Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial

ABSTRACT

We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24–32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p?=?0.029) and higher median percentage of condom use for anal intercourse (p?=?0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p?=?0.001), popper usage (p?=?0.002), median number of sexual partners (p?=?0.003), and increased median condom use percentage (p?=?0.006). Our study highlights that “Vialogues” intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.     

Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

Objective: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). Methods: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. Results: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p?=?0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p?=?0.02). Conclusion: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.     

The effect of parental social support and acculturation on childhood asthma control

Objective: There exists large ethnic disparities in asthma among Latino children; Puerto Ricans (PRs) are disproportionately affected, while Mexicans have the lowest prevalence and morbidity. Disparities are poorly understood, however, acculturation and social support are suggested to influence asthma control among children. This study investigated the relationship between acculturation, social support and asthma control among PR and Mexican children and their caregivers. Methods: Primary caregiver-child dyads (n?=?267) of PR (n?=?79) and Mexican (n?=?188) descent were recruited from clinics at two inner-city hospitals in Bronx, NY and three clinics in Phoenix, AZ. Children were 5–12 years of age and had a confirmed asthma diagnosis. Dyads completed measures of social support, acculturation and asthma control; logistic regression was used for analysis. Results: Mexican children had better asthma control than PR children (p?<?0.001). PR caregivers were more acculturated than Mexican caregivers (p?<?0.05); however, acculturation did not predict control. Across Latino subgroups caregivers’ total level of social support predicted better asthma control among children (p?<?0.05), and support received from family and friends each independently predicted better control (p?<?0.05). Conclusions: Results suggest that social support reduces some of the burden associated with asthma management enabling caretakers to better control their children’s asthma.     

Environmental exposures and family history of asthma

Background: Asthma pathogenesis is a complex interaction of genetic, ethnic, environmental and social/life style risk factors. Aim: The goal of this study was to identify associations, if any, in children with asthma, between environmental risk factors (exposure to second-hand tobacco smoke (STS), pet ownership, race and a family history of asthma. Methods: After IRB approval, from June 2011 to December 2014, 823 children with asthma were enrolled in this prospective cross sectional study. At the initial visit, families completed a questionnaire with information on family history of asthma, having a pet at home and exposure to STS by parents at home. Chi square analyses were calculated, with alpha level of significance ≤0.05. Results: History of asthma in parents, siblings or grandparents was reported by 575 (69.8%) patients including father (n?=?154, 17.8%) and mother (n?=?235, 26.5%). Children with family history of asthma (n?=?575) were significantly more likely to have a pet at home and exposure to STS (n?=?347, 60.3% and n?=?198, 34.4%, respectively) compared to families without a history of asthma (n?=?124, 50%, p?=?0.006 and n?=?44, 17.7%, p?<?0.001, respectively). Similarly, asthmatic children with exposure to STS (n?=?241) were significantly more likely to have a pet at home and a family history of asthma (n?=?153, 63.5% and n?=?197, 81.7%, respectively) compared to children with no STS exposure (n?=?315, 55.5%, p?=?0.034 and n?=?371, 65.3%, p?<?0.001 respectively). Conclusions: Significantly more asthmatic children with immediate relatives with a history of asthma have a pet at home and experience STS exposure compared to children without relatives with a history of asthma, suggesting association between life style choices/environmental exposures and family history of asthma.     

Associations between asthma trigger reports,mental health conditions,and asthma morbidity among world trade center rescue and recovery workers

Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r²=0.05, p?<?0.01), physical activity (partial r²=0.03, p?<?0.01) and air pollution (partial r²=0.02, p?=?0.04) subscales while PD was significantly associated with air pollution (partial r²=0.03, p?=?0.03) and general allergens (partial r²=0.02, p?=?0.03). ATI subscales explained a large percentage of variance in asthma control (r²=0.37, p?<?0.01) and quality of life scores (r²=0.40, p?<?0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r²= 0.11, p?=?0.72) and AQLQ (partial r²=0.14, p?=?0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.     

Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States – results from two national surveys

Abstract

Objective: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States. Methods: We used 2008–2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008–2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population. Results: Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%–7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%–18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR]?=?1.5 [1.1–2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR?=?1.6 [1.3–1.9]), smoking (aPR?=?1.4 [1.1–1.9]) and being female (aPR?=?1.9 [1.5–2.4]). Conclusion: Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research.     

