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Eposse Ekoube C, Abba S, Endale Mangamba M, Mandeng Ma Linwa E, Tchouamo Pokem A, Mbonjo Bitsie D, Disso Massako J, Heles Nsang E, Ngo Linwa EE, Kedy Mangamba Koum DC. Factors associated with sensitisation to selected aero-allergens in children and adolescents with asthma followed up at Laquintinie Hospital Douala, Cameroon. Pediatr Pulmonol 2024; 59:1207-1216. [PMID: 38289059 DOI: 10.1002/ppul.26883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/16/2023] [Accepted: 01/11/2024] [Indexed: 04/30/2024]
Abstract
INTRODUCTION In spite of the substantial impact of pediatric asthma on healthcare resources, there is a notable dearth of research focusing on allergen sensitization specifically in children and adolescents with asthma in Cameroon, with existing studies primarily concentrating on adult populations. We, therefore, set out to determine factors associated with sensitization to selected aero-allergens in children and adolescents with asthma followed up at Laquintinie Hospital Douala, Cameroon. METHODOLOGY We conducted a cross-sectional analytical study on patients aged 2-17 years followed up for pediatric asthma at Laquintinie Hospital Douala for 8 months (January to August 2023). Skin prick tests were performed using selected standardized aeroallergens extracts. Factors associated with sensitization were determined using multivariable logistic regression analysis. The threshold for significance was set at p < .05. RESULTS In total, 126 children and adolescents with asthma were recruited, 50.79% of whom were male with an average age of 8.00 ± 3.99 years. Eight out of 10 patients (83.52%) were sensitized to common aero-allergens (20.59% monosensitized and 79.41% polysensitized). The most common aero-allergens found were the dust mites Dermatophagoïdes pteronyssinus (81.37%), Blomia tropicalis (67.64%) and Dermatophagoïdes farinae (52.94%) followed by Blatella species (25.49%). The factors independently associated with sensitization in our population were the personal history of allergic rhinitis in the patient [adjusted odds ratio, aOR: 4.07 (95% confidence interval, CI: 1.41-11.76), b = 0.54, p = .009], chest tightness at rest [aOR: 5.92 (95% CI: 1.08-32.38), b = 0.87, p = .040), and age above 5 years [aOR: 4.65 (95% CI: 1.47-14.69), b = 0.59, p = .009). CONCLUSION Sensitization to multiple aeroallergens is common in children and adolescents with asthma, especially for dust mites and cockroaches. Factors associated with sensitization are patients aged >5 years, chest tightness at rest, and a personal history of allergic rhinitis.
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Affiliation(s)
- Charlotte Eposse Ekoube
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Department of Paediatrics, General Paediatrics Unit, Douala Laquintinie Hospital, Douala, Cameroon
| | - Soumaiyatou Abba
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Mireille Endale Mangamba
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Edgar Mandeng Ma Linwa
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Annick Tchouamo Pokem
- Department of Paediatics, Child and Adolescent Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Dora Mbonjo Bitsie
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Jeannette Disso Massako
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Emmanuel Heles Nsang
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Esther Eleonore Ngo Linwa
- Department of Clinical Sciences, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
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Wu T, Santos S, Quezada-Pinedo HG, Vernooij MW, Jaddoe VWV, Klein S, Duijts L, Oei EHG. Body composition and respiratory outcomes in children: a population-based prospective cohort study. Thorax 2024; 79:448-456. [PMID: 38182426 DOI: 10.1136/thorax-2023-220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Body composition might influence lung function and asthma in children, but its longitudinal relations are unclear. We aimed to identify critical periods for body composition changes during childhood and adolescence in relation to respiratory outcomes in adolescents. METHODS In a population-based prospective cohort study, we measured body mass index, fat mass index (FMI), lean mass index (LMI) and the ratio of android fat mass divided by gynoid fat mass (A/G ratio) by dual-energy X-ray absorptiometry at 6, 10 and 13 years. At 13 years, lung function was measured by spirometry, and current asthma was assessed by questionnaire. RESULTS Most prominently and consistently, higher FMI and A/G ratio at age 13 years were associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and forced expiratory flow after exhaling 75% of FVC (FEF75) (range Z-score difference -0.13 (95% CI -0.16 to -0.10) to -0.08 (95% CI -0.11 to -0.05) per SD score increase), and higher LMI at all ages was associated with higher FEF75 (range Z-score difference 0.05 (95% CI 0.01 to 0.08) to 0.09 (95% CI 0.06 to 0.13)). Between the ages of 6 and 13 years, normal to high FMI and A/G ratio were associated with lower FEV1/FVC and FEF75 (range Z-score difference -0.20 (95% CI -0.30 to -0.10) to -0.17 (95% CI -0.28 to -0.06)) and high to high LMI with higher FEF75 (range Z-score difference0.32 (95% CI 0.23 to 0.41)). Body composition changes were not associated with asthma. CONCLUSION Adolescents with higher total and abdominal fat indices may have impaired lung function, while those with a higher lean mass during childhood and adolescence may have better small airway function. Public health measures should focus on a healthy body composition in adolescents to minimise respiratory morbidity.
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Affiliation(s)
- Tong Wu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susana Santos
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hugo G Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kouis P, Galanakis E, Michaelidou E, Kinni P, Michanikou A, Pitsios C, Perez J, Achilleos S, Middleton N, Anagnostopoulou P, Dimitriou H, Revvas E, Stamatelatos G, Zacharatos H, Savvides C, Vasiliadou E, Kalivitis N, Chrysanthou A, Tymvios F, Papatheodorou SI, Koutrakis P, Yiallouros PK. Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial. Thorax 2024:thorax-2023-220877. [PMID: 38388489 DOI: 10.1136/thorax-2023-220877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma. OBJECTIVE The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece. DESIGN, PARTICIPANTS, INTERVENTIONS AND SETTING Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO). RESULTS In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls. CONCLUSION Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma. TRIAL REGISTRATION NUMBER NCT03503812.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Antonis Michanikou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Constantinos Pitsios
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | | | | | | | - Chrysanthos Savvides
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Emily Vasiliadou
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Nikos Kalivitis
- Department of Chemistry, University of Crete, Heraklion, Greece
| | - Andreas Chrysanthou
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus
| | - Filippos Tymvios
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Heraklion, Cyprus
| | - Stefania I Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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Meme H, Amukoye E, Bowyer C, Chakaya J, Das D, Dobson R, Dragosits U, Fuld J, Gray C, Hahn M, Kiplimo R, Lesosky M, Loh MM, McKendree J, Mortimer K, Ndombi A, Netter L, Obasi A, Orina F, Pearson C, Price H, Quint JK, Semple S, Twigg M, Waelde C, Walnycki A, Warwick M, Wendler J, West SE, Wilson M, Zurba L, Devereux G. Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya. Thorax 2023; 78:1118-1125. [PMID: 37280096 DOI: 10.1136/thorax-2023-220057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. METHODS Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. RESULTS 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, 'current wheeze' (9.5% vs 6.4%, p=0.007) and 'trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to 'vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. CONCLUSION Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.
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Affiliation(s)
- Hellen Meme
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evans Amukoye
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cressida Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Jeremiah Chakaya
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Darpan Das
- Institute of Occupational Medicine, Edinburgh, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Jonathan Fuld
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, Glasgow, UK
| | - Matthew Hahn
- Theatre for Development Facilitator, Folkstone, UK
| | - Richard Kiplimo
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maia Lesosky
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Jean McKendree
- Department of Environment and Geography, University of York, York, UK
| | - Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
| | - Amos Ndombi
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Louis Netter
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Fred Orina
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Heather Price
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
| | | | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | | | - Anna Walnycki
- International Institute for Environment and Development, London, UK
| | - Melaneia Warwick
- School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | | | - Sarah E West
- Department of Environment and Geography, University of York, York, UK
| | - Michael Wilson
- School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | | | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Pitrez PM, Nanthapisal S, Castro APBM, Teli C, P G A. Managing moderate-to-severe paediatric asthma: a scoping review of the efficacy and safety of fluticasone propionate/salmeterol. BMJ Open Respir Res 2023; 10:e001706. [PMID: 37620110 PMCID: PMC10450074 DOI: 10.1136/bmjresp-2023-001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Fluticasone propionate/salmeterol xinafoate (FP/SAL) is an inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA) combination, indicated for the regular treatment of children (aged >4 years) with asthma that is inadequately controlled with ICS monotherapy plus as-needed short-acting β2-agonists, or already adequately controlled with ICS/LABA. OBJECTIVE Compared with the adult population, fewer clinical studies have investigated the efficacy of FP/SAL in paediatric patients with moderate and moderate-to-severe asthma. In this review, we synthesise the available evidence for the efficacy and safety of FP/SAL in the paediatric population, compared with other available therapies indicated for asthma in children. ELIGIBILITY CRITERIA A literature review identified randomised controlled trials and observational studies of FP/SAL in the paediatric population with moderate-to-severe asthma. SOURCES OF EVIDENCE The Medline database was searched using PubMed (https://pubmed.ncbi.nlm.nih.gov/), with no publication date restrictions. Search strategies were developed and refined by authors. CHARTING METHODS Selected articles were screened for clinical outcome data (exacerbation reduction, nocturnal awakenings, lung function, symptom control, rescue medication use and safety) and a table of key parameters developed. RESULTS Improvements in asthma outcomes with FP/SAL include reduced risk of asthma-related emergency department visits and hospitalisations, protection against exercise-induced asthma and improvements in measures of lung function. Compared with FP monotherapy, greater improvements in measures of lung function and asthma control are reported. In addition, reduced incidence of exacerbations, hospitalisations and rescue medication use is observed with FP/SAL compared with ICS and leukotriene receptor antagonist therapy. Furthermore, FP/SAL therapy can reduce exposure to both inhaled and oral corticosteroids. CONCLUSIONS FP/SAL is a reliable treatment option in patients not achieving control with ICS monotherapy or a different ICS/LABA combination. Evidence shows that FP/SAL is well tolerated and has a similar safety profile to FP monotherapy. Thus, FP/SAL provides an effective option for the management of moderate-to-severe asthma in the paediatric population.
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Affiliation(s)
- Paulo Marcio Pitrez
- Pediatric Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Bansal E, Mehra S, Bhalla K. Improvement of quality of life in a family of a child with asthma after using the Written Asthma Action Plan (WAAP). J Family Med Prim Care 2023; 12:1336-1341. [PMID: 37649773 PMCID: PMC10465022 DOI: 10.4103/jfmpc.jfmpc_1828_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 09/01/2023] Open
Abstract
Background Asthma is a common childhood disease that leads to impairment of quality of life (QOL) of both the children affected by the disease and their caregivers. Management of asthma includes pharmacotherapy along with education about asthma and its self-management, which is most often given verbally. There is limited evidence regarding the benefits of using a written asthma action plan (WAAP) that has been improved using pictorial representation. Objective The study aimed to assess the effectiveness of a WAAP in improving the QOL of children with bronchial asthma and also of their caregivers. It also educates the patients and families about various triggers and danger signs of an acute attack of asthma. Methods This was an interventional study with the aim of improving the quality of asthma management. Children of age group 7-17 years in whom the diagnosis of asthma was made and those parents and children who could read and answer the questionnaire (mini-PAQLQ and PACQLQ) were included in the study. Subjects were randomized into Case and Control groups. The intervention was to give the randomly selected patients (Case group) an individualized WAAP along with standard asthma care to both groups. Both groups were followed up to assess and record variations in the quality of life. Results The P value was highly significant in the following parameters post-intervention: missed doses of controller medication (P value = 0.001), need for rescue medication (<0.001), ACT score (0.001), total PAQLQ (<0.001), and PACQLQ (<0.001) score. Though statistical significance was not established, improvement was also observed in the number of unscheduled OPD visits (P value = 0.082) and hospitalization events (P value = 0.554). Conclusion On being provided with the WAAP, the frequency of acute asthma events, treatment compliance, and QOL improved. There was a significant increase in the primary outcomes-PAQLQ and PACQLQ scores. Significant improvement in the secondary outcomes-number of missed school days, missed doses of controller medication, need for rescue medication, and ACT score was also observed.
