Emotional quality-of-life and outcomes in adolescents with asthma

OBJECTIVE: Examine the association between emotional quality-of-life (QOL) and asthma morbidity in adolescents with asthma. STUDY DESIGN: Cross-sectional survey of 185 adolescents with asthma 11 to 17 years of age cared for in three managed care organizations (MCOs) in the United States. The asthma-specific Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a short version of the generic Child Health and Illness Profile-Adolescent Edition (CHIP-AE) were used to assess emotional QOL. Asthma morbidity measures were: asthma control, emergency department (ED) visits, hospitalizations, doctor visits for worsening asthma, and missed school because of asthma. RESULTS: Of the adolescents surveyed, 45% reported feeling depressed, 41% had ED visits, and 30% missed >or=1 day of school because of asthma. Poorer asthma-specific emotional QOL was associated with poorer control of asthma symptoms ( P < .0001), missed school (OR 7.1, P < .05), and doctor visits for worsened asthma (OR = 7.0, P < .05). CONCLUSIONS: Emotional symptoms related to asthma are common in adolescents with persistent asthma and asthma-specific QOL is related to increased asthma morbidity, healthcare use, and school absenteeism. Adolescents with high morbidity from asthma exhibit poorer QOL. Therefore, the evaluation of asthma-specific emotional QOL should be included in the assessment of adolescents with asthma.     

Quality of life in childhood asthma: use of the Paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7 to 9 years old

To validate a Swedish translation of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and to study determinants of asthmatic children's quality of life, seventy-one 7-9-y-old children and their families were approached. Sixty-one children (86%) participated, 36 boys and 25 girls: 11 children with mild, 40 with moderate and 10 with severe asthma. The mean age was 8.7 y. Most commonly restricted activities during the week preceding the investigation were running (74%), gymnastics (30%), walking uphill (26%), playing football (20%) and shouting (13%). Parental rating of symptoms (Spearman's rho = -0.40, p = 0.001), percentage of expected peak flow rate (PEFR) (rho = 0.30, p = 0.009) and physicians' grading (mild, moderate and severe asthma, p = 0.047) all correlated significantly with PAQLQ scores. Younger children reported more impairment of QoL, as did children of parents not sharing household. Sex or presence of eczema or rhinoconjunctivitis did not significantly affect the scores. Children suffering from food allergy scored less impairment of QoL. The instrument was easy to administer, was well accepted by the children and had acceptable internal consistency.     

Pediatric asthma quality of life questionnaire (PAQLQ): Validation among asthmatic children in Thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai-translated version of the PAQLQ. The study design consisted of a five-week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained-interviewer administered the PAQLQ and performed spirometric measurements. Fifty-one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross-sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, beta-agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbach's alpha-coefficient = 0.83-0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra-class correlation coefficient--ICC = 0.84) and for total score (alpha = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.     

Comparison of the efficacy and safety of ciclesonide 160 μg once daily vs. budesonide 400 μg once daily in children with asthma

