegiazoglou
- Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey Marshall
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Deepali Thosar
- Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Mitchell Deck
- Emergency Department of The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jennifer Peat
- Australian Catholic University, Sydney, New South Wales, Australia
| | - Joanna Ging
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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16
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Shmool JLC, Kinnee E, Sheffield PE, Clougherty JE. Spatio-temporal ozone variation in a case-crossover analysis of childhood asthma hospital visits in New York City. ENVIRONMENTAL RESEARCH 2016; 147:108-14. [PMID: 26855129 PMCID: PMC5552364 DOI: 10.1016/j.envres.2016.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 05/26/2023]
Abstract
BACKGROUND Childhood asthma morbidity has been associated with short-term air pollution exposure. To date, most investigations have used time-series models, and it is not well understood how exposure misclassification arising from unmeasured spatial variation may impact epidemiological effect estimates. Here, we develop case-crossover models integrating temporal and spatial individual-level exposure information, toward reducing exposure misclassification in estimating associations between air pollution and child asthma exacerbations in New York City (NYC). METHODS Air pollution data included: (a) highly spatially-resolved intra-urban concentration surfaces for ozone and co-pollutants (nitrogen dioxide and fine particulate matter) from the New York City Community Air Survey (NYCCAS), and (b) daily regulatory monitoring data. Case data included citywide hospital records for years 2005-2011 warm-season (June-August) asthma hospitalizations (n=2353) and Emergency Department (ED) visits (n=11,719) among children aged 5-17 years. Case residential locations were geocoded using a multi-step process to maximize positional accuracy and precision in near-residence exposure estimates. We used conditional logistic regression to model associations between ozone and child asthma exacerbations for lag days 0-6, adjusting for co-pollutant and temperature exposures. To evaluate the effect of increased exposure specificity through spatial air pollution information, we sequentially incorporated spatial variation into daily exposure estimates for ozone, temperature, and co-pollutants. RESULTS Percent excess risk per 10ppb ozone exposure in spatio-temporal models were significant on lag days 1 through 5, ranging from 6.5 (95% CI: 0.2-13.1) to 13.0 (6.0-20.6) for inpatient hospitalizations, and from 2.9 (95% CI: 0.1-5.7) to 9.4 (6.3-12.7) for ED visits, with strongest associations consistently observed on lag day 2. Spatio-temporal excess risk estimates were consistently but not statistically significantly higher than temporal-only estimates on lag days 0-3. CONCLUSION Incorporating case-level spatial exposure variation produced small, non-significant increases in excess risk estimates. Our modeling approach enables a refined understanding of potential measurement error in temporal-only versus spatio-temporal air pollution exposure assessments. As ozone generally varies over much larger spatial scales than that observed within NYC, further work is necessary to evaluate potential reductions in exposure misclassification for populations spanning wider geographic areas, and for other pollutants.
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Affiliation(s)
- Jessie Loving Carr Shmool
- University of Pittsburgh Graduate School of Public Health, Department of Environmental and Occupational Health, 100 Technology Drive, Ste. 350, Pittsburgh, PA 15219, USA.
| | - Ellen Kinnee
- University of Pittsburgh Graduate School of Public Health, Department of Environmental and Occupational Health, 100 Technology Drive, Ste. 350, Pittsburgh, PA 15219, USA.
| | - Perry Elizabeth Sheffield
- Icahn School of Medicine at Mount Sinai, DPM, 1 Gustave L. Levy Pl., Box 1057, New York, NY 10029, USA.
| | - Jane Ellen Clougherty
- University of Pittsburgh Graduate School of Public Health, Department of Environmental and Occupational Health, 100 Technology Drive, Ste. 350, Pittsburgh, PA 15219, USA.
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17
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Liao TC, Lien YT, Wang S, Huang SL, Chen CY. Comorbidity of Atopic Disorders with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. J Pediatr 2016; 171:248-55. [PMID: 26846570 DOI: 10.1016/j.jpeds.2015.12.063] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the relationship between allergic manifestations in early life and the occurrence of newly diagnosed autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) throughout childhood. STUDY DESIGN We collected a population-based longitudinal cohort comprising children enrolled in Taiwan's National Health Insurance Program during 2000-2010. We first identified 387,262 children who had a diagnosis of atopic dermatitis (AD) before age 2 years, with 1:1 individualized matching to children without AD. Cox regression analyses were performed to estimate the early-onset and cumulative effects of allergic manifestations on ASD and ADHD. RESULTS An estimated 0.5% of AD-exposed children received a diagnosis of ASD, and 3.7% were diagnosed with ADHD, significantly higher than the respective rates of 0.4% and 2.9% found in their nonexposed peers. Having AD before age 2 years was associated with an increased hazard ratio (HR) for ASD by 10% and that for ADHD by 16%; such increases were particularly prominent among those with earlier-onset or more severe AD. HRs were especially higher for children with persistent AD and emerging atopic respiratory diseases in childhood (eg, for ASD, adjusted HR, 1.75 and 2.13, respectively; P < .001). CONCLUSION The observed increased risks of ASD and ADHD associated with AD in infancy suggest that a disordered immunologic response may exert effects on neurodevelopment and have implications for research into etiology and treatment strategies.