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Affiliation(s)
- Eshita Bansal
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Shuchi Mehra
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Kapil Bhalla
- Department of Paediatrics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Islam JY, Hoppin J, Mora AM, Soto-Martinez ME, Gamboa LC, Castañeda JEP, Reich B, Lindh C, van Wendel de Joode B. Respiratory and allergic outcomes among 5-year-old children exposed to pesticides. Thorax 2023; 78:41-49. [PMID: 35210357 PMCID: PMC9533533 DOI: 10.1136/thoraxjnl-2021-218068] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the effects of pesticides on children's respiratory and allergic outcomes. We evaluated associations of prenatal and current pesticide exposures with respiratory and allergic outcomes in children from the Infants' Environmental Health Study in Costa Rica. METHODS Among 5-year-old children (n=303), we measured prenatal and current specific gravity-corrected urinary metabolite concentrations of insecticides (chlorpyrifos, pyrethroids), fungicides (mancozeb, pyrimethanil, thiabendazole) and 2,4-D. We collected information from caregivers on respiratory (ever doctor-diagnosed asthma and lower respiratory tract infections (LRTI), wheeze and cough during last 12 months) and allergic (nasal allergies, itchy rash, ever eczema) outcomes. We fitted separate multivariable logistic regression models for high (≥75th percentile (P75)) vs low (<P75) metabolite concentrations with respiratory and allergic outcomes. We also ran models including metabolite concentrations as continuous exposure variables. RESULTS Children's respiratory outcomes were common (39% cough, 20% wheeze, 12% asthma, 5% LRTI). High current pyrethroid metabolite concentrations (∑pyrethroids) were associated with wheeze (OR=2.37, 95% CI 1.28 to 4.34), itchy rash (OR=2.74, 95% CI 1.33 to 5.60), doctor-diagnosed asthma and LRTI. High current ethylene thiourea (ETU) (specific metabolite of mancozeb) was somewhat associated with LRTI (OR=2.09, 95% CI 0.68 to 6.02). We obtained similar results when modelling ∑pyrethroids and ETU as continuous variables. We saw inconsistent or null associations for other pesticide exposures and health outcomes. CONCLUSIONS Current pyrethroid exposure may affect children's respiratory and allergic health at 5 years of age. Current mancozeb exposure might contribute to LRTI. These findings are important as pyrethroids are broadly used in home environments and agriculture and mancozeb in agriculture.
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Affiliation(s)
- Jessica Y Islam
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Jane Hoppin
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Ana M Mora
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica,Center for Environmental Research and Children's Health (CERCH), University of California, Berkeley, California, USA
| | | | - Leonel Córdoba Gamboa
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jorge Ernesto Peñaloza Castañeda
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Brian Reich
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biostatistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Berna van Wendel de Joode
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
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Fujiogi M, Zhu Z, Raita Y, Ooka T, Celedon JC, Freishtat R, Camargo CA, Hasegawa K. Nasopharyngeal lipidomic endotypes of infants with bronchiolitis and risk of childhood asthma: a multicentre prospective study. Thorax 2022; 77:1059-1069. [PMID: 35907638 PMCID: PMC10329482 DOI: 10.1136/thorax-2022-219016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bronchiolitis is the leading cause of hospitalisation of US infants and an important risk factor for childhood asthma. Recent evidence suggests that bronchiolitis is clinically heterogeneous. We sought to derive bronchiolitis endotypes by integrating clinical, virus and lipidomics data and to examine their relationship with subsequent asthma risk. METHODS This is a multicentre prospective cohort study of infants (age <12 months) hospitalised for bronchiolitis. We identified endotypes by applying clustering approaches to clinical, virus and nasopharyngeal airway lipidomic data measured at hospitalisation. We then determined their longitudinal association with the risk for developing asthma by age 6 years by fitting a mixed-effects logistic regression model. To account for multiple comparisons of the lipidomics data, we computed the false discovery rate (FDR). To understand the underlying biological mechanism of the endotypes, we also applied pathway analyses to the lipidomics data. RESULTS Of 917 infants with bronchiolitis (median age, 3 months), we identified clinically and biologically meaningful lipidomic endotypes: (A) cinicalclassiclipidmixed (n=263), (B) clinicalseverelipidsphingolipids-high (n=281), (C) clinicalmoderatelipidphospholipids-high (n=212) and (D) clinicalatopiclipidsphingolipids-low (n=161). Endotype A infants were characterised by 'classic' clinical presentation of bronchiolitis. Profile D infants were characterised by a higher proportion of parental asthma, IgE sensitisation and rhinovirus infection and low sphingolipids (eg, sphingomyelins, ceramides). Compared with endotype A, profile D infants had a significantly higher risk of asthma (22% vs 50%; unadjusted OR, 3.60; 95% CI 2.31 to 5.62; p<0.001). Additionally, endotype D had a significantly lower abundance of polyunsaturated fatty acids (eg, docosahexaenoic acid; FDR=0.01). The pathway analysis revealed that sphingolipid metabolism pathway was differentially expressed in endotype D (FDR=0.048). CONCLUSIONS In this multicentre prospective cohort study of infants with bronchiolitis, integrated clustering of clinical, virus and lipidomic data identified clinically and biologically distinct endotypes that have a significantly differential risk for developing asthma.Delete.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zhaozhong Zhu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tadao Ooka
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juan C Celedon
- Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Freishtat
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, District of Columbia, USA
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Powell WT, Rich LM, Vanderwall ER, White MP, Debley JS. Temperature synchronisation of circadian rhythms in primary human airway epithelial cells from children. BMJ Open Respir Res 2022; 9:9/1/e001319. [PMID: 36198442 PMCID: PMC9535174 DOI: 10.1136/bmjresp-2022-001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cellular circadian rhythms regulate immune pathways and inflammatory responses that mediate human disease such as asthma. Circadian rhythms in the lung may also contribute to exacerbations of chronic diseases such as asthma by regulating observed rhythms in mucus production, bronchial reactivity, airway inflammation and airway resistance. Primary human airway epithelial cells (AECs) are commonly used to model human lung diseases, such as asthma, with circadian symptoms, but a method for synchronising circadian rhythms in AECs has not been developed, and the presence of circadian rhythms in human AECs remains uninvestigated. METHODS We used temperature cycling to synchronise circadian rhythms in undifferentiated and differentiated primary human AECs. Reverse transcriptase-quantitative PCR was used to measure expression of the core circadian clock genes ARNTL, CLOCK, CRY1, CRY2, NR1D1, NR1D2, PER1 and PER2. RESULTS Following temperature synchronisation, the core circadian genes ARNTL, CRY1, CRY2, NR1D1, NR1D2, PER1 and PER2 maintained endogenous 24-hour rhythms under constant conditions. Following serum shock, the core circadian genes ARNTL, NR1D1 and NR1D2 demonstrated rhythmic expression. Following temperature synchronisation, CXCL8 demonstrated rhythmic circadian expression. CONCLUSIONS Temperature synchronised circadian rhythms in AECs differentiated at an air-liquid interface can serve as a model to investigate circadian rhythms in pulmonary diseases.
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Affiliation(s)
- Weston T Powell
- Seattle Children's Research Institute, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Lucille M Rich
- Seattle Children's Research Institute, Seattle, Washington, USA,Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elizabeth R Vanderwall
- Seattle Children's Research Institute, Seattle, Washington, USA,Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Maria P White
- Seattle Children's Research Institute, Seattle, Washington, USA,Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jason S Debley
- Seattle Children's Research Institute, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA,Center for Immunity and Immunotherapies, Seattle Children's Research Institute, Seattle, Washington, USA
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10
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Crump C, Sundquist J, Sundquist K. Preterm or early term birth and long-term risk of asthma into midadulthood: a national cohort and cosibling study. Thorax 2022:thorax-2022-218931. [PMID: 35907641 PMCID: PMC9884998 DOI: 10.1136/thorax-2022-218931] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preterm birth is associated with pulmonary complications early in life; however, long-term risks of asthma into adulthood are unclear. OBJECTIVE To determine asthma risks from childhood into adulthood associated with gestational age at birth in a large population-based cohort. METHODS A national cohort study was conducted of all 4 079 878 singletons born in Sweden during 1973-2013, followed up for asthma identified from primary care, specialty outpatient and inpatient diagnoses in nationwide registries through 2018 (up to 46 years). Cox regression was used to adjust for potential confounders, and cosibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors. RESULTS In 91.9 million person-years of follow-up, 607 760 (14.9%) persons were diagnosed with asthma. Preterm birth was associated with increased risk of asthma at ages <10 years (adjusted HR 1.73; 95% CI 1.70 to 1.75), 10-17 years (1.29; 1.27 to 1.32) and 18-46 years (1.19; 1.17 to 1.22). Across all ages, adjusted HRs further stratified were 3.01 (95% CI 2.88 to 3.15) for extremely preterm (22-27 weeks), 1.76 (1.72 to 1.79) for very or moderately preterm (28-33 weeks), 1.31 (1.29 to 1.32) for late preterm (34-36 weeks) and 1.13 (1.12 to 1.14) for early term (37-38 weeks), compared with full-term (39-41 weeks) birth. These findings were not explained by shared familial factors. Asthma risks were elevated after spontaneous or medically indicated preterm birth and with or without perinatal respiratory complications. CONCLUSIONS In this large national cohort, preterm and early term birth were associated with increased risks of asthma from childhood into midadulthood. Persons born prematurely need long-term follow-up into adulthood for timely detection and treatment of asthma.
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Affiliation(s)
- Casey Crump
- Icahn School of Medicine at Mount Sinai, Departments of Family Medicine and Community Health and of Population Health Science and Policy, One Gustave L. Levy Place, New York, New York 10029, USA
| | - Jan Sundquist
- Lund University, Department of Clinical Sciences, Clinical Research Centre (CRC), building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Kristina Sundquist
- Lund University, Department of Clinical Sciences, Clinical Research Centre (CRC), building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02 Malmö, Sweden
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11
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Craig S, Powell CVE, Nixon GM, Oakley E, Hort J, Armstrong DS, Ranganathan S, Kochar A, Wilson C, George S, Phillips N, Furyk J, Lawton B, Borland ML, O'Brien S, Neutze J, Lithgow A, Mitchell C, Watkins N, Brannigan D, Wood J, Gray C, Hearps S, Ramage E, Williams A, Lew J, Jones L, Graudins A, Dalziel S, Babl FE. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ Open Respir Res 2022; 9:9/1/e001137. [PMID: 35301198 PMCID: PMC8932260 DOI: 10.1136/bmjresp-2021-001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and low-flow oxygen. Current large asthma datasets report parenteral therapy only. OBJECTIVES To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. METHODS Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). MEASUREMENTS AND MAIN RESULTS Of 14 029 children (median age 3 (IQR 1-3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3-63.2 hours) than children without escalation 6.7 hours, IQR 3.5-16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%). CONCLUSIONS Overall, 7.3% children with acute severe asthma received some form of escalated treatment, with 4.2% receiving parenteral bronchodilators and 4.3% respiratory support. There is wide variation treatment escalation.