Ciclesonide is an onsite-activated inhaled corticosteroid (ICS) for the treatment of asthma. This study compared the efficacy, safety and effect on quality of life (QOL) of ciclesonide 160 microg (ex-actuator; nominal dose 200 microg) vs. budesonide 400 microg (nominal dose) in children with asthma. Six hundred and twenty-one children (aged 6-11 yr) with asthma were randomized to receive ciclesonide 160 microg (ex-actuator) once daily (via hydrofluoroalkane metered-dose inhaler and AeroChamber Plus spacer) or budesonide 400 microg once daily (via Turbohaler) both given in the evening for 12 wk. The primary efficacy end-point was change in forced expiratory volume in 1 s (FEV1). Additional measurements included change in daily peak expiratory flow (PEF), change in asthma symptom score sum, change in use of rescue medication, paediatric and caregiver asthma QOL questionnaire [PAQLQ(S) and PACQLQ, respectively] scores, change in body height assessed by stadiometry, change in 24-h urinary cortisol adjusted for creatinine and adverse events. Both ciclesonide and budesonide increased FEV1, morning PEF and PAQLQ(S) and PACQLQ scores, and improved asthma symptom score sums and the need for rescue medication after 12 wk vs. baseline. The non-inferiority of ciclesonide vs. budesonide was demonstrated for the change in FEV1 (95% confidence interval: -75, 10 ml, p = 0.0009, one-sided non-inferiority, per-protocol). In addition, ciclesonide and budesonide showed similar efficacy in improving asthma symptoms, morning PEF, use of rescue medication and QOL. Ciclesonide was superior to budesonide with regard to increases in body height (p = 0.003, two-sided). The effect on the hypothalamic-pituitary-adrenal axis was significantly different in favor of ciclesonide treatment (p < 0.001, one-sided). Both ciclesonide and budesonide were well tolerated. Ciclesonide 160 microg once daily and budesonide 400 microg once daily were effective in children with asthma. In addition, in children treated with ciclesonide there was significantly less reduction in body height and suppression of 24-h urinary cortisol excretion compared with children treated with budesonide after 12 wk.     

儿童哮喘控制水平的影响因素和评估指标分析

目的 分析儿童哮喘控制水平的影响因素,评价哮喘评估指标的实用性。方法 选取185例哮喘患儿,采用问卷及肺功能检测的方法,分析儿童哮喘控制水平及影响因素,以及评估指标与哮喘控制水平的相关性。结果 185例患儿中,完全控制的139例 （75.1%）,部分控制的36例 （19.5%）,未控制10例 （5.4%）。是否规范吸入糖皮质激素和嗜酸性粒细胞计数水平对哮喘控制的影响有统计学意义 （P < 0.05）。第1秒用力呼气容积占预计值的百分比 （FEV1%）、呼出气一氧化氮 （FeNO）以及儿童哮喘控制测试问卷 （C-ACT）、儿科哮喘生命质量调查问卷 （PAQLQ）得分等哮喘检测指标在控制组、部分控制组和未控制组之间的差异有统计学意义 （P < 0.05）。哮喘患儿FEV1%与C-ACT、PAQLQ呈正相关性 （r = 0.214、0.312,P < 0.05）,而与FeNO水平没有显著的相关性 （r = -0.18,P > 0.05）。结论 吸入糖皮质激素治疗的依从性和嗜酸性粒细胞计数水平是儿童哮喘控制的影响因素。联合FEV1%、FeNO水平以及C-ACT、PAQLQ评分等多个指标评估哮喘控制水平,更有利于儿童哮喘的临床诊疗。     

Computerised paediatric asthma quality of life questionnaires in routine care.

BACKGROUND: Asthma quality of life questionnaires are not readily incorporated into clinical care. We therefore computerised the Paediatric Asthma Quality of Life Questionnaire (standardised) (PAQLQ(S)) and the Paediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), with a colour-coded printed graphical report. OBJECTIVES: To (a) assess the feasibility of the electronic questionnaires in clinical care and (b) compare the child's PAQLQ scores with the parent's score, physician's clinical score and spirometry. METHODS: Children with asthma were given a clinical severity score of 1-4 (increasing severity) and then completed the PAQLQ(S) electronically (scores 1-7 for increasing quality of life in emotional, symptoms and activity limitation domains) followed by spirometry and physician review. Parents completed the PACQLQ. Inclusion criteria required fluent Hebrew and reliable performance of spirometry. Children with additional chronic diseases were excluded. RESULTS: 147 children with asthma aged 7-17 years completed PAQLQs and 115 accompanying parents completed PACQLQs, taking 8.3 (4.3-15) and 4.4 (1.5-12.7) min, respectively (mean (range)). Graphical reports enabled physicians to address quality of life during even brief visits. Children's (PAQLQ) and parents' (PACQLQ) total scores correlated (r = 0.61, p<0.001), although the children's median emotional score of 6.3 was higher than their parents' 5.7 (p<0.001), whereas median activity limitation score was lower than their parents': 5.0 and 6.8, respectively (p<0.001). No correlation was found with physician's clinical score or spirometry. CONCLUSIONS: Electronic PAQLQs are easy to use, providing additional insight to spirometry and physician's assessment, in routine asthma care. Future studies must assess impact on asthma management.     

