Factors in infancy and childhood related to reduced lung function in asthmatic children: A birth cohort study (BAMSE)

Changes in lung function due to childhood asthma have been reported to occur before school age, and to persist throughout life. The aim was to assess the relationship between aspects of lung function and asthma over time in 4,089 children participating in the large population‐based birth cohort BAMSE. Questionnaires were administered at 1, 2, 4, and 8 years of age. At 4 and 8 years, children were invited to a clinical examination, in which 2,965 and 2,630 children participated, respectively. The examinations included blood sampling for evaluation of sensitization to airway allergens (n = 2,053), peak expiratory flow (PEF) measurements at 4 and 8 years (n = 1,957), and forced expiratory flows (n = 2,455) at 8 years. Asthma onset before the age of 4 years, but no thereafter, was at 8 years associated with impaired spirometric flows. This was seen irrespective of symptom presence after the age of 4. Reduced PEF growth between the age of 4 and 8 was seen only for the group of children with early onset transient asthma, while an association between sensitization and lung function was only seen in the late‐onset asthma group. In conclusion, school children with asthma have reductions of spirometric flows when categorized as persistent or transient early onset asthma, even if this latter group of children is completely symptom‐free at school age. Pediatr Pulmonol. 2010; 45:341–348. © 2010 Wiley‐Liss, Inc.     

Childhood asthma

Asthma is the most common chronic disease of childhood. Despite increasing evidence indicating that genetic and environmental factors have significant effects on airway development and function in early life, our understanding of the natural history of the disease is limited. The development of objective outcome measures will enable us to distinguish between children with transient early wheeze and those who will progress to persistent asthma, and to investigate factors affecting airway function throughout early childhood. A thorough knowledge of lung physiology in early life and its relationship with environmental exposures and prior or subsequent development of asthma would have a profound effect on our understanding of the natural history of asthma and the design of future strategies for disease prevention.     

Risk factors for childhood asthma in Costa Rica

BACKGROUND: Little is known about factors determining the pathogenesis and severity of asthma in Latin American countries. Costa Rica, one of the most prosperous Latin American nations, has a very high asthma prevalence. OBJECTIVE: To examine the relation between potential risk factors and childhood asthma in Costa Rica. METHODS: Cross-sectional study of 214 schoolchildren aged 10 to 13 years participating in phase II of the International Study of Asthma and Allergies in Childhood. RESULTS: After adjustment for age, gender, area of residence, maternal smoking during pregnancy, and airway responsiveness to hypertonic saline solution, sensitization to house dust mites was associated with asthma (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1 to 4.4; p = 0.02). In the multivariate analysis, parental education no higher than high school (OR, 3.0; 95% CI, 1.4 to 6.4; p < 0.01) and parental history of asthma (OR, 2.6; 95% CI, 1.3 to 5.2; p < 0.01) were also independent predictors of childhood asthma. CONCLUSIONS: Sensitization to house dust mites, low parental education, and parental history of asthma are associated with asthma in Costa Rica.     

Japanese Guideline for Childhood Asthma

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2010 (JAGL 2010) describes childhood asthma based on the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2008 (JPGL 2008) published by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2010 provides information on diagnosis by age groups from infancy to puberty, treatment for acute exacerbations, long-term management by medication, daily life guidance, and patient education to allow physicians, not specialized in childhood asthma, to refer to this guideline for routine medical treatment.JAGL differs from the Global Initiative for Asthma Guideline (GINA) in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at < 2 years and 2–5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents.     

Management of asthma in children in low-income countries.