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Affiliation(s)
- Simon Craig
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia .,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Department of Emergency Medicine, Sidra Medicine, Ad-Dawhah, Doha, Qatar
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ed Oakley
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Jason Hort
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - David S Armstrong
- Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Sarath Ranganathan
- Respiratory Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Catherine Wilson
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Shane George
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Emergency Medicine and Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia.,Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Natalie Phillips
- Child Health Research Centre, Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Jeremy Furyk
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ben Lawton
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Emergency Department, Logan Hospital, Loganholme, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Nursing, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Jocelyn Neutze
- Kidz First Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | - Anna Lithgow
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Clare Mitchell
- Emergency Department, Royal Darwin Hospital, Tiwi, Northern Territory of Australia, Australia
| | - Nick Watkins
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Domhnall Brannigan
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Joanna Wood
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Charmaine Gray
- Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Hearps
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Ramage
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Paediatric Intensive Care, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Amanda Williams
- Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jamie Lew
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leonie Jones
- Emergency Department, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Andis Graudins
- Emergency Department, Dandenong Hospital, Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand.,Departments of Surgery and Paediatrics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Auckland, New Zealand
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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12
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Filipow N, Main E, Sebire NJ, Booth J, Taylor AM, Davies G, Stanojevic S. Implementation of prognostic machine learning algorithms in paediatric chronic respiratory conditions: a scoping review. BMJ Open Respir Res 2022; 9:9/1/e001165. [PMID: 35297371 PMCID: PMC8928277 DOI: 10.1136/bmjresp-2021-001165] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/06/2022] [Indexed: 11/23/2022] Open
Abstract
Machine learning (ML) holds great potential for predicting clinical outcomes in heterogeneous chronic respiratory diseases (CRD) affecting children, where timely individualised treatments offer opportunities for health optimisation. This paper identifies rate-limiting steps in ML prediction model development that impair clinical translation and discusses regulatory, clinical and ethical considerations for ML implementation. A scoping review of ML prediction models in paediatric CRDs was undertaken using the PRISMA extension scoping review guidelines. From 1209 results, 25 articles published between 2013 and 2021 were evaluated for features of a good clinical prediction model using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines. Most of the studies were in asthma (80%), with few in cystic fibrosis (12%), bronchiolitis (4%) and childhood wheeze (4%). There were inconsistencies in model reporting and studies were limited by a lack of validation, and absence of equations or code for replication. Clinician involvement during ML model development is essential and diversity, equity and inclusion should be assessed at each step of the ML pipeline to ensure algorithms do not promote or amplify health disparities among marginalised groups. As ML prediction studies become more frequent, it is important that models are rigorously developed using published guidelines and take account of regulatory frameworks which depend on model complexity, patient safety, accountability and liability.
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Affiliation(s)
- Nicole Filipow
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eleanor Main
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Neil J Sebire
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,GOSH NIHR BRC, Great Ormond Street Hospital for Children, London, UK
| | - John Booth
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,GOSH NIHR BRC, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- GOSH NIHR BRC, Great Ormond Street Hospital for Children, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Gwyneth Davies
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,GOSH NIHR BRC, Great Ormond Street Hospital for Children, London, UK
| | - Sanja Stanojevic
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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13
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Standl M. Limited side effects of asthma treatment on growth and bone health in children. Thorax 2022; 77:741. [PMID: 35246485 DOI: 10.1136/thoraxjnl-2021-218531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Marie Standl
- Helmholtz - Zentrum Munchen Deutsches Forschungszentrum fur Umwelt und Gesundheit, Neuherberg, Bayern, Germany
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14
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Sørensen KG, Øymar K, Dalen I, Halvorsen T, Mikalsen IB. Asthma, atopy and lung function in young adults after hospitalisation for bronchiolitis in infancy: impact of virus and sex. BMJ Open Respir Res 2022; 9:9/1/e001095. [PMID: 35046087 PMCID: PMC8772454 DOI: 10.1136/bmjresp-2021-001095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Hospitalisation for bronchiolitis is a risk factor for asthma and impaired lung function during childhood, but outcomes in young adults are poorly described. Our primary aim was to study the prevalence of asthma and atopy, and lung function at 17–20 years of age after bronchiolitis in infancy and, secondarily, the impact of viral aetiology (respiratory syncytial virus (RSV) vs non-RSV) and sex on these outcomes. Methods This Norwegian cohort study enrolled 225 young adults hospitalised for bronchiolitis in infancy during 1996–2001 and 167 matched control subjects. The follow-up included questionnaires for asthma and examinations of lung function and atopy. Outcomes were analysed by mixed effects regressions. Results Current asthma was more frequent in the postbronchiolitis group versus the control group: 25.1% (95% CI 19.0% to 31.2%) vs 13.1% (95% CI 7.9% to 18.2%), but not atopy: 44.3% (95% CI 37.1% to 51.5%) vs 48.2% (95% CI 40.5% to 55.8%), adjusted predicted proportions (95% CIs). Asthma prevalence did not differ between the RSV group and the non-RSV group: 24.0% (95% CI 16.1% to 32.0%) vs 23.8% (95% CI 12.8% to 34.7%) nor between sexes. Forced expiratory volume in 1 s (FEV1), the ratio FEV1/forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC, were lower in the postbronchiolitis group. Conclusion Young adults hospitalised for bronchiolitis had higher prevalence of asthma, but not atopy, and a more obstructive lung function pattern than control subjects. The asthma prevalence was high after both RSV bronchiolitis and non-RSV bronchiolitis, and there was no difference between sexes. Bronchiolitis in infancy is associated with respiratory morbidity persisting into young adulthood.
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Affiliation(s)
- Karen Galta Sørensen
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway .,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Paediatric Department, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Bruun Mikalsen
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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15
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Kunøe A, Sevelsted A, Chawes BLK, Stokholm J, Krakauer M, Bønnelykke K, Bisgaard H. Height and bone mineral content after inhaled corticosteroid use in the first 6 years of life. Thorax 2022; 77:745-751. [PMID: 35046091 DOI: 10.1136/thoraxjnl-2020-216755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infants and young children might be particularly susceptible to the potential side effects from inhaled corticosteroid (ICS) on height and bone mineral content (BMC), but this has rarely been studied in long-term prospective studies. METHODS Children from two Copenhagen Prospective Studies on Asthma in Childhood cohorts were included. ICS use was registered prospectively from birth to age 6 and the cumulative dose was calculated. Primary outcomes were height and BMC from dual-energy X-ray absorptiometry (DXA) scans at age 6. RESULTS At age 6, a total of 930 children (84%) from the cohorts had a valid height measurement and 792 (71%) had a DXA scan. 291 children (31%) received a cumulated ICS dose equivalent to or above 10 weeks of standard treatment before age 6. We found an inverse association between ICS use and height, -0.26 cm (95% CI: -0.45 to -0.07) per 1 year standard treatment from 0 to 6 years of age, p=0.006. This effect was mainly driven by children with ongoing treatment between age 5 and 6 years (-0.31 cm (95% CI: -0.52 to -0.1), p=0.004), while there was no significant association in children who stopped treatment at least 1 year before age 6 (-0.09 cm (95% CI: -0.46 to 0.28), p=0.64). There was no association between ICS use and BMC at age 6. CONCLUSIONS ICS use in early childhood was associated with reduced height at age 6 years but only in children with continued treatment in the sixth year of life.
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Affiliation(s)
- Asja Kunøe
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Astrid Sevelsted
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo L K Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Pediatrics, Næstved Hospital, Næstved, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Gentofte, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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16
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Ardura-Garcia C, Blakey JD, Cooper PJ, Romero-Sandoval N. Caregivers' and healthcare professionals' perspective of barriers and facilitators to health service access for asthmatic children: a qualitative study. BMJ Open Respir Res 2021; 8:8/1/e001066. [PMID: 34949576 PMCID: PMC8705230 DOI: 10.1136/bmjresp-2021-001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is a high burden of asthma morbidity and mortality in Latin America. It has been proposed that this relates to limited access to diagnostic tests, asthma medications and specialised doctors. However, little is known of what caregivers of asthmatic children and healthcare professionals (HCPs) perceive as barriers and facilitators to adequate care. We aimed to explore the barriers and facilitators to asthma care access from caregivers' and HCP's perspective in an Ecuadorian low-resource setting. METHODS In 2017, we conducted 5 focus group discussions (FGD) with 20 caregivers of asthmatic children and 12 in-depth interviews with 3 paediatricians, 6 general doctors and 3 respiratory therapists in Esmeraldas city, Ecuador. FGDs and interviews were digitally recorded, transcribed, open-coded in QDA Miner, categorised using an interpretative phenomenological approach and analysed thematically. Barriers and facilitators were classified into availability, accessibility, acceptability and contact of healthcare services, based on Tanahashi model of health service access. RESULTS Limited resources, use of alternative medicines, fear of medication side-effects and lack of specific training for doctors and knowledge in families were common barriers for both caregivers and HCPs. Caregivers and HCPs proposed the implementation of public health asthma-focused programmes that would include close community-based follow-up of people with asthma, educational sessions for their families and public engagement activities. HCPs also suggested implementing training programmes on asthma management for general doctors. CONCLUSION Multiple barriers identified by caregivers and HCPs referred to economic and health service organisational issues, fear of side effects of medication or ineffective self-management. Increasing caregivers and HCPs' asthma knowledge, as well as HCPs' communication skills to establish a patient-centred approach with a shared decision-making process could improve asthma care in this setting.
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Affiliation(s)
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, Curtin University, Perth, Western Australia, Australia
| | - Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - Natalia Romero-Sandoval
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.,Grups de Recerca d'Amèrica i Àfrica Llatines GRAAL Nodo Ecuador, Quito, Ecuador
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17
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Chipps BE, Albers FC, Reilly L, Johnsson E, Cappelletti C, Papi A. Efficacy and safety of as-needed albuterol/budesonide versus albuterol in adults and children aged ≥4 years with moderate-to-severe asthma: rationale and design of the randomised, double-blind, active-controlled MANDALA study. BMJ Open Respir Res 2021; 8:8/1/e001077. [PMID: 34887317 PMCID: PMC8663093 DOI: 10.1136/bmjresp-2021-001077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction Uncontrolled asthma is associated with substantial morbidity. While fast-acting bronchodilators provide quick relief from asthma symptoms, their use as rescue fails to address the underlying inflammation. Combining a short-acting beta2-agonist, such as albuterol (salbutamol), with an inhaled corticosteroid, such as budesonide, in a single inhaler as rescue therapy could help control both bronchoconstriction and inflammation, and reduce the risk of asthma exacerbations. Methods and analysis The Phase 3 MANDALA study was designed to determine the efficacy of albuterol in combination with budesonide (albuterol/budesonide 180/160 µg or 180/80 µg, two actuations of 90/80 µg or 90/40 µg, respectively) versus albuterol (180 µg, two actuations of 90 µg) as rescue therapy in adult, adolescent and paediatric patients with moderate-to-severe asthma. This event-driven study enrolled symptomatic patients (3000 adults/adolescents and 100 children aged 4–11 years) who experienced ≥1 severe asthma exacerbation in the previous year and were receiving maintenance therapy for ≥3 months prior to study entry. The primary efficacy endpoint was time-to-first severe asthma exacerbation. Ethics and dissemination The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, and that are consistent with International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use and Good Clinical Practice and the applicable regulatory requirements. Trial registration NCT03769090.