Predicting children's quality of life in an asthma clinical trial: what do children's reports tell us?

OBJECTIVE: To define predictors of disease-specific quality of life (QOL) and the relationship between asthma symptoms and disease-specific QOL. STUDY DESIGN: Three hundred thirty-nine children participated at 4 of 8 Childhood Asthma Management Program clinical centers. Included in the analyses were 2 weeks of asthma symptom data, child-reported health status, and QOL scores from the Pediatric Asthma Quality of Life Questionnaire. Data were obtained 12 months after randomization into the Childhood Asthma Management Program. RESULTS: Children were rated at baseline as having "moderate" asthma (63%) and "mild" asthma (37%). QOL scores were correlated with the child-reported anxiety measures. Factor analysis of the QOL measure resulted in 2 factors. Stepwise multiple regression indicated that the strongest independent predictors of QOL were the child's anxiety level, age, sex, and a measure of the child's tendency to minimize or exaggerate symptoms. CONCLUSIONS: Children had few asthma symptoms in the 2 weeks before their 12-month follow-up clinic visit and a generally positive QOL, suggesting that mild-to-moderate asthma does not significantly impair QOL. A child's QOL was predicted primarily by their level of anxiety.     

Critical comparison of some questionnaires for the evaluation of the quality of life in children affected by asthma

AIM: The aim of this study was to critically compare 9 different questionnaires for the evaluation of the Quality of Life in children affected by asthma. METHODS: The questionnaires were analyzed by considering their psychometric characteristics (reliability, validity, responsiveness, least clinically relevant difference), together with other practical and technical aspects (number of items, number and kind of domains, scaling of items, scoring, time to complete). Data were obtained from the scientific literature. RESULTS: Only 1 of the 9 analyzed questionnaires (Pediatric Asthma Quality of Life Questionnaire, PAQLQ) appears fully validated from a psychometrical standpoint. Moreover, it is the only one to have a validate translation into the Italian language. CONCLUSIONS: The authors suggest the use of the PAQLQ as tool of choice in the evaluation of the Quality of Life in children affected by asthma.     

哮喘儿童气质及哮喘危险因素的研究

目的：哮喘被认为是一种典型的心身疾病。为了探讨儿童的哮喘与气质和其他危险因素之间的关系,更好地开展对哮喘高危儿童的疾病监测和干预,该文对哮喘儿童气质及危险因素进行了研究。方法：采用Carry气质量表,通过病例对照研究方法, 调查了南京地区106例哮喘儿童和106例正常儿童的气质类型、维度和哮喘危险因素。结果：哮喘组与对照组相比,气质适应性、心境、持久性分值较高;哮喘儿童中气质类型,平易型少,中间偏烦型多,差别均有统计意义。同时多因素分析,3～7岁期间每年患感冒次数、过敏史、特应性体质、父母哮喘史、家庭装修及气质心境、持久性与儿童哮喘有关。结论：应该把中间偏烦型气质的儿童作为重点对象,并结合其他危险因素对哮喘儿童进行早期干预和管理。［中国当代儿科杂志,2007,9（5）：411-414］     

Bronchoalveolar lavage in asthmatic children: Evidence of neutrophil activation in mild-to-moderate persistent asthma

Little information is available on cell profiles and mediator production in the lower airways of children with asthma by comparison with the adult population. To study the bronchoalveolar lavage (BAL) cell profiles and production of eosinophil cationic protein (ECP) and myeloperoxidase (MPO) in childhood bronchial asthma, a retrospective study was performed in 29 children (13 allergic asthmatic children and 16 controls). Six of the asthmatics had mild-to-moderate persistent disease and seven had intermittent asthma. The BAL cell count and ECP and MPO values of asthmatic children were compared with those from 16 controls. The asthmatic patients had higher values than controls for the total cell count (p=0.08), for neutrophils (p=0.02), and for ECP and MPO (p<0.001). MPO levels (p=0.04), neutrophil count (p=0.06), and ECP values (p=0.06) were higher in patients with mild-to-moderate persistent asthma than in those with intermittent asthma. Our results demonstrate that neutrophil-mediated inflammation is greater in patients with more severe asthma.     