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Affiliation(s)
- Tzu-Chu Liao
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ting Lien
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Sabrina Wang
- Institute of Anatomy and Cell Biology, National Yang-Ming University, Taipei, Taiwan
| | - Song-Lih Huang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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18
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Park HW, Ge B, Tse S, Grundberg E, Pastinen T, Kelly HW, Tantisira KG. Genetic risk factors for decreased bone mineral accretion in children with asthma receiving multiple oral corticosteroid bursts. J Allergy Clin Immunol 2015; 136:1240-6.e1-8. [PMID: 26025128 PMCID: PMC4641004 DOI: 10.1016/j.jaci.2015.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Long-term intermittent oral corticosteroid (OCS) use in children with asthma leads to significant decreases in bone mineral accretion (BMA). OBJECTIVE We aimed to identify genetic factors influencing OCS dose effects on BMA in children with asthma. METHODS We first performed a gene-by-OCS interaction genome-wide association study (GWAS) of BMA in 489 white participants in the Childhood Asthma Management Program trial who took short-term oral prednisone bursts when they experienced acute asthma exacerbations. We selected the top-ranked 2000 single nucleotide polymorphisms (SNPs) in the GWAS and determined whether these SNPs also had cis-regulatory effects on dexamethasone-induced gene expression in osteoblasts. RESULTS We identified 2 SNPs (rs9896933 and rs2074439) associated with decreased BMA and related to the tubulin γ pathway. The rs9896933 variant met the criteria for genome-wide significance (P = 3.15 × 10(-8) in the GWAS) and is located on the intron of tubulin folding cofactor D (TBCD) gene. The rs2074439 variant (P = 2.74 × 10(-4) in the GWAS) showed strong cis-regulatory effects on dexamethasone-induced tubulin γ gene expression in osteoblasts (P = 8.64 × 10(-4)). Interestingly, we found that BMA worsened with increasing prednisone dose as the number of mutant alleles of the 2 SNPs increased. CONCLUSIONS We have identified 2 novel tubulin γ pathway SNPs, rs9896933 and rs2074439, showing independent interactive effects with cumulative corticosteroid dose on BMA in children with asthma receiving multiple OCS bursts.
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Affiliation(s)
- Heung-Woo Park
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bing Ge
- McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, Canada
| | - Szeman Tse
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pediatrics, Sainte-Justine University Health Center, University of Montreal, Montreal, Quebec, Canada
| | - Elin Grundberg
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Tomi Pastinen
- McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, Canada; Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, McGill University, Montreal, Quebec, Canada
| | - H William Kelly
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Kelan G Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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19
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Rodriguez-Martinez CE, Nino G, Castro-Rodriguez JA. Cost-utility analysis of daily versus intermittent inhaled corticosteroids in mild-persistent asthma. Pediatr Pulmonol 2015; 50:735-46. [PMID: 24965279 PMCID: PMC5538803 DOI: 10.1002/ppul.23073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/06/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies. METHODS A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). RESULTS For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US$437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant. CONCLUSIONS The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Research Unit, Military Hospital of Colombia, Bogota, Colombia
| | - Gustavo Nino
- Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology, Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, District of Columbia
| | - Jose A Castro-Rodriguez
- Department of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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20
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Sheffield PE, Zhou J, Shmool JLC, Clougherty JE. Ambient ozone exposure and children's acute asthma in New York City: a case-crossover analysis. Environ Health 2015; 14:25. [PMID: 25889205 PMCID: PMC4373115 DOI: 10.1186/s12940-015-0010-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Childhood asthma morbidity has been associated with ambient ozone in case-crossover studies. Varying effects of ozone by child age and sex, however, have been less explored. METHODS This study evaluates associations between ozone exposure and asthma emergency department visits and hospitalizations among boys and girls aged 5-17 years in New York City for the 2005-2011 warm season period. Time-stratified case-crossover analysis was conducted and, for comparison, time-series analysis controlling for season, day-of-week, same-day and delayed effects of temperature and relative humidity were also performed. RESULTS We found associations between ambient ozone levels and childhood asthma emergency department visits and hospitalizations in New York City, although the relationships varied among boys and girls and by age group. For an increase of interquartile range (0.013 ppm) in ozone, there was a 2.9-8.4% increased risk for boys and 5.4-6.5% for girls in asthma emergency department visits; and 8.2% increased risk for girls in hospitalizations. Among girls, we observed stronger associations among older children (10-13 and 14-17 year age groups). We did not observe significant modification by age for boys. Boys exhibited a more prompt response (lag day 1) to ozone than did girls (lag day 3), but significant associations for girls were retained longer, through lag day 6. CONCLUSIONS Our study indicates significant variance in associations between short-term ozone concentrations and asthma events by child sex and age. Differences in ozone response for boys and girls, before and after puberty, may point towards both social (gendered) and biological (sex-linked) sources of effect modification.