Asthma is a common disease in children living in low-income countries. Asthma is diagnosed in children, especially those aged over 2 years, who have wheezing episodes that improve after a bronchodilator is given (bronchodilator response test). Children are classified as having either intermittent or persistent asthma and treated according to the severity of the disease with either an inhaled bronchodilator (reliever) or a combination of an inhaled bronchodilator and inhaled corticosteroid (controller). Treatment is best given by inhalation, and as children under 5 years cannot coordinate their breathing with the multidose inhaler, spacers are required. These can be made locally from plastic bottles. Care givers need to be educated about how to manage asthma and should receive a written management plan on the management of the child's asthma. Children should be examined to see if they are allergic to especially airborne allergens, and if these are present they should be removed from the environment. Adult smoking worsens childhood asthma, and care givers need to be given support with smoking cessation. Regular planned follow-up is needed to ensure that the asthma is well controlled and the lowest dose of inhaled corticosteroid is used. Inhaled bronchodilators and corticosteroids must become freely available and should be inexpensive in low-income countries in order to treat childhood asthma correctly.     

Abstracts

Objective. To examine the prevalence and natural course of asthma from childhood to adolescence in a population-based, Greek birth cohort and to identify associated factors. Methods. Longitudinal information on asthma symptoms, physician diagnosed and treated, was available for 2133 children at 7 and 18 years of age. Results. The prevalence of current asthma was 9.0% and 5.0% at 7 and 18 years, respectively. The prevalence of lifetime asthma was 26.3% at 18 years. More than half of the children (58.2%) with early onset asthma were asymptomatic at 7 years and only 7.6% continued to have symptoms during adolescence. However, in 48.2% of those with late onset asthma, symptoms persisted up to 18 years. Logistic regression analyses showed that male gender, family history of atopy, active adolescent smoking and maternal smoking were significantly positively associated with lifetime asthma at 18 years. In addition, smoking during pregnancy was associated with an increased risk for persistence of asthma symptoms at 18 years. Asthma during childhood and active adolescent smoking were positively associated, and daily consumption of fruit and vegetables was negatively associated with current asthma at 18 years of age. Finally, children who were breastfed had a lower risk for lifetime asthma at 7 years. Conclusion. The prevalence of asthma symptoms at 7 and 18 years of age was low throughout Greece. Our results suggest that, among others, nutrition is an important correlate of asthma in Greek children.     

Associations of Age,Gender, and BMI with Prevalence of Allergic Diseases in Children: PATCH Study

Background. Little is known about the prevalence of allergic diseases in children of different ages. This study aimed to investigate the prevalence of allergic diseases and allergic sensitization in children over a wide age range, with emphasis on the influence of age, gender, and body mass index (BMI). Methods. In a cross-sectional study, we assessed 5351 Taiwanese children aged 4–18 years using an International Study of Asthma and Allergies in Childhood questionnaire, BMI, and total and specific serum immunoglobulin E. Results. Forty-eight percent were currently symptomatic for at least one of three allergic diseases. Prevalence of wheeze ever, current wheeze, and diagnosed asthma were 17.0%, 7.5%, and 9.8%, respectively; analogous features for rhinitis were 47.8%, 44.2%, and 39.8%. Allergic sensitization was very common (57.3%). Half of the children (50.6%) with current wheeze had not been diagnosed with asthma by physicians, whereas undiagnosed rates were 32.3% for rhinitis and 25.3% for eczema. The male-to-female prevalence ratios of current wheeze increased with age from <1 at 4–5 years, peaked at 10–11 years (2.24), then reversed to 0.57 at 16–18 years. Childhood wheezing tended to remit with age, but rhinitis and eczema were more persistent. Total immunoglobulin E levels increased with age until 14–15 years, and declined thereafter. Elevated BMI was associated with greater prevalence of wheezing and eczema, with no evidence of significant effect modification by either gender or age. Multivariate analyses revealed that younger age, boys, and obesity were significantly and independently associated with current wheezing in children (all p < .01). Conclusions. The burden and co-morbidity of childhood allergies are substantial. There are striking age-dependent gender differences in asthma prevalence, exhibiting an inverted U-shaped curve for male-to-female prevalence ratios by age. Obesity is associated with a greater prevalence of asthma in children with no evidence of a significant modulation by either gender or age.     