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Affiliation(s)
| | | | - Laurence Reilly
- Acumen Life Science Investment Consulting Limited, Tamworth, UK
| | - Eva Johnsson
- BioPharmaceuticals R&D, AstraZeneca R&D Gothenburg, Goteborg, Sweden
| | - Christy Cappelletti
- BioPharmaceuticals R&D, AstraZeneca Pharmaceuticals LP Durham, Durham, North Carolina, USA
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
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18
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Song Y, Pan K, Chen Y, Wang X, Tian J. The efficacy of mometasone furoate for children with asthma: a meta-analysis of randomized controlled trials. Postepy Dermatol Alergol 2021; 38:740-5. [PMID: 34849118 DOI: 10.5114/ada.2020.93273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction The influence of mometasone furoate for paediatric asthma remains controversial. Aim We conducted a systematic review and meta-analysis to explore the efficacy and safety of mometasone furoate for paediatric asthma. Material and methods We have searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through October 2019 for randomized controlled trials assessing the effect of mometasone furoate versus placebo for paediatric asthma. This meta-analysis was performed using the random-effects model. Results Four RCTs were included in the meta-analysis. Overall, as compared to placebo for paediatric asthma, mometasone furoate is associated with substantially increased predicted forced expiratory volume in 1 s (FEV1) (mean difference (MD) = 7.53; 95% CI: 7.02–8.04; p < 0.00001), FEV1 (MD = 0.11; 95% CI: 0.10–0.12; p < 0.00001), and morning peak expiratory flow (AM PEF) (MD = 17.70; 95% CI: 9.91–25.49; p < 0.00001), but demonstrates no obvious effect on pharyngitis (RR = 0.96; 95% CI: 0.59–1.58; p = 0.89), upper respiratory tract infections (RR = 0.73; 95% CI: 0.50–1.05; p = 0.09), or adverse events (RR = 1.05; 95% CI: 0.84–1.31; p = 0.69). Conclusions Mometasone furoate may be effective and safe for paediatric asthma.
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19
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Lee S, Lasky-Su J, Won S, Laurie C, Celedón JC, Lange C, Weiss S, Hecker J. Novel recessive locus for body mass index in childhood asthma. Thorax 2021; 76:1227-1230. [PMID: 33888571 PMCID: PMC8531156 DOI: 10.1136/thoraxjnl-2020-215742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/16/2020] [Accepted: 03/16/2021] [Indexed: 11/03/2022]
Abstract
Most genome-wide association studies of obesity and body mass index (BMI) have so far assumed an additive mode of inheritance in their analysis, although association testing supports a recessive effect for some of the established loci, for example, rs1421085 in FTO In two whole-genome sequencing (WGS) studies of children with asthma and their parents (892 Costa Rican trios and 286 North American trios), we discovered an association between a locus (rs9292139) in LOC102724122 and BMI that reaches genome-wide significance under a recessive model in the combined analysis. As the association does not achieve significance under an additive model, our finding illustrates the benefits of the recessive model in WGS analyses.
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Affiliation(s)
- Sanghun Lee
- Department of Medical Consilience, Division of Medicine, Graduate School, Dankook University-Jukjeon Campus, Yongin, South Korea
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sungho Won
- Department of Public Health Science, Seoul National University, Gwanak-gu, South Korea
| | - Cecelia Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Christoph Lange
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julian Hecker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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20
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Adibi A, Turvey SE, Lee TY, Sears MR, Becker AB, Mandhane PJ, Moraes TJ, Subbarao P, Sadatsafavi M. Development of a conceptual model of childhood asthma to inform asthma prevention policies. BMJ Open Respir Res 2021; 8:8/1/e000881. [PMID: 34740941 PMCID: PMC8573659 DOI: 10.1136/bmjresp-2021-000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is no definitive cure for asthma, as prevention remains a major goal. Decision analytic models are routinely used to evaluate the value-for-money proposition of interventions. Following best practice standards in decision-analytic modelling, the objective of this study was to solicit expert opinion to develop a concept map for a policy model for primary prevention of asthma. Methods We reviewed currently available decision analytic models for asthma prevention. A steering committee of economic modellers, allergists and respirologists was then convened to draft a conceptual model of paediatric asthma. A modified Delphi method was followed to define the context of the problem at hand (evaluation of asthma prevention strategies) and develop the concept map of the model. Results Consensus was achieved after three rounds of discussions, followed by concealed voting. In the final conceptual model, asthma diagnosis was based on three domains of lung function, atopy and their symptoms. The panel recommended several markers for each domain. These domains were in turn affected by several risk factors. The panel clustered all risk factors under three groups of ‘patient characteristic’, ‘family history’ and ‘environmental factors’. To be capable of modelling the interplay among risk factors, the panel recommended the use of microsimulation, with an open-population approach that would enable modelling phased implementation and gradual and incomplete uptake of the intervention. Conclusions Economic evaluation of childhood interventions for preventing asthma will require modelling of several codependent risk factors and multiple domains that affect the diagnosis. The conceptual model can inform the development and validation of a policy model for childhood asthma prevention.
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Affiliation(s)
- Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart E Turvey
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
| | - Tae Yoon Lee
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Malcolm R Sears
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Allen B Becker
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Faculty of Medicine & Dentistry, Pediatrics Department, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
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21
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Ali H, Brooks C, Crane J, Beasley R, Holgate S, Gibson P, Pattemore P, Tzeng YC, Stanley T, Pearce N, Douwes J. Enhanced airway sensory nerve reactivity in non-eosinophilic asthma. BMJ Open Respir Res 2021; 8:8/1/e000974. [PMID: 34728474 PMCID: PMC8565536 DOI: 10.1136/bmjresp-2021-000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neural mechanisms may play an important role in non-eosinophilic asthma (NEA). This study compared airway sensory nerve reactivity, using capsaicin challenge, in eosinophilic asthma (EA) and NEA and non-asthmatics. METHODS Thirty-eight asthmatics and 19 non-asthmatics (aged 14-21 years) underwent combined hypertonic saline challenge/sputum induction, fractional exhaled nitric oxide, atopy and spirometry tests, followed by capsaicin challenge. EA and NEA were defined using a sputum eosinophil cut-point of 2.5%. Airway hyperreactivity was defined as a ≥15% drop in FEV1 during saline challenge. Sensory nerve reactivity was defined as the lowest capsaicin concentration that evoked 5 (C5) coughs. RESULTS Non-eosinophilic asthmatics (n=20) had heightened capsaicin sensitivity (lower C5) compared with non-asthmatics (n=19) (geometric mean C5: 58.3 µM, 95% CI 24.1 to 141.5 vs 193.6 µM, 82.2 to 456.0; p<0.05). NEA tended to also have greater capsaicin sensitivity than EA, with the difference in capsaicin sensitivity between NEA and EA being of similar magnitude (58.3 µM, 24.1 to 141.5 vs 191.0 µM, 70.9 to 514.0) to that observed between NEA and non-asthmatics; however, this did not reach statistical significance (p=0.07). FEV1 was significantly reduced from baseline following capsaicin inhalation in both asthmatics and non-asthmatics but no differences were found between subgroups. No associations with capsaicin sensitivity and atopy, sputum eosinophils, blood eosinophils, asthma control or treatment were observed. CONCLUSION NEA, but not EA, showed enhanced capsaicin sensitivity compared with non-asthmatics. Sensory nerve reactivity may therefore play an important role in the pathophysiology of NEA.
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Affiliation(s)
- Hajar Ali
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Collin Brooks
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Julian Crane
- School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Philip Pattemore
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Yu-Chieh Tzeng
- Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Neil Pearce
- Department of Non-communicable Disease Epidemiology and Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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22
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Affiliation(s)
- Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK .,Asthma UK and British Lung Foundation Partnership, London, UK
| | - Warren Lenney
- Respiratory Medicine, University Hospital of North Staffordshire, Wybunbury, UK
| | - Simon Langton-Hewer
- Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, Bristol, UK.,British Paediatric Respiratory Society, London, UK
| | - Jonathan Bennett
- Respiratory Medicine, Glenfield Hospital, Leicester, UK.,British Thoracic Society, London, London, UK
| | - Ema Swingwood
- Adult Therapy Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Association of Chartered Physiotherapists in Respiratory Care, London, UK
| | - Alison Hughes
- Association of Respiratory Nurse Specialists, London, UK.,Respiratory Medicine, Solent NHS Trust, Southampton, Southampton, UK
| | | | - Sarah Woolnough
- Asthma UK and British Lung Foundation Partnership, London, UK
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23
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Baggott C, Hardy JK, Sparks J, Sabbagh D, Beasley R, Weatherall M, Fingleton J. Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis. Thorax 2021; 77:563-572. [PMID: 34593615 DOI: 10.1136/thoraxjnl-2021-217124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/04/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND International asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2-agonist in acute asthma. METHODS We included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death. RESULTS Thirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I2=56%. The pooled Peto's OR for treatment failure with epinephrine versus selective β2-agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2-agonist improved outcomes. CONCLUSION The low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome. PROSPERO REGISTRATION NUMBER CRD42017079472.
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Affiliation(s)
| | | | - Jenny Sparks
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Doñah Sabbagh
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand
| | - Mark Weatherall
- Medicine, University of Otago Wellington, Wellington, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Wellington, New Zealand .,Capital and Coast District Health Board, Wellington, New Zealand.,Medicine, University of Otago Wellington, Wellington, New Zealand
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24
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Tanner N, Saglani S, Li AM, Bush A, Fleming L. Airway inflammation in severe asthmatics with acid gastro-oesophageal reflux. Thorax 2021; 77:398-399. [PMID: 34497139 DOI: 10.1136/thoraxjnl-2020-216304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 08/13/2021] [Indexed: 11/03/2022]
Abstract
The relationship between childhood asthma and gastro-oesophageal reflux (GOR) is contentious. Recent studies in adult asthmatics suggest that GOR is associated with worse control and differences in sputum proteomics related to epithelial integrity, systemic inflammation and host defence. We assessed 127 children with severe asthma undergoing bronchoscopy and pH study. There were no differences in asthma control or measures of airway inflammation or remodelling when those with acid GOR were compared with those without. These results suggest that acid GOR is not an important comorbidity in paediatric severe asthma.
