Why are some children with early onset of asthma getting better over the years?--diagnostic failure or salutogenetic factors

Allergic Rhinitis and House Dust Mite Sensitization Determine Persistence of Asthma in Children

OBJECTIVE

To specify clinical and immunological parameters of the mechanisms, which may lead to development of persistent asthma, or regression of the disease symptoms.

METHODS

Eighty children with childhood asthma, diagnosed in the past by using the modified Asthma Predicted Index (mAPI), were divided into two groups: remission group and persistent group. There were 3 study visits (baseline, at 6 mo, and at 12 mo). Clinical remission of asthma was defined as the absence of asthma symptoms for at least 12 mo without treatment. The patients could switch from one group to another during the 12 mo of follow-up. Clinical, inflammatory, and immunoregulatory predictors of asthma remission/persistence were analyzed.

RESULTS

The presence of mAPI criteria as well as house dust mite (HDM) allergy and allergic rhinitis at 7-10 y, were associated with a reduced prevalence of asthma remission. The increased eosinophil blood count in mAPI criteria was associated with a lower expression of CD25 positive cells. HDM allergy was associated with a higher fractional exhaled nitric oxide (FeNO) level (p = 0.0061) and higher expression of CD25CD71 (p = 0.0232). Allergic rhinitis was associated with a higher expression of PPAR (p = 0.0493) and CD25CD71 (p = 0.0198), and lower expression of glycoprotein A repetitions predominant (GARP).

CONCLUSIONS

Persistence of childhood asthma was largely determined by the presence of allergic rhinitis and sensitization to HDM. Additionally, API criteria but not immunoregulation processes, were related to asthma persistence.

Use of Salutogenic Approach Among Children and Adolescents with Chronic Illnesses: A Scoping Review

PROBLEM

A pathogenic medical orientation focusing on disease management relies heavily on the skills of healthcare professionals. In contrast, a salutogenic approach focuses on health promotion by encouraging resource strengthening among patients to maintain and support recovery, which could help alleviate healthcare burden and enhance healthcare quality. Considering the increased life expectancies of chronically ill children, this review aimed to consolidate evidence on the use of salutogenesis among children and adolescents with chronic illnesses.

ELIGIBILITY CRITERIA

A scoping review guided by Arksey and O'Malley's five-stage framework was conducted. Studies with samples of children or adolescents aged 19 years and below with chronic disease were included in the review.

SAMPLE

A library search was performed across six electronic databases (PubMed, Embase, CINAHL, PsycInfo, and Web of Science) from each database's inception to March 2020. Twelve studies were included.

RESULTS

Current evidence only highlighted the trend and advantages of high sense of coherence and identify factors that enhance sense of coherence. Boys, younger age, higher cognitive functioning, non-migrants, non-smokers, and available peer and family support contribute to higher levels of sense of coherence, which lead to better perceived health, quality of life, and more positive coping strategies.

CONCLUSIONS

Healthcare professionals should adopt a salutogenic approach to encourage patient involvement, independence, and responsibility in maintaining their own health.

IMPLICATIONS

Further research is needed to provide a holistic view of the sense of coherence and application of salutogenesis (especially other salutogenic concepts) among this sample group, which can also inform future salutogenic intervention studies.

Prevalence of asthma in patients with atopic dermatitis: A systematic review and meta-analysis

BACKGROUND

It is well established that asthma is common in patients with atopic dermatitis (AD).

OBJECTIVES

We performed a systematic review and meta-analysis to determine the prevalence of asthma and respiratory symptoms in individuals with AD as well as the association between AD and asthma.

METHODS

At least 2 authors independently searched the medical databases PubMed, EMBASE, LILACS, and SCOPUS for all English-language studies with data on asthma prevalence among patients with AD or the association between AD and asthma. Pooled odds ratios with 95% confidence intervals (CIs) and pooled proportions were estimated with random-effects models. The Newcastle-Ottawa scale was used to assess study quality.

RESULTS

The search yielded 39,503 articles. Of these, 213 studies were included in a quantitative analysis. The overall pooled prevalence of asthma was 25.7% (95% CI, 23.7-27.7) in patients with AD and 8.1% (95% CI, 7.0-9.4) among reference individuals. There was a significant association between AD and asthma when compared with reference individuals (odds ratio, 3.03; 95% CI, 2.64-3.47).

LIMITATIONS

The definitions of AD and asthma differed across the included studies and varied from self-report to physician diagnosed.

CONCLUSIONS

Asthma is a common comorbidity of AD. Physicians should be cognizant of this relationship and address asthma symptoms in their patients.

Predicting asthma outcomes

This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.

Association between respiratory syncytial virus hospitalizations in infants and respiratory sequelae: systematic review and meta-analysis

BACKGROUND

The association between hospitalization for respiratory syncytial virus (RSV) infection in infancy and asthma/wheezing in later life has long been studied. However, no published studies have combined systematic review and meta-analysis of existing evidence.

PURPOSE

To quantify the link between RSV hospitalization in early life and subsequent diagnosis of asthma.

METHOD

A systematic search was conducted using MEDLINE and EMBASE databases. Studies were selected for meta-analysis if they assessed the association between RSV-confirmed hospitalization for up to 3 years of age and asthma/wheezing later in life. Potential sources of heterogeneity were identified by stratified analysis.

RESULTS

Twenty articles representing 15 unique studies of 82,008 unique individuals (including 1533 with RSV-confirmed hospitalization) were selected for meta-analysis. Children who had RSV disease in early life had a higher incidence of asthma/wheezing in later life (odds ratio: 3.84; 95% confidence interval: 3.23-4.58). There was moderate heterogeneity between studies (I² = 45%). The association was found to decrease with age at follow-up, consistent with the findings of longitudinal studies. When age at follow-up was considered, heterogeneity was low (residual I² = 17%).

LIMITATIONS

Study quality was generally poor because randomization to hospitalization for RSV infection was not possible, appropriate blinding was rare and adjustment for confounding variables was not always appropriate.

CONCLUSIONS

The meta-analysis suggests an association between infant RSV hospitalization and respiratory morbidity that decreases with age. If the association is causal, the development of an effective vaccine against RSV could decrease the burden of asthma.