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Affiliation(s)
- Perry Elizabeth Sheffield
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1057, DPM, New York, NY, 10029, USA.
| | - Jiang Zhou
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Jessie Loving Carr Shmool
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Jane Ellen Clougherty
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
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21
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Indinnimeo L, Chiarotti F, De Vittori V, Baldini L, De Castro G, Zicari AM, Tancredi G, Leonardi L, Duse M. Risk factors affecting quality of life in a group of Italian children with asthma. Int J Immunopathol Pharmacol 2014; 27:235-44. [PMID: 25004835 DOI: 10.1177/039463201402700210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The measure of Quality of Life (QoL) has become one of the most important criteria used to assess the impact of chronic illness, such as asthma, on the patients daily life, in adults and children alike. The objective of our open observational study was to measure the QoL and analyze several factors that potentially affect QoL, such as symptoms and functional respiratory parameters, in a cohort of children with asthma. One hundred and twenty-seven children with asthma, 6 to 14 years of age, living in the city of Rome, were enrolled as outpatients. They were subjected to Skin Prick Tests (SPT), underwent spirometry and filled out the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). One hundred and eleven children were diagnosed with intermittent asthma, 12 (10%) with mild asthma, and four with moderate persistent asthma. Ninety-six children had a positive SPT. The mean total score of QoL, obtained from the questionnaire, was 5.4 (∓1.2 SD). Two QoL groups were created. Children with total QoL score <5.5 were included in the Lower QoL score group while children with total QoL score ≥ 5.5 were included in the Higher QoL score group. Children in the Higher group and their mothers had a higher mean age, suffered from fewer asthma exacerbations during the year preceding the study, and showed a higher mean value of forced expiratory volume (FEV1) compared to the children in the Lower category. Using Logistic regression we identified the main factors that may affect QoL as FEV1, symptoms in the previous year and mothers age. QoL is correlated with the frequency of asthma exacerbations and FEV1 values. Furthermore, our research shows that a significant impairment of QoL may also occur in patients with normal lung function, pointing out the importance of evaluating QoL in all children with asthma.
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Affiliation(s)
- L Indinnimeo
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - F Chiarotti
- Department of Cellular Biology and Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - V De Vittori
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - L Baldini
- Deparment of Psychology of the Processes of Development and Socialization, Sapienza University of Rome, Rome, Italy
| | - G De Castro
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - A M Zicari
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - G Tancredi
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - L Leonardi
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - M Duse
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
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22
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Abstract
Childhood asthma is a widespread health problem because of its epidemic prevalence, as asthma affects more than 300 million people worldwide. Results from cross-sectional and cohort studies show that asthma starts in childhood in a large proportion of cases. A proper diagnosis is easier to make in adults and school-age children, as permanent changes in lung development, the strong impact of environmental factors on the airways, the immunologic maturity process, and the use of some diagnostic tools make asthma more difficult to diagnose in preschool children. This period of a child's life is an interesting challenge for pediatricians and specialists. The aim of the present review is to analyze the current knowledge regarding making an early and accurate asthma diagnosis and therefore deciding on the correct treatment to gain control over asthma symptoms and minimize health risks.
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Affiliation(s)
- Carlos E Baena-Cagnani
- CIMER (Centro de Investigación en Medicina Respiratoria), Catholic University of Córdoba, Santa Rosa 381, X 5000 ESG, Córdoba, Argentina.
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