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Affiliation(s)
- Nicole Tanner
- Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Albert M Li
- Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK.,Respiratory Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK .,Respiratory Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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25
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Wang N, Brix S, Larsen JM, Thysen AH, Rasmussen MA, Workman CT, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. Innate IL-23/Type 17 immune responses mediate the effect of the 17q21 locus on childhood asthma. Clin Exp Allergy 2021; 51:892-901. [PMID: 33987892 DOI: 10.1111/cea.13900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several childhood asthma risk loci that relate to immune function have been identified by genome-wide association studies (GWAS), but the underlying mechanisms remain unknown. OBJECTIVE Here, we examined whether perturbed innate immune responses mediate the association between known genetic risk variants and development of childhood asthma. METHODS Peripheral blood mononuclear cells from 336 six-month-old infants from the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2000 ) cohort were stimulated in vitro with six different innate ligands (LPS, CpG, poly(I:C), R848, HDMAPP and aluminium hydroxide together with low levels of LPS) followed by quantification of 18 released cytokines and chemokines 40 h after the stimulations. The innate immune response profiles were decomposed by principal component (PC) analysis, and PC1-5 were used in mediation analyses of the effect of 25 known genetic risk variants on childhood asthma until age 7. RESULTS The effects of two variants from the 17q21 locus (rs7216389, rs2305480) on asthma and exacerbation risk were significantly mediated by immune parameters induced in response to ligands mimicking intracellular colonization; bacterial DNA (CpG) and double-stranded viral RNA (poly(I:C)). The Th17 and innate lymphoid cell type 3-amplifying cytokine IL-23 was the most prominent cytokine involved. CONCLUSION The 17q21 effect on childhood asthma and exacerbations was partly mediated by deregulation of IL-23 in response to intracellular microbial ligands, which may suggest ineffective clearance of intracellular pathogens in the lungs.
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Affiliation(s)
- Ni Wang
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Jeppe M Larsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Anna H Thysen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Morten A Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Christopher T Workman
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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Hand S, Dunstan F, Jones K, Doull I. The effect of diet in infancy on asthma in young adults: the Merthyr Allergy Prevention Study. Thorax 2021; 76:1072-1077. [PMID: 33963089 DOI: 10.1136/thoraxjnl-2020-215040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Early infant diet might influence the risk of subsequent allergic disease. METHODS The Merthyr Allergy Prevention Study (MAPS) was a randomised controlled trial in infants at high risk of allergic disease. The trial determined whether a cow's milk exclusion diet for the first 4 months of life decreased the risk of allergic disease including asthma compared with a normal diet. A soya milk preparation was offered to those in the intervention group. A standardised questionnaire for allergic disease was completed at ages 1, 7, 15 and 23 years, with clinical assessment at 1, 7 and 23 years. The effect of the intervention on the risk of atopy, asthma and wheeze at age 23 years was determined. FINDINGS 487 subjects entered the study; at age 23 years 299 completed the questionnaire, of which 119 attended clinical assessment. Subjects randomised to the intervention group had a significantly increased risk of atopy (adjusted OR 2.97, 95% CI 1.30 to 6.80; p=0.01) and asthma (OR 2.07, 95%CI 1.09 to 3.91; p=0.03) at age 23 years, but not wheeze (OR 1.43, 95%CI 0.87 to 2.37; p=0.16). Earlier exposure to cow's milk was associated with a decreased risk of wheeze and asthma at age 23 years, while earlier exposure to soya milk was associated with an increased risk of atopy and asthma. INTERPRETATION In infants at high risk of allergic disease, either cow's milk exclusion or early soya milk introduction for the first 4 months of life increases the risk of atopy, wheeze and asthma in adulthood.
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Affiliation(s)
- Sadiyah Hand
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | | | - Ken Jones
- School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Iolo Doull
- Respiratory/Cystic Fibrosis Unit, Children's Hospital for Wales, Cardiff, UK .,Medical Directorate, Welsh Health Specialised Services Committee, Pontypridd, UK
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27
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Rylance S, Chinoko B, Mnesa B, Jewell C, Grigg J, Mortimer K. An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial. Thorax 2021; 76:434-440. [PMID: 33479040 PMCID: PMC8070641 DOI: 10.1136/thoraxjnl-2020-216065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles. METHODS We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3 months. Secondary outcomes included asthma exacerbations requiring emergency healthcare and school absence. FINDINGS Between September 2018 and December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3 months, intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared with standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1 to 3.1, p<0.001). Fewer intervention children attended emergency healthcare (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001) compared with standard care children. INTERPRETATION The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings. TRIAL REGISTRATION NUMBER PACTR201807211617031.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Beatrice Chinoko
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Bright Mnesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Jonathan Grigg
- Centre for Child Health, Queen Mary University London, London, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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Pape K, Cowell W, Sejbaek CS, Andersson NW, Svanes C, Kolstad HA, Liu X, Hougaard KS, Wright RJ, Schlünssen V. Adverse childhood experiences and asthma: trajectories in a national cohort. Thorax 2021; 76:547-553. [PMID: 33766987 PMCID: PMC8223631 DOI: 10.1136/thoraxjnl-2020-214528] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
Objective Research has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome. Methods Based on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997–2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes. Results We identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively. Conclusion In a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.
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Affiliation(s)
- Kathrine Pape
- National Research Centre for the Working Environment, Kobenhavn, Denmark .,Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark
| | - Whitney Cowell
- Departments of Pediatrics & Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Niklas Worm Andersson
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark.,Department of Clinical Pharmacology, Bispeberg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Cecilie Svanes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Henrik Albert Kolstad
- Department of Clinical Medicine, Occupational Medicine, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- NCRR-The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Karin Sørig Hougaard
- National Research Centre for the Working Environment, Kobenhavn, Denmark.,Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Rosalind J Wright
- Departments of Pediatrics & Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, Kobenhavn, Denmark.,Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark
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Finkelstein EA, Lau E, Doble B, Ong B, Koh MS. Economic burden of asthma in Singapore. BMJ Open Respir Res 2021; 8:8/1/e000654. [PMID: 33737309 PMCID: PMC7978329 DOI: 10.1136/bmjresp-2020-000654] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/09/2020] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective Up-to-date economic burden of asthma in Singapore is currently unknown. Methods We quantify the per capita and total annual costs of asthma for adults and children by level of symptom control (uncontrolled, partly controlled, and well controlled) via a cross-sectional online survey administered to a national web panel. Participants were asked about healthcare utilisation, days missed from work, and reduced productivity due to their symptoms. These values were then monetised and multiplied by prevalence estimates of adult and child asthmatics to generate total costs. Results A total of 300 adults and 221 parents of children with asthma were included in analysis. The total annual cost of adult asthma was estimated to be SGD 1.74 billion (US$1.25 billion) with 42% coming from the uncontrolled group, 45% from the partly controlled group, and 13% from the well-controlled group. For children, the total cost is SGD 0.35 billion (US$0.25 billion), with 64%, 26% and 10% coming from each group respectively. Combined, the annual economic burden of asthma in Singapore is SGD 2.09 billion (US$1.50 billion) with 79% due to productivity losses. Conclusion Poorly controlled asthma imposes a significant economic burden. Therefore, better control of disease has the potential to generate not only health improvements, but also medical expenditure savings and productivity gains.
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Affiliation(s)
- Eric A Finkelstein
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Eden Lau
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore
| | - Brett Doble
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore
| | | | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
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30
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Crisford H, Sapey E, Rogers GB, Taylor S, Nagakumar P, Lokwani R, Simpson JL. Neutrophils in asthma: the good, the bad and the bacteria. Thorax 2021; 76:thoraxjnl-2020-215986. [PMID: 33632765 PMCID: PMC8311087 DOI: 10.1136/thoraxjnl-2020-215986] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022]
Abstract
Airway inflammation plays a key role in asthma pathogenesis but is heterogeneous in nature. There has been significant scientific discovery with regard to type 2-driven, eosinophil-dominated asthma, with effective therapies ranging from inhaled corticosteroids to novel biologics. However, studies suggest that approximately 1 in 5 adults with asthma have an increased proportion of neutrophils in their airways. These patients tend to be older, have potentially pathogenic airway bacteria and do not respond well to classical therapies. Currently, there are no specific therapeutic options for these patients, such as neutrophil-targeting biologics.Neutrophils comprise 70% of the total circulatory white cells and play a critical defence role during inflammatory and infective challenges. This makes them a problematic target for therapeutics. Furthermore, neutrophil functions change with age, with reduced microbial killing, increased reactive oxygen species release and reduced production of extracellular traps with advancing age. Therefore, different therapeutic strategies may be required for different age groups of patients.The pathogenesis of neutrophil-dominated airway inflammation in adults with asthma may reflect a counterproductive response to the defective neutrophil microbial killing seen with age, resulting in bystander damage to host airway cells and subsequent mucus hypersecretion and airway remodelling. However, in children with asthma, neutrophils are less associated with adverse features of disease, and it is possible that in children, neutrophils are less pathogenic.In this review, we explore the mechanisms of neutrophil recruitment, changes in cellular function across the life course and the implications this may have for asthma management now and in the future. We also describe the prevalence of neutrophilic asthma globally, with a focus on First Nations people of Australia, New Zealand and North America.
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Affiliation(s)
- Helena Crisford
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Geraint B Rogers
- SAHMRI Microbiome Research Laboratory, Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steven Taylor
- SAHMRI Microbiome Research Laboratory, Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Prasad Nagakumar
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ravi Lokwani
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jodie L Simpson
- Faculty of Health and Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
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31
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Mahon GM, Koppelman GH, Vonk JM. Grandmaternal smoking, asthma and lung function in the offspring: the Lifelines cohort study. Thorax 2021; 76:441-447. [PMID: 33542091 PMCID: PMC8070652 DOI: 10.1136/thoraxjnl-2020-215232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/01/2022]
Abstract
Background/objective Limited research exists regarding the association between grandmaternal smoking during pregnancy and the risk for asthma and altered lung function in grandchildren. This study aimed to investigate this association in a three-generation design. Methods 37 291 participants (25 747 adults and 11 544 children) were included from the Lifelines study, a prospective longitudinal three generation cohort study in The Netherlands. Spirometry was available in 69.5% and 61.1% of the included adults and children. Logistic and linear regression were used to analyse the association between grandmaternal smoking during pregnancy and (1) asthma, (2) early childhood asthma (ie, onset before 6 years) and (3) lung function level. Maternal and paternal grandmaternal smoking were studied separately and the analyses were stratified by adult/child and by gender. The analyses were adjusted for gender, current smoking, birth variables and socioeconomic status. Results In the adult population, maternal grandmaternal smoking during pregnancy was associated with a higher risk for asthma (OR (95% CI): 1.38 (1.06 to 1.79)), early childhood asthma (1.49 (95% CI 1.06 to 2.11)) and a lower FEV1/FVC% predicted (B (95% CI): −1.04 (−1.91 to −0.16) in men. These findings were not observed in a separate analysis of children that participated in this study. There was also no significant association between paternal grandmaternal smoking and asthma/lung function. Conclusion Maternal grandmaternal smoking during pregnancy is associated with higher asthma risk and lower lung function in male grandchildren and a reverse effect in male grandchildren of subsequent generations. Our study highlights the deep-rooted effects of tobacco smoking across generations.
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Affiliation(s)
- Gillian M Mahon
- Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, University Medical Center Groningen Beatrix Children's Hospital, Groningen, The Netherlands
| | - Judith M Vonk
- Department of Epidemiology, GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands
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32
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Lenney W. Task shifting: a common-sense approach in children with asthma? Thorax 2021; 76:430-431. [PMID: 33542088 DOI: 10.1136/thoraxjnl-2020-216695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Warren Lenney
- Department of Medicine, School of Pharmacy and Bioengineering, Keele University, Keele, UK
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33
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Brew B, Gibberd A, Marks GB, Strobel N, Allen CW, Jorm L, Chambers G, Eades S, McNamara B. Identifying preventable risk factors for hospitalised asthma in young Aboriginal children: a whole-population cohort study. Thorax 2021; 76:539-546. [PMID: 33419952 DOI: 10.1136/thoraxjnl-2020-216189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. AIM To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1-4 years of age). METHODS Birth, hospital and emergency data for all Aboriginal children born 2003-2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life. RESULTS There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks' gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%-7%. We did not observe a higher risk of asthma in those children who were from remote areas. CONCLUSION Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.