Early life events in asthma--diet

It has been hypothesized that the recent increase in the prevalence of asthma may, in part, be a consequence of changing diet. There is now increasing interest in the possibility that childhood asthma may be influenced by maternal diet during pregnancy and/or diet during early childhood. A number of observational studies and a childhood fish oil supplementation study provide little support for the notion that early childhood intake of polyunsaturated fatty acids (PUFAs) influence the development of childhood asthma. Recent work however, suggests that supplementation of maternal diet with fish oil is associated with altered neonatal immune responses to allergens. Further work is required to establish whether this immunological observation is translated into clinical outcomes. Two birth cohorts have now reported reduced maternal intake of vitamin E, zinc and vitamin D during pregnancy to be associated with increased asthma and wheezing outcomes in children up to the age of 5 years. Early life diet could modulate the likelihood of childhood asthma by affecting fetal airway development and/or influencing the initial early life interactions between allergens and the immune system. In animal models, vitamin E, zinc and vitamin D have been shown to modify fetal lung development and vitamin E, zinc, vitamin D and PUFA can modulate T-cell responses. Further research, particularly, early life intervention studies need to be carried out to establish whether early life dietary intervention can be used as a public health measure to reduce the prevalence of childhood asthma.     

Japanese guidelines for childhood asthma 2017

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0–15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at <2 years or 2–5 years of age. The first choice of treatment depends on the severity and frequency of symptoms. Pharmacological management, including step-up or step-down of drugs used for long-term management based on the status of asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists).     

Conference scene: Parasites to treat immune-mediated diseases?

A growing number of childhood diseases, such as allergic disorders (e.g., allergic rhinitis, atopic dermatitis and asthma) and other immune-mediated diseases (e.g., Type 1 diabetes), have been linked to environmental exposures during prenatal and early postnatal life, along with genetic determinants. Immunological mechanisms, diagnosis, treatment, prevention and management of allergies and other immune-mediated diseases were discussed at the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology in Orlando, FL, USA, 2-6 March 2012.     

The prevalence of asthma and related symptoms in Middle East countries

Objectives

Asthma is a chronic inflammatory airway disease characterized by reversible airway constriction and airway hyperresponsiveness. Asthma is a worldwide problem and its prevalence varies among different parts of the world. There are insufficient data about the prevalence and risk factors of this disease in Middle East countries.

Data source

The objective of this review article was to determine the prevalence of asthma in Middle East countries by searching EMBASE, Medline, Web of Science and Google Scholar for articles about asthma prevalence in children and adults in this region.

Study selection

The prevalence of asthma in different countries and different cities of each country in the Middle East was reviewed in children and adults of both sexes. The possible risk factors for asthma in different areas were also reviewed from 1985 to 2012.

Results

The highest asthma prevalence in children and adults was 35.4% in Tehran, Iran by ISAAC phase I and 15% in Kuwait by self‐designed questionnaire and the lowest prevalence was 1% in Kermanshah, Iran by ISAAC and 2% in Tehran, Iran by ECRHS questionnaire, respectively. Most studies showed that the prevalence of this common disease declines with increasing age.

Conclusion

The data showed that the prevalence of asthma varies among different countries and even among different cities of the same country. The common risk factors for this disease were genetic predisposition, cigarette smoking, family history of asthma and allergic diseases.     

The prevalence of asthma and wheezing illnesses amongst 10-year-old schoolchildren