Asthma in patients with atopic dermatitis

Objective  This cross-sectional study was designed to estimate the frequency of asthma in patients with atopic dermatitis (AD), and its related factors. Methods  The study population consisted of 236 patients with AD who were referred to Children Medical Center in 1997–2002 and their diagnosis was based on Hanifin & Rajka criteria. Severity of AD was categorized based on Severity Scoring of Atopic Dermatitis (SCORAD) index. Asthma was diagnosed with medical history and clinical examination (three or more episodes of wheezing and/or dyspnea and/or cough after 1 year old). The patients were divided in two groups according to having or not having asthma. Results  The mean age of patients with AD was 38.67±2.68 month and the mean age at onset of asthma was 20±2.5 month. The frequency of asthma in AD patients was 27.5%. The mean of SCORAD in nonasthmatic patients was 52.27 ± 2.52 and in asthmatic patients was 56.2± 4.2 (P= 0.4). The mean of duration of breastfeeding in asthmatic patients was 12.2±1.6 month and in non-asthmatic patients was 11.16±6.3 month (P = 0.87). There was no significant difference between asthmatic patients and others in serum IgE levels (P = 0.65) and blood eosinophil count. (P = 0.49) Conclusion  These results confirmed that development of asthma in patients with AD is more than normal population and AD can be a significant predisposing factor to developing asthma but the causative factors are not clear.     

The Paediatric Asthma Caregiver's Quality of Life Questionnaire in Swedish parents

With the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), parents grade impaired activities (5 items) and emotional concern (8 items) from 1 to 7 regarding how much their own quality of life (QoL) has been affected by the disease of their child during the last week. The questionnaire was translated into Swedish. To test the feasibility and validity of the Swedish version, 71 asthmatic children and their families were approached. Sixty-one families (86%) participated. The mean age of the children was 8.7 y. Parental grading of symptoms (Spearman's rho = 0.637, p < 0.001), the asthma-specific QoL of the child (rho = 0.359, p = 0.002) and gradings of asthma from medical records (mild asthma median score 6.69, moderate 6.27 and severe 5.12, p = 0.001) were all related to overall PACQLQ scores. The sex of the child, the presence of other diseases related to allergy, peak flow rate (PEFR) and socio-economic level did not affect the scores. Lower scores in the emotional domain were seen in parents of children on steroids (p = 0.049). The distribution of scores was heavily skewed towards the positive end of the scale, leading to limited power to discriminate among parents of children with mild asthma. The instrument had good internal consistency and was well accepted by the parents.     

Mannose-binding lectin levels in children with asthma

Mannose-binding lectin (mbl), one of the important components of innate immunity, can activate the lectin pathway of the complement system. After binding mannose containing carbohydrate structures of foreign antigen, mbl initiates and regulates the inflammatory responses. Asthma is a complex inflammatory disease of the lung involving many components of the immune system. Our objective was to investigate the serum mbl levels of asthmatic children in comparison with healthy controls. Serum mbl levels were determined by nephelometric assay in 72 asthmatic children (5-15 yr old) and 30 healthy age-matched controls. Mbl levels of asthmatic children were measured both during acute attack and after complete remission. There was no significant difference between the mbl levels during acute attack (median 4.1 mg/l) or quiescence of symptoms (median 3.6 mg/l). Serum mbl levels both during acute attack or quiescence of symptoms was significantly higher in asthmatic children than in the healthy controls (median 2.8 mg/l, p < 0.0001 for each). Furthermore, mbl levels of asthmatic children positively correlated with peripheral blood eosinophils (r = 0.377, p < 0.001), which is a systemic component of airway inflammation in asthma. Our findings indicate that mbl may be implicated in the pathogenesis of asthma by contributing to airway inflammation or by increasing the risk of developing asthma.     