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Affiliation(s)
- Bronwyn Brew
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia .,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Alison Gibberd
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Clare Wendy Allen
- Children's Hospital Westmead, University of Sydney, Westmead, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Georgina Chambers
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, 2033, New South Wales, Australia
| | - Sandra Eades
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Bridgette McNamara
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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34
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Wang JG, Liu B, Kroll F, Hanson C, Vicencio A, Coca S, Uribarri J, Bose S. Increased advanced glycation end product and meat consumption is associated with childhood wheeze: analysis of the National Health and Nutrition Examination Survey. Thorax 2020; 76:292-294. [PMID: 33443194 PMCID: PMC7892397 DOI: 10.1136/thoraxjnl-2020-216109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/01/2020] [Indexed: 11/03/2022]
Abstract
We examined 4388 children from the 2003 to 2006 National Health and Nutrition Examination Survey and used survey-design-adjusted multivariable logistic regression to evaluate associations between dietary advanced glycation end product (AGE) and meat consumption frequencies and respiratory symptoms. Higher AGE intake was significantly associated with increased odds of wheezing (adjusted OR 1.18; 95% CI 1.02 to 1.36), wheeze-disrupted sleep (1.26; 95% CI 1.05 to 1.51) and exercise (1.34; 95% CI 1.08 to 1.67) and wheezing requiring prescription medication (1.35; 95% CI 1.13 to 1.63). Higher intake of non-seafood meats was associated with wheeze-disrupted sleep (2.32; 95% CI 1.11 to 4.82) and wheezing requiring prescription medication (2.23; 95% CI 1.10 to 4.54).
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Affiliation(s)
- Jing Gennie Wang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Francesca Kroll
- Krieger School of Arts and Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Corrine Hanson
- Division of Medical Nutrition Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alfin Vicencio
- Division of Pediatric Pulmonology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Steven Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sonali Bose
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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35
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Del-Río-Navarro BE, Berber A, Reyes-Noriega N, Navarrete-Rodríguez EM, García-Almaraz R, Ellwood P, Garcia-Marcos L, Saucedo-Ramírez OJ, Mérida-Palacio VJ, Ramos-García BDC, Escalante-Domínguez AJ, Linares-Zapién FJ, Moreno-Gardea HL, Ochoa-López G, Hernández-Mondragón LO, Lozano-Sáenz JS, Sacre-Hazouri JA, Juan-Pineda Á, Sánchez-Coronel MG, Rodríguez-Pérez N, Ambriz-Moreno MDJ. Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study. BMJ Open Respir Res 2020; 7:7/1/e000658. [PMID: 33268340 PMCID: PMC7713197 DOI: 10.1136/bmjresp-2020-000658] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally. Objective To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico. Methods GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6–7-year-old primary school pupils (school children) and by 13–14-year-old adolescents. Results A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres’ sea level altitude higher than 1500 m above mean sea level (p<0.005). Conclusions The most important risk factors for asthma symptoms in both age groups were the presence of rhinitis and rash symptoms or diagnosis. On the other hand, sea level altitude higher than 1500 metres was a protective factor.
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Affiliation(s)
| | - Arturo Berber
- Allergy and Immunology, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | - Nayely Reyes-Noriega
- Allergy and Immunology, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | | | | | - Philippa Ellwood
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Luis Garcia-Marcos
- Paediatric Allergy and Pulmonology Units 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Universidad de Murcia, Murcia, Spain
| | | | | | | | | | - Francisco Javier Linares-Zapién
- Allergy and Immunology, Centro de Investigación, Diagnóstico y Tratamiento de Asma y Alergias, Toluca, Estado de México, Mexico
| | | | | | | | | | | | | | | | - Noel Rodríguez-Pérez
- Allergy and Immunology, Benemérita Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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Andersson CK, Iwasaki J, Cook J, Robinson P, Nagakumar P, Mogren S, Fleming L, Bush A, Saglani S, Lloyd CM. Impaired airway epithelial cell wound-healing capacity is associated with airway remodelling following RSV infection in severe preschool wheeze. Allergy 2020; 75:3195-3207. [PMID: 32578219 DOI: 10.1111/all.14466] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes exacerbations of asthma and preschool wheeze (PSW). However, the anti-viral and repair responses of the bronchial epithelium in children with severe therapy-resistant asthma (STRA) and PSW are poorly understood. METHODS Children with STRA (age 12 [6-16] years), PSW (age 2 [1-5] years) and non-asthmatic controls (age 7 [2-14] years) underwent bronchoscopy with endobronchial brushings and biopsies. Anti-viral, wound injury responses were quantified in biopsies and primary bronchial epithelial cells (PBECs) in response to RSV, poly(I:C), house dust mite (HDM) or IL-33 using RT-qPCR, Luminex and live cell imaging. Collagen deposition and tissue expression of epithelial growth factor receptor (EGFR), IL-33 and receptor ST2 were investigated in bronchial biopsies. RESULTS PBECs from STRA and PSW had increased TLR3 gene expression and increased secretion of anti-viral and pro-inflammatory cytokines (IFN-γ, IL-6 and IL-13) in response to RSV compared to controls. Exposure of PBECs to concomitant TLR3 agonist poly(I:C) and HDM resulted in a significant reduction in epithelial cell proliferation in PSW compared to controls. Wound-healing was also impaired in PSW compared to controls at baseline and following IL-33 stimulation. In addition, tissue EGFR expression was significantly reduced in PSW and correlated with collagen deposition in endobronchial biopsies. CONCLUSIONS Despite increased anti-viral responses, preschool children with severe wheeze had impaired airway epithelial proliferative responses following damage. This might be connected to the low expression of EGFR in PSW which may affect epithelial function and contribute to asthma pathogenesis.
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Affiliation(s)
- Cecilia K. Andersson
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
- Respiratory Cell Biology Lund University Lund Sweden
| | - Jua Iwasaki
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
| | - James Cook
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Polly Robinson
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Prasad Nagakumar
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Sofia Mogren
- Respiratory Cell Biology Lund University Lund Sweden
| | - Louise Fleming
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Andrew Bush
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Sejal Saglani
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
- Respiratory Paediatricsthe Royal Brompton and Harefield NHS Trust London UK
| | - Clare M. Lloyd
- Inflammation, Repair and Development Section National Heart and Lung InstituteImperial College London
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Rodriguez A, Rodrigues L, Chico M, Vaca M, Barreto ML, Brickley E, Cooper PJ. Measuring urbanicity as a risk factor for childhood wheeze in a transitional area of coastal ecuador: a cross-sectional analysis. BMJ Open Respir Res 2020; 7:7/1/e000679. [PMID: 33257440 PMCID: PMC7705553 DOI: 10.1136/bmjresp-2020-000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The urbanisation process has been associated with increases in asthma prevalence, an observation supported largely by studies comparing urban with rural populations. The nature of this association remains poorly understood, likely because of the limitations of the urban–rural approach to understand what a multidimensional process is. Objective This study explored the relationship between the urbanisation process and asthma prevalence using a multidimensional and quantitative measure of urbanicity. Methods A cross-sectional analysis was conducted in 1843 children living in areas with diverse levels of urbanisation in the district of Quinindé, Ecuador in 2013–2015. Categorical principal components analysis was used to generate an urbanicity score derived from 18 indicators measured at census ward level based on data from the national census in 2010. Indicators represent demographic, socioeconomic, built environment and geographical dimensions of the urbanisation process. Geographical information system analysis was used to allocate observations and urban characteristics to census wards. Logistic random effects regression models were used to identify associations between urbanicity score, urban indicators and three widely used definitions for asthma. Results The prevalence of wheeze ever, current wheeze and doctor diagnosis of asthma was 33.3%, 13% and 6.9%, respectively. The urbanicity score ranged 0–10. Positive significant associations were observed between the urbanicity score and wheeze ever (adjusted OR=1.033, 95% CI 1.01 to 1.07, p=0.05) and doctor diagnosis (adjusted OR=1.06, 95% CI 1.02 to 1.1, p=0.001). For each point of increase in urbanicity score, the prevalence of wheeze ever and doctor diagnosis of asthma increased by 3.3% and 6%, respectively. Variables related to socioeconomic and geographical dimensions of the urbanisation process were associated with greater prevalence of wheeze/asthma outcomes. Conclusions Even small increases in urbanicity are associated with a higher prevalence of asthma in an area undergoing the urban transition. The use of a multidimensional urbanicity indicator has greater explanatory power than the widely used urban–rural dichotomy to improve our understanding of how the process of urbanisation affects the risk of asthma.
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Affiliation(s)
- Alejandro Rodriguez
- Facultad de ciencias Médicas de la salud y la Vida, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador .,SCAALA project, Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Quininde, Esmeraldas, Ecuador
| | - Laura Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Martha Chico
- SCAALA project, Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Quininde, Esmeraldas, Ecuador
| | - Maritza Vaca
- SCAALA project, Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Quininde, Esmeraldas, Ecuador
| | - Mauricio Lima Barreto
- Centro de de Integração de Dados e Conhecimentos para Saúde (CIDACS) FIOCRUZ, Salvador, Bahia, Brazil.,Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Elizabeth Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip J Cooper
- Facultad de ciencias Médicas de la salud y la Vida, Universidad Internacional del Ecuador, Quito, Pichincha, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, Esmeraldas, UK
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Evans A, Farewell D, Demmler J, Bandyopadhyay A, Powell CVE, Paranjothy S. Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: population-based record-linkage study. Thorax 2020; 76:116-125. [PMID: 33177228 PMCID: PMC7815901 DOI: 10.1136/thoraxjnl-2020-215422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 10/09/2020] [Indexed: 12/05/2022]
Abstract
Background There is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute asthma to investigate if there is an association for poorer educational attainment at age 6–7 years, and the role of respiratory infections and school absence. Methods This study used a population-based electronic cross-sectional birth cohort 1998–2005, in Wales, UK, using health and education administrative datasets. Current asthma or wheeze categories were developed using clinical management guidelines in general practice (GP) data, acute asthma was inpatient hospital admissions and respiratory infections were the count of GP visits, from birth to age 6–7 years. We used multilevel logistic regression grouped by schools to ascertain if asthma or wheeze was associated with not attaining the expected level in teacher assessment at Key Stage 1 (KS1) adjusting for sociodemographics, perinatal, other respiratory illness and school characteristics. We tested if absence from school was a mediator in this relationship using the difference method. Results There were 85 906 children in this population representative cohort with 7-year follow-up. In adjusted multilevel logistic regression, only asthma inpatient hospital admission was associated with increased risk for not attaining the expected level at KS1 (adjusted OR 1.14 95% CI (1.02 to 1.27)). Lower respiratory tract infection (LRTI) GP contacts remained an independent predictor for not attaining the expected level of education. Absence from school was a potential mediator of the association between hospital admission and educational attainment. Conclusions Clinicians and educators need to be aware that children who have inpatient hospital admissions for asthma or wheeze, or repeated LRTI, may require additional educational support for their educational outcomes.