Asthma and wheezing illnesses carry a significant burden of disease during childhood. Prevalence studies have the capacity to provide invaluable insights into the nature of these common conditions. As part of the Isle of Wight Whole Population Birth Cohort Study (n=1456) we have examined wheezing and asthma development amongst 10-year-old children. At this age 1373 children completed ISAAC written questionnaires whilst 1043 children performed further testing including skin-prick testing, serum inhalant IgE antibody screening, spirometry and bronchial challenge. At 10-years, prevalence of current wheeze was 18.9%, current asthma (symptomatic bronchial hyper-responsiveness--BHR) 14.4% and currently diagnosed asthma (current wheeze and asthma ever--CDA) 13.0%. Both wheezing and asthma at 10 years were associated with average symptom onset at 3 years of age indicating an early life origin for such conditions. Current wheeze (P=0.011) and CDA (P=0.008) showed significant male predominance.Considerable disease morbidity was identified for these states that tended to be greatest amongst children defined asthmatic rather than simply current wheezers.Wheezing and asthma were significantly associated with both atopy (P<0.001) and allergic co-morbidity Children with these states, particularly current asthma, also demonstrated impaired lung function (FEV1, P<0.001 and FEV1/FVC, P=0.010) and increased BHR (inverse slope, P<0.001). In conclusion, Asthma and wheezing showed substantial prevalence at 10 years of age. Strong associations to male gender, atopy, impaired lung function and BHR were seen for both wheeze and asthma. In regard to prevalence and morbidity characteristics, a questionnaire-based definition of currently diagnosed asthma gave similar results to the use of symptomatic BHR in defining current asthma.     

Prevalence of Childhood Asthma and Associated Morbidity in Los Angeles County: Impacts of Race/Ethnicity and Income

Racial/ethnic and socioeconomic disparities in the prevalence of childhood asthma have been reported nationally but few population-based studies in local and regional settings have been reported. To assess variation in the prevalence of childhood asthma and associated morbidity across race/ethnic and income groups in the Los Angeles County population, we analyzed data on a random sample of 6004 children (≤17 years old) enrolled in a countywide health survey from 09 1999 through 04 2000. The prevalence of childhood asthma was highest in blacks (15.8%), intermediate in whites (7.3%) and Asians (6.0%), and lowest in Latinos (3.9%; p<0.001). These differences persisted after controlling for income, measures of health care access, and other covariates. Asthma prevalence was inversely related to income in all racial/ethnic groups except Latinos from Spanish-speaking households. Among children with asthma, blacks and Latinos were more likely than whites to report asthma-related limitations in physical activity and need for urgent medical services. These findings indicate marked disparities in asthma prevalence and related morbidity in this large urban child population and highlight the importance of efforts to identify high-risk subpopulations for focused prevention and treatment interventions.     

Besonderheiten des kindlichen Asthmas

Asthma is the most commonly observed chronic disease in childhood and the incidence has been increasing in industrialized countries over the last decades. Airway obstruction due to increased sensitivity of the small airways, mucus production and chronic inflammation are key features in the pathophysiology of asthma. Environmental and genetic factors predispose for the disease, which is clinically characterized by sudden occurrence of episodes of expiratory airway obstruction (wheezing). In the majority of preschool infants such obstructive episodes are triggered by viral infections (especially during the winter season) and do not necessarily predispose for asthma later in adulthood. Patient and family history (e.g. atopy), good clinical examination and differential diagnosis (e.g. exclusion of cystic fibrosis) are of prime importance as the role of lung function measurements is limited as the disease frequently occurs before the age of 5 years. Information about asthma is important for children, parents and caregivers. Acute and chronic medication should control asthma symptoms and allow the affected child to lead a normal life including physical exercise.     

Asthma in children - is it different?

Asthma is the most commonly observed chronic disease in childhood and the incidence has been increasing in industrialized countries over the last decades. Airway obstruction due to increased sensitivity of the small airways, mucus production and chronic inflammation are key features in the pathophysiology of asthma. Environmental and genetic factors predispose for the disease, which is clinically characterized by sudden occurrence of episodes of expiratory airway obstruction (wheezing). In the majority of preschool infants such obstructive episodes are triggered by viral infections (especially during the winter season) and do not necessarily predispose for asthma later in adulthood. Patient and family history (e.g. atopy), good clinical examination and differential diagnosis (e.g. exclusion of cystic fibrosis) are of prime importance as the role of lung function measurements is limited as the disease frequently occurs before the age of 5 years. Information about asthma is important for children, parents and caregivers. Acute and chronic medication should control asthma symptoms and allow the affected child to lead a normal life including physical exercise.     