Is there any relationship between asthma and asthma attack in children and atypical bacterial infections; Chlamydia pneumoniae, Mycoplasma pneumoniae and Helicobacter pylori

Asthma is a chronic inflammatory airway disease characterized by variable airway obstruction and bronchial hyperresponsiveness. There are many factors affecting the development and severity of childhood asthma such as genetic predisposition, atopy, environmental factors, obesity, diet, socioeconomic status, and infectious triggers. In the present study we aimed to investigate the frequency of Mycdoplasma pneumoniae, Chlamydia pneumoniae, and Helicobacter pylori infections in asthmatic children. We investigated also whether there is a relationship between these agents and asthma attacks. MATERIAL AND METHODS: Seventy-nine asthmatic children (46 males, aged 5-15 years) were included in study. The study group was divided into two groups: group 1 consisted of 37 children with asthma attacks and group 2 consisted of 42 children with stable asthma. As a control group we studied 36 healthy children. Pulmonary function tests, skin prick tests for common allergens were performed; serum total IgE, phadiatop, specific IgM and IgG antibody levels (ELISA) for M. pneumoniae, C. pneumoniae and H. pylori were measured in all patients. RESULTS: Mycoplasma IgM and Chlamidia IgM were positive in 8.1% (3 patients) and 18.9% (7 patients) of group 1 patients, respectively. There was a statistically significant difference for Mycoplasma IgM (p = 0.031) and Chlamidia IgM (p = 0.03) between group1 and other two groups. We have not found significant difference for M. pneumoniae IgG, C. pneumoniae IgG and H. pylori IgM and IgG among groups. CONCLUSION: M. Pneumoniae and C. Pneumoniae may play a role in development of asthma exacerbations in childhood. We could not find a relationship between H. Pylori and asthma.     

An Examination of Factors Affecting Quality of Life for Children With Asthma and Their Caregivers in Southeastern Georgia

IntroductionDespite effective treatments and interventions, asthma continues to affect children's health-related quality of life (QOL). This study explored factors affecting QOL of children with asthma and their caregivers.MethodsA mixed-model design was used. Children (7–17 years) completed the Paediatric Asthma Quality of Life Questionnaire, and parents/caregivers completed the Paediatric Asthma Caregiver's Quality of Life Questionnaire. These surveys focused on activity limitations, emotional function, and child symptoms.ResultsThe sample included 104 children and 104 caregivers. Analysis showed emergency department (ED) visits as a significant predictor of QOL for children in the domains of Physical Activity, Emotional, and Symptoms. Increased ED visits and reliever medication use predicted lower emotional QOL and physical QOL for parents, whereas increased use of controller medications predicated improved physical QOL.DiscussionFactors contributing to QOL, along with characteristics of those with the lowest QOL indicators, have been determined. Identification of interventions to reduce ED visits warrants further investigation.     