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Affiliation(s)
- Annette Evans
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Joanne Demmler
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Data Science Building, School of Medicine, Swansea University, Swansea, UK
| | - Amrita Bandyopadhyay
- Administrative Data Research Wales, Swansea University Medical School, Swansea, UK
| | - Colin Victor Eric Powell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.,Department of Pediatric Emergency Medicine, Senior Attending Physician (Head of Research), Sidra Medicine, Education City, Al Rayyan, Qatar
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.,Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University College of Arts Humanities and Social Sciences, Cardiff, UK.,Centre for Improvement in Population Health through E-records Research, Institute of Life Science Medical School, Swansea University, Swansea, UK
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Makhecha S, Chan A, Pearce C, Jamalzadeh A, Fleming L. Novel electronic adherence monitoring devices in children with asthma: a mixed-methods study. BMJ Open Respir Res 2020; 7:7/1/e000589. [PMID: 33154086 PMCID: PMC7646352 DOI: 10.1136/bmjresp-2020-000589] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Adherence monitoring to inhaled corticosteroids is an essential component of asthma management. Electronic monitoring devices (EMD) provide objective data on date, time and number of actuations. However, most give no information on inhalation. Novel EMD (NEMD) platforms have the potential to monitor both activation and inhalation. Aim To assess the feasibility of NEMDs, in terms of usability, acceptability to patients and healthcare professionals and accuracy. Methods This was an open-label, prospective, mixed-methods, pragmatic randomised study. Children with asthma attending specialist tertiary care were randomised to one of four NEMD: Remote Directly Observed Therapy (R-DOT), Hailie Smartinhaler, INhaler Compliance Assessment device (INCA) and the Rafi-tone App. Following monitoring, participants were invited to focus groups or one-to-one interviews. Usability and acceptability were evaluated using themes identified from the focus groups and interviews. Adherence accuracy was determined using adherence data from each NEMD. Results Thirty-five children were recruited; 18 (51%), (11 males, median age 13.5 (7–16) years) completed monitoring, 14 (78%) provided feedback. Participants identified various features such as ease of use and minimal effort as desirable criteria for an NEMD. The Hailie and INCA fulfilled these criteria and were able to record both actuation and inhalation. Negative themes included a ‘Big Brother’ effect and costs. Conclusion There was no ‘one size fits all’, as participants identified advantages and disadvantages for each NEMD. Devices that can easily calculate adherence to activation and inhalation have the potential to have greatest utility in clinical practice. Each NEMD has different functionality and therefore choice of platform should be determined by the needs of the patient and healthcare professional.
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Affiliation(s)
- Sukeshi Makhecha
- Paediatrics, Respiratory, Royal Brompton Hospital, London, London, UK
| | - Amy Chan
- The University of Auckland School of Pharmacy, Auckland, Auckland, New Zealand.,Centre of Behavioural Medicine, School of Pharmacy, UCL, London, London, UK
| | - Christina Pearce
- Centre of Behavioural Medicine, School of Pharmacy, UCL, London, London, UK
| | - Angela Jamalzadeh
- Paediatrics, Respiratory, Royal Brompton Hospital, London, London, UK
| | - Louise Fleming
- Paediatrics, Respiratory, Royal Brompton Hospital, London, London, UK .,Imperial College London, London, London, UK
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40
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van Meel ER, Saharan G, Jaddoe VW, de Jongste JC, Reiss IK, Tiemeier H, El Marroun H, Duijts L. Parental psychological distress during pregnancy and the risk of childhood lower lung function and asthma: a population-based prospective cohort study. Thorax 2020; 75:1074-1081. [PMID: 33046570 PMCID: PMC7677473 DOI: 10.1136/thoraxjnl-2019-214099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Background Although maternal psychological distress during pregnancy is associated with increased risks of respiratory morbidity in preschool children, it is unknown whether this association persists into later childhood. Objective To examine the association between parental psychological distress during pregnancy and lung function and asthma in children of school age. Methods This study of 4231 children was embedded in a population-based prospective cohort. Parental psychological distress was assessed by the Brief Symptom Inventory during and 3 years after pregnancy, and in mothers also at 2 and 6 months after pregnancy. At age 10 years, lung function was obtained by spirometry and asthma by questionnaire. Results The prevalence of asthma was 5.9%. Maternal overall psychological distress during pregnancy was associated with a lower forced vital capacity (FVC) (z-score difference −0.10 (95% CI −0.20 to –0.01) per 1-unit increase), maternal depressive symptoms during pregnancy with a lower forced expiratory volume in the first second (FEV1) and FVC (−0.13 (95% CI −0.24 to –0.01) and −0.13 (95% CI −0.24 to –0.02) when using clinical cut-offs) in their children. All maternal psychological distress measures during pregnancy were associated with an increased risk of asthma (range OR: 1.46 (95% CI 1.12 to 1.90) to 1.91 (95% CI 1.26 to 2.91)). Additional adjustment for paternal psychological distress during pregnancy and parental psychological distress after pregnancy did not materially change the associations. Paternal psychological distress during pregnancy was not associated with childhood respiratory morbidity. Conclusion Maternal, but not paternal, psychological distress during pregnancy is associated with an increased risk of asthma and partly lower lung function in children. This suggests intrauterine programming for the risk of later-life respiratory disease.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gautam Saharan
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent Wv Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irwin Km Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Social and Behavioural Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Hanan El Marroun
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands .,Department of Pediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Caffrey Osvald E, Bower H, Lundholm C, Larsson H, Brew BK, Almqvist C. Asthma and all-cause mortality in children and young adults: a population-based study. Thorax 2020; 75:1040-1046. [PMID: 32963117 PMCID: PMC7677462 DOI: 10.1136/thoraxjnl-2020-214655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies suggest an increased all-cause mortality among adults with asthma. We aimed to study the relationship between asthma in children and young adults and all-cause mortality, and investigate differences in mortality rate by also having a life-limiting condition (LLC) or by parental socioeconomic status (SES). METHODS Included in this register-based study are 2 775 430 individuals born in Sweden between January 1986 and December 2012. We identified asthma cases using the National Patient Register (NPR) and the Prescribed Drug Register. Those with LLC were identified using the NPR. Parental SES at birth (income and education) was retrieved from Statistics Sweden. We estimated the association between asthma and all-cause mortality using a Cox proportional hazards regression model. Effect modification by LLC or parental SES was studied using interaction terms in the adjusted model. RESULTS The adjusted hazard rate (adjHR) for all-cause mortality in asthma cases versus non-asthma cases was 1.46 (95% CI 1.33 to 1.62). The highest increased rate appeared to be for those aged 5-15 years. In persons with asthma and without LLC, the adjHR remained increased at 1.33 (95% CI 1.18 to 1.50), but differed (p=0.002) from those with asthma and LLC, with an adjHR of 1.87 (95% CI 1.57 to 2.22). Parental SES did not alter the association (income, p=0.55; education, p=0.83). CONCLUSION This study shows that asthma is associated with an increased mortality in children and young adults regardless of LLC or parental SES. Further research is warranted to investigate the possible mechanisms for this association.
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Affiliation(s)
- Emma Caffrey Osvald
- Paediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro Universitet - Campus USÖ, Örebro, Sweden
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Paediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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42
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Tsai CH, Wu AC, Chiang BL, Yang YH, Hung SP, Su MW, Chang YJ, Lee YL. CEACAM3 decreases asthma exacerbations and modulates respiratory syncytial virus latent infection in children. Thorax 2020; 75:725-734. [PMID: 32606071 DOI: 10.1136/thoraxjnl-2019-214132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is associated with childhood asthma. Nevertheless, not all children exposed to RSV develop asthma symptoms, possibly because genes modulate the effects of RSV on asthma exacerbations. OBJECTIVE The purpose of this study was to identify genes that modulate the effect of RSV latent infection on asthma exacerbations. METHODS We performed a meta-analysis to investigate differentially expressed genes (DEGs) of RSV infection from Gene Expression Omnibus datasets. Expression quantitative trait loci (eQTL) methods were applied to select single nucleotide polymorphisms (SNPs) that were associated with DEGs. Gene-based analysis was used to identify SNPs that were significantly associated with asthma exacerbations in the Taiwanese Consortium of Childhood Asthma Study (TCCAS), and validation was attempted in an independent cohort, the Childhood Asthma Management Program (CAMP). Gene-RSV interaction analyses were performed to investigate the association between the interaction of SNPs and RSV latent infection on asthma exacerbations. RESULTS A total of 352 significant DEGs were found by meta-analysis of RSV-related genes. We used 38 123 SNPs related to DEGs to investigate the genetic main effects on asthma exacerbations. We found that eight RSV-related genes (GADD45A, GYPB, MS4A3, NFE2, RNASE3, EPB41L3, CEACAM6 and CEACAM3) were significantly associated with asthma exacerbations in TCCAS and also validated in CAMP. In TCCAS, rs7251960 (CEACAM3) significantly modulated the effect of RSV latent infection on asthma exacerbations (false-discovery rate <0.05). The rs7251960 variant was associated with CEACAM3 mRNA expression in lung tissue (p for trend=1.2×10-7). CEACAM3 mRNA was reduced in nasal mucosa from subjects with asthma exacerbations in two independent datasets. CONCLUSIONS rs7251960 is an eQTL for CEACAM3, and CEACAM3 mRNA expression is reduced in subjects experiencing asthma exacerbations. CEACAM3 may be a modulator of RSV latent infection on asthma exacerbations.
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Affiliation(s)
- Ching-Hui Tsai
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP), PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Pin Hung
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Ming-Wei Su
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ya-Jen Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yungling L Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
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Zhu C, Zhang L, Liu Z, Li C, Bai Y, Wang L. Atractylenolide III reduces NLRP3 inflammasome activation and Th1/Th2 imbalances in both in vitro and in vivo models of asthma. Clin Exp Pharmacol Physiol 2020; 47:1360-1367. [PMID: 32196713 DOI: 10.1111/1440-1681.13306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/07/2020] [Accepted: 03/15/2020] [Indexed: 01/02/2023]
Abstract
Paediatric asthma is a common inflammatory disease in children. Atractylenolide III is an active component of the Atractylodes rhizome, an herbal medicine that has been used as an asthma treatment. This study aimed to explore the effects and underlying mechanisms of atractylenolide III in IL-4-induced 16HBE cells and ovalbumin-induced asthmatic mice. The results showed that IL-4 stimulation significantly decreased, and atractylenolide III treatment increased, growth and apoptosis of 16HBE cells. In 16HBE cells, administration of atractylenolide III also significantly suppressed the IL-4-induced increases in the expression of cleaved caspase-1; apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC); and nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3). Moreover, the numbers of total leukocytes, neutrophils, eosinophils, and macrophages significantly increased in ovalbumin-induced mice, and then decreased after atractylenolide III treatment. In ovalbumin-induced asthmatic mice, atractylenolide III treatment also significantly inhibited NLRP3 inflammasome activation and restored the Th1/Th2 balance. These results indicate that atractylenolide III reduced NLRP3 inflammasome activation and regulated the Th1/Th2 balance in IL-4 induced 16HBE cells and ovalbumin-induced asthmatic mice, suggesting it has a protective effect that may be useful in the treatment of paediatric asthma.