Helicobacter pylori colonization is inversely associated with childhood asthma

BACKGROUND: Asthma, a serious health problem worldwide, is becoming more common. Colonization with Helicobacter pylori, a major human indigenous (commensal) microbe, during early life may be relevant to the risk of childhood asthma. METHODS: We conducted cross-sectional analyses, using data from 7412 participants in the National Health and Nutrition Examination Survey (NHANES) 1999-2000, to assess the association between H. pylori and childhood asthma. RESULTS: H. pylori seropositivity was inversely associated with onset of asthma before 5 years of age and current asthma in children aged 3-13 years. Among participants 3-19 years of age, the presence of H. pylori was inversely related to ever having had asthma (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.45-1.06), and the inverse association with onset of asthma before 5 years of age was stronger (OR, 0.58; 95% CI, 0.38-0.88). Among participants 3-13 years of age, H. pylori positivity was significantly inversely associated with current asthma (OR, 0.41; 95% CI, 0.24-0.69). H. pylori seropositivity also was inversely related to recent wheezing, allergic rhinitis, and dermatitis, eczema, or rash. CONCLUSIONS: This study is the first to report an inverse association between H. pylori seropositivity and asthma in children. The findings indicate new directions for research and asthma prevention.     

Mental,Emotional, and Social Problems Among School Children with Asthma

Objectives: To use representative population chronic disease and risk factor data to investigate the relationship between asthma and social factors in school-age children. Methods: Representative cross-sectional data for children 5 to 15 years of age were collected from 2002 to June 2007 (n = 4,611) in the South Australian Monitoring and Surveillance System (SAMSS) using Computer-Assisted Telephone Interviews (CATI). Univariate and multivariate analyses were conducted to investigate the variables that were associated with asthma among children. Results: The overall prevalence of self-reported asthma among children 5 to 15 years of age was 18.6% (95% CI = 17.5–19.8). Children with asthma were more likely to have been treated for a mental health problem, have been unhappy at school, have been absent from school in the last month, have fair or poor overall health and well-being, have ongoing pain or chronic illness, and less likely to have a group of friends to play with. Asthma was also more prevalent among males and less likely to occur in children from households where the gross annual income was greater than $AU80,000. Conclusions: Children with asthma were more likely to be treated for a mental health problem and demonstrate more negative social outcomes as well as poorer overall health and well-being. Asthma management plans need to be sensitive to these psychosocial factors for adequate care of these vulnerable young patients.     

Bronchial hyperresponsiveness in childhood: A narrative review

Bronchial hyperresponsiveness (BHR) is an important but not asthma-specific characteristic and can be assessed by direct and indirect methods, based on the stimulus causing airway obstruction. BHR has been proposed as a prognostic marker of asthma severity and persistence, and may also be used to control pharmacological management of asthma. The most recent data on the prevalence and development of BHR in childhood and its predictive value for subsequent asthma development in late adolescence and adulthood is discussed in this review. According to the BHR-related scientific articles written in the English language and indexed in the publicly searchable PubMed database, the prevalence of BHR varies based upon the methods used to assess it and the population examined. In general, however, BHR prevalence is reduced as children grow older, in both healthy and asthmatic populations. While asthma can be predicted by BHR, the predictive value is limited. Reduced lung function, allergic sensitization, female sex, and early respiratory illness have been identified as risk factors for BHR. The collective studies further indicate that BHR is a dynamic feature related to asthma, but asymptomatic BHR is also common. Ultimately, the prevalence of BHR varies depending on the population, the environment, and the evaluation methods used. While both the methacholine challenge and the exercise test may predict asthma in adolescence or early adulthood, the predictive value is higher for the methacholine challenge compared to the exercise test. The collective data presented in the present study demonstrate how BHR develops through childhood and its relation to bronchial asthma.