Indoor environmental risk factors and seasonal variation of childhood asthma

Seasonality of asthma may result from varying exposures. This cross‐sectional study was designed to examine the relationship between indoor environmental factors and seasonal childhood asthma. Study subjects were participants from the International Study of Asthma and Allergies in Childhood (ISAAC) in 2004, a population‐based surveillance, which included school children aged 6–15 yr in south Taiwan. Cases included 1725 children who experienced asthma symptoms in the past 12 months and the references consisted of 19,646 children who reportedly have no asthma history. By using a moving average and principal component analysis, asthmatic children were grouped into four asthma subtypes: winter, spring, summer/fall, and perennial. Multivariate logistic regression was used to evaluate the effect of indoor environmental factors on seasonality of childhood asthma. For all asthma prevalence, a peak occurred in the winter and a nadir appeared in summer. Contributing factors of asthma for children, regardless of seasonality, included younger age, parental atopy, maternal smoking during pregnancy, breast feeding, and perceived air pollution. After adjusted for salient risk factors, water damage was significantly associated with all subtypes of asthma. Presence of cockroaches was related to the summer/fall asthma (adjusted odds ratio [aOR] = 1.65, 95% confidence interval [CI] = 1.12–2.55). Visible mold on the walls was associated with an increased occurrence of winter and spring asthma (aOR = 1.53, 95% CI = 1.26–1.85 and aOR = 1.34, 95% CI = 1.10–1.62, respectively). Passive smoking was shown to be related to spring and summer/fall asthma. Water damage is a possible risk for childhood asthma year‐round. Cockroaches and visible mold on the walls may play essential roles for seasonality of childhood asthma in Taiwan. Plausible mechanisms and allergic effects should be further determined. Elimination of these allergens is necessary to help prevent the development of asthma.     

Stress and Quality of Life in Caregivers of Inner-City Minority Children With Poorly Controlled Asthma

IntroductionCaregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL.MethodData were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL.ResultsChildren (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL.DiscussionFindings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.     

212例儿童哮喘预后的5年随访研究

目的：探讨儿童哮喘转归和影响发病与预后的因素。方法：对随访5年以上的212例哮喘儿童资料进行回顾性分析。 结果：5年随访中,哮喘停止发作121例（57.1%）,哮喘持续91例（42.9%）。哮喘急性发作的主要诱因为呼吸道感染（71.7%）,其次是过敏原吸入（17.0%）。由呼吸道感染诱发的哮喘患儿（61.2%）较由过敏原（41.7%)或运动（26.3%）诱发者缓解率高（P＜0.05）。湿疹合并过敏性鼻炎、父母哮喘、过敏原诱发的喘息是发展成持续性哮喘的3个危险因素。结论：5年以上的随访中大部分哮喘患儿停止发作。呼吸道感染是儿童哮喘急性发作的主要诱因。由呼吸道感染诱发的哮喘转归较好。特应质及有特应质遗传背景的患儿更有可能发展成持续性哮喘。     

The effects of NOS1 gene on asthma and total IgE levels in Taiwanese children,and the interactions with environmental factors

Wang T‐N, Tseng H‐I, Kao C‐C, Chu Y‐T, Chen W‐Y, Wu P‐F, Lee C‐H, Ko Y‐C. The effects of NOS1 gene on asthma and total IgE levels in Taiwanese children, and the interactions with environmental factors.
Pediatr Allergy Immunol 2010: 21: 1064–1071.
© 2010 John Wiley & Sons A/S Asthma is a complex disorder, which is known to be affected by interactions between genetic and environmental factors. The aim of this study was to investigate the three microsatellite polymorphisms of GT repeats in intron 2, AAT repeats in intron 20, and CA repeats in exon 29 of the NOS1 gene in 155 asthmatic children and 301 control children, and the interaction with environmental factors in southern Taiwan. Total serum IgE, phadiatop test and genetic polymorphisms were measured. The genotype frequency of 14/14‐AAT repeats of the NOS1 gene was significantly higher in the asthmatic group (p = 0.01). Total IgE concentrations were higher in asthmatic children (p = 0.015) carrying the NOS1 14/14‐AAT genotype than in subjects with other polymorphisms. The gene and environmental interaction effects were 3.83‐fold, 6.86‐fold, and 8.04‐fold (all corrected p‐values <0.001) between subjects carrying at least one NOS1 14‐AAT allele and exposure to cockroaches, high levels of total IgE, and positive response against the phadiatop test in asthmatic children. The findings of this study provide strong evidence that NOS1 gene with 14‐AAT tandem repeats has a significant effect in asthmatic children. Environmental factors and atopic status will enhance the asthmatic risk for children who carry NOS1 susceptible allele.