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Affiliation(s)
- Cuimin Zhu
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Leguo Zhang
- Department of Internal Neurology, Cangzhou Central Hospital, Cangzhou, China
| | - Zhiming Liu
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Chen Li
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Yajie Bai
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Linlin Wang
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
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Seol HY, Rolfes MC, Chung W, Sohn S, Ryu E, Park MA, Kita H, Ono J, Croghan I, Armasu SM, Castro-Rodriguez JA, Weston JD, Liu H, Juhn Y. Expert artificial intelligence-based natural language processing characterises childhood asthma. BMJ Open Respir Res 2020; 7:7/1/e000524. [PMID: 33371009 PMCID: PMC7011897 DOI: 10.1136/bmjresp-2019-000524] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/04/2020] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The lack of effective, consistent, reproducible and efficient asthma ascertainment methods results in inconsistent asthma cohorts and study results for clinical trials or other studies. We aimed to assess whether application of expert artificial intelligence (AI)-based natural language processing (NLP) algorithms for two existing asthma criteria to electronic health records of a paediatric population systematically identifies childhood asthma and its subgroups with distinctive characteristics. METHODS Using the 1997-2007 Olmsted County Birth Cohort, we applied validated NLP algorithms for Predetermined Asthma Criteria (NLP-PAC) as well as Asthma Predictive Index (NLP-API). We categorised subjects into four groups (both criteria positive (NLP-PAC+/NLP-API+); PAC positive only (NLP-PAC+ only); API positive only (NLP-API+ only); and both criteria negative (NLP-PAC-/NLP-API-)) and characterised them. Results were replicated in unsupervised cluster analysis for asthmatics and a random sample of 300 children using laboratory and pulmonary function tests (PFTs). RESULTS Of the 8196 subjects (51% male, 80% white), we identified 1614 (20%), NLP-PAC+/NLP-API+; 954 (12%), NLP-PAC+ only; 105 (1%), NLP-API+ only; and 5523 (67%), NLP-PAC-/NLP-API-. Asthmatic children classified as NLP-PAC+/NLP-API+ showed earlier onset asthma, more Th2-high profile, poorer lung function, higher asthma exacerbation and higher risk of asthma-associated comorbidities compared with other groups. These results were consistent with those based on unsupervised cluster analysis and lab and PFT data of a random sample of study subjects. CONCLUSION Expert AI-based NLP algorithms for two asthma criteria systematically identify childhood asthma with distinctive characteristics. This approach may improve precision, reproducibility, consistency and efficiency of large-scale clinical studies for asthma and enable population management.
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Affiliation(s)
- Hee Yun Seol
- Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA,Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Mary C Rolfes
- Mayo Clinic Alix School of Medicine, Rocheser, Minnesota, USA
| | - Wi Chung
- Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunghwan Sohn
- Digital Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Euijung Ryu
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Miguel A Park
- Allergic Diseases, Mayo Clinic, Rochester, MN, United States
| | - Hirohito Kita
- Allergic Diseases, Mayo Clinic, Rochester, MN, United States
| | - Junya Ono
- Research and Development Unit, Shino-Test Corporation, Sagamihara, Japan
| | - Ivana Croghan
- Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sebastian M Armasu
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | | | - Jill D Weston
- Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hongfang Liu
- Digital Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Young Juhn
- Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Jin X, Wu L, Wang J, Feng M. The comparison of fluticasone propionate/formoterol with fluticasone propionate/salmeterol for paediatric asthma: a meta-analysis of randomized controlled trials. Postepy Dermatol Alergol 2021; 38:377-83. [PMID: 34377116 DOI: 10.5114/ada.2020.92519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The comparison of fluticasone propionate/formoterol (FP/FORM) with fluticasone propionate/salmeterol (FP/SAL) for paediatric asthma remains controversial. Aim We conduct a systematic review and meta-analysis to explore the efficacy and safety of FP/FORM versus FP/SAL for paediatric asthma. Material and methods We have searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of FP/FORM versus FP/SAL for paediatric asthma. This meta-analysis is performed using the random-effects model. Results Three RCTs are included in the meta-analysis. Overall for paediatric asthma, FP/FORM and FP/SAL demonstrate a comparable influence on FEVj (Std. MD = -0.01; 95% CI: -0.04 to 0.03; p = 0.62), FVC (Std. MD = 0; 95% CI: -0.07 to 0.06; p = 0.87), FEF25 (Std. MD = -1.69; 95% CI: -6.69 to 3.31; p = 0.51), FEF50 (Std. MD = 0.10; 95% CI: -0.12 to 0.33; p = 0.37), FEF75 (Std. MD = 0.01; 95% CI: -0.21 to 0.24; p = 0.91), asthma symptom scores (Std. MD = -0.03; 95% CI: -0.11 to 0.04; p = 0.43), sleep disturbance scores (Std. MD = 0.03; 95% CI: -0.19 to 0.24; p = 0.81) and adverse events (RR = 1.07; 95% CI: 0.83 to 1.38; p = 0.61). Conclusions FP/FORM and FP/SAL show a comparable efficacy for paediatric asthma.
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Affiliation(s)
| | - Louise Fleming
- Imperial College London, London, UK
- Department of Paediatrics, Royal Brompton Hospital, London, UK
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47
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Lo DK, Beardsmore CS, Roland D, Richardson M, Yang Y, Danvers L, Wilson A, Gaillard EA. Lung function and asthma control in school-age children managed in UK primary care: a cohort study. Thorax 2019; 75:101-107. [PMID: 31666388 DOI: 10.1136/thoraxjnl-2019-213068] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/22/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Spirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring from 5 years in all healthcare settings. There is little spirometry and FeNO data in children managed for asthma in UK primary care to support their use. OBJECTIVES To study the prevalence of abnormal spirometry and FeNO in children with asthma managed in primary care and to explore their relationship with asthma control and unplanned healthcare attendances (UHA). METHODS Prospective observational cohort study in children aged 5-16 years with suspected or doctor-diagnosed asthma attending an asthma review in UK general practice. Spirometry, FeNO, asthma control test (ACT) scores and number of UHAs were studied. RESULTS Of 612 children from 10 general practices, 23.5% had abnormal spirometry, 36.0% had raised FeNO ≥35 parts per billion and 41.8% reported poor control. Fifty-four per cent of children reporting good asthma control had abnormal spirometry and/or raised FeNO. At follow-up, the mean number of UHAs fell from 0.31/child in the 6 months preceding review to 0.20/child over the 6 months following review (p=0.0004). Median ACT scores improved from 20 to 22 (p=0.032), and children's ACT from 21 to 23 (p<0.0001). CONCLUSIONS Abnormal lung function and FeNO are common in children attending for asthma review in primary care and relate poorly to symptom scores. A symptoms-based approach to asthma monitoring without objective testing is likely to miss children at high risk of future severe asthma attacks.
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Affiliation(s)
- David Kh Lo
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester College of Life Sciences, Leicester, UK.,Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline S Beardsmore
- Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Mathew Richardson
- Leicester NIHR Biomedical Research Centre, National Institute for Health Research, Leicester, UK.,Department of Respiratory Sciences, University of Leicester College of Life Sciences, Leicester, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lesley Danvers
- Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Wilson
- Health Sciences, University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK .,Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, UK
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48
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Mentz G, Robins TG, Batterman S, Naidoo RN. Effect modifiers of lung function and daily air pollutant variability in a panel of schoolchildren. Thorax 2019; 74:1055-1062. [PMID: 31534032 DOI: 10.1136/thoraxjnl-2017-211458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute pollutant-related lung function changes among children varies across pollutants and lag periods. We examined whether short-term air pollutant fluctuations were related to daily lung function among a panel of children and whether these effects are modified by airway hyperresponsiveness, location and asthma severity. METHODS Students from randomly selected grade 4 classrooms at seven primary schools in Durban, participated, together with asthmatic children from grades 3-6 (n=423). The schools were from high pollutant exposed communities (south) and compared with schools from communities with lower levels of pollution (north), with similar socioeconomic profiles. Interviews, spirometry and methacholine challenge testing were conducted. Bihourly lung function measurements were performed over a 3-week period in four phases. During all schooldays, students blew into their personal digital monitors every 1.5-2 hours. Nitrogen dioxide (NO2), nitrogen oxide (NO), sulphur dioxide and particulate matter (<10 μm diameter) (PM10) were measured at each school. Generalised estimating equations assessed lag effects, using single-pollutant (single or distributed lags) models. RESULTS FEV1 declines ranged from 13 to 18 mL per unit increase in IQR for NO and 14-23 mL for NO2. Among the 5-day average models, a 20 mL and 30 mL greater drop in FEV1 per IQR for NO2 and NO, respectively, among those with airway hyperresponsiveness compared with those without. Effects were seen among those with normal airways. CONCLUSIONS This first panel study in sub-Saharan Africa, showed significant declines in lung function, in response to NO and NO2 with effects modified by airway hyperresponsiveness or persistent asthma.
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Affiliation(s)
| | | | | | - Rajen N Naidoo
- Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
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49
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Rylance S, Nightingale R, Naunje A, Mbalume F, Jewell C, Balmes JR, Grigg J, Mortimer K. Lung health and exposure to air pollution in Malawian children (CAPS): a cross-sectional study. Thorax 2019; 74:1070-1077. [PMID: 31467192 PMCID: PMC6860406 DOI: 10.1136/thoraxjnl-2018-212945] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/25/2019] [Accepted: 06/01/2019] [Indexed: 11/30/2022]
Abstract
Background Non-communicable lung disease and exposure to air pollution are major problems in sub-Saharan Africa. A high burden of chronic respiratory symptoms, spirometric abnormalities and air pollution exposures has been found in Malawian adults; whether the same would be true in children is unknown. Methods This cross-sectional study of children aged 6–8 years, in rural Malawi, included households from communities participating in the Cooking and Pneumonia Study (CAPS), a trial of cleaner-burning biomass-fuelled cookstoves. We assessed; chronic respiratory symptoms, anthropometry, spirometric abnormalities (using Global Lung Initiative equations) and personal carbon monoxide (CO) exposure. Prevalence estimates were calculated, and multivariable analyses were done. Results We recruited 804 children (mean age 7.1 years, 51.9% female), including 476 (260 intervention; 216 control) from CAPS households. Chronic respiratory symptoms (mainly cough (8.0%) and wheeze (7.1%)) were reported by 16.6% of children. Average height-for-age and weight-for-age z-scores were −1.04 and −1.10, respectively. Spirometric abnormalities (7.1% low forced vital capacity (FVC); 6.3% obstruction) were seen in 13.0% of children. Maximum CO exposure and carboxyhaemoglobin levels (COHb) exceeded WHO guidelines in 50.1% and 68.5% of children, respectively. Children from CAPS intervention households had lower COHb (median 3.50% vs 4.85%, p=0.006) and higher FVC z-scores (−0.22 vs −0.44, p=0.05) than controls. Conclusion The substantial burden of chronic respiratory symptoms, abnormal spirometry and air pollution exposures in children in rural Malawi is concerning; effective prevention and control strategies are needed. Our finding of potential benefit in CAPS intervention households calls for further research into clean-air interventions to maximise healthy lung development in children.
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Affiliation(s)
- Sarah Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrew Naunje
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Frank Mbalume
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - John R Balmes
- Environmental Health Sciences Division, University of California Berkeley, Berkeley, California, USA
| | - Jonathan Grigg
- Centre for Child Health, Queen Mary University London, London, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK .,Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
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50
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Schultz A, le Souef P, Barwick M. Suboptimal asthma care: Lessons from Australia and a way forward. Respirology 2019; 25:45-46. [PMID: 31376311 DOI: 10.1111/resp.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- André Schultz
- Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Peter le Souef
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia Medical School, Perth, WA, Australia
| | - Melanie Barwick
- Research Institute, Hospital for Sick Children, Toronto, BC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, BC, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, BC, Canada
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