Racial and Ethnic Differences in the Management of Childhood Asthma in the United States

Objectives. We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices. Methods. Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities). Results. African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child’s asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments. Conclusions. This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.     

Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics

Aim: To examine the relationship between body mass index (BMI) and different indicators of asthma severity in a large community-based sample of Danish adolescents and adults.

Methods: A total of 1186 subjects, 14–44 years of age, who in a screening questionnaire had reported a history of airway symptoms suggestive of asthma and/or allergy, or who were taking any medication for these conditions were clinically examined. All participants were interviewed about respiratory symptoms and furthermore height and weight, skin test reactivity, lung function, and airway responsiveness were measured.

Results: A total of 516 individuals had asthma. The mean BMI was 24.9?kg/m² (SD?=?5.1). Asthma severity measured by GINA score increased with increasing BMI (p?=?0.009). The result remained significant after adjusting for age, sex, medication use for asthma and smoking (p?=?0.010). Severity of individual asthma symptoms; cough (p?=?0.002) and chest tightness (p?=?0.023) was also significantly related to BMI, whereas severity of wheezing and shortness of breath was not. Airway obstruction was more pronounced in subjects with increased BMI (p?<?0.001) but the effect disappeared after adjustment for covariates (p?=?0.233). Lung function, airway responsiveness, and atopy were not significantly related to BMI as were use of medication for asthma and adherence to treatment.

Conclusions: In adults, increased body mass index predicts severity of asthma symptoms but not objective asthma traits.     

Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders

Objective: To assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma. Methods: Children aged 2–13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. Results: Forty-one participants (mean age 5.9) were randomized to intervention (n = 21) or control (n = 20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention = 36%; control = 32%, P = 0.73). Three adherence trajectories were identified with none ever exceeding 80% adherence. Conclusions: Within a high-risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.     

Impact of a multi-trigger intervention on seasonal patterns of asthma symptoms in inner city children

Objectives: Peaks in childhood asthma symptoms and asthma morbidity occur universally in the fall and late winter/early spring. This study examines whether there is a time of the year best suited to implement environmental interventions to attenuate this pattern. Methods: From September 2006 to June 2010, mid-Atlantic inner-city children asthmatics with 1 asthma-related hospitalization (IP) or 2 emergency (ED) visits the year prior to enrollment received 5 in-home self-management education sessions which included multi-trigger avoidance techniques and supplies. Children’s daily asthma symptoms were recorded for 12 months by caregivers. Results: One-hundred and thirty-six children (48%) completed 12 months of symptoms diaries. Symptom days were reduced by 4.5 days at 12 months follow-up (p?<?0.001). Symptom severity improved with a decreased severity score of 29.0 to 7.9 at month 12 (p?<?0.001). Sixty-one percent of patients with ≥2 ED visits at baseline dropped to 0–1visits (p?<?0.001). Eighty percent of patients with ≥1 IP visits dropped to 0 visits at 12 months (p?<?0.001). Patients who received intervention in the summer months had half the average monthly symptoms score (10.8) as those who received intervention in the spring months (20.8). When controlling for environment and morbidity, the summer enrolled group had a significantly lower (p?=?0.021) symptom score than those in other seasons. Conclusion: Home self-management/environmental interventions for this cohort appear to have the greatest effect for those receiving the intervention in the summer and fall. The largest impact occurs in the summer cohort. Further studies with a control group are necessary to confirm these findings.     

Reducing Home Triggers for Asthma: The Latino Community Health Worker Approach

This study assessed the ability of a community health worker asthma intervention to change home asthma triggers. A total of 56 children and 47 adults with asthma were enrolled. Home trigger scores for the children averaged 2.8 at the initial home visit and then 2.3, 2.1, and 2.0 at 3, 6, and 12 months. Home trigger scores for the adults showed a similar trend. Every home visit was associated with a 0.32 reduction in home trigger score (p < 0.01) for children and a 0.41 reduction (p < 0.01) for adults. This intervention shows promise as a way to reduce asthma triggers in urban low-income Latino communities.     

Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life

Objective: To describe the pattern and severity of rhinitis in pregnancy and the impact rhinitis has on asthma control and quality of life (QoL) in pregnant women with asthma. Methods: Two hundred and eighteen non-smoking pregnant women with asthma were participants in a randomised controlled trial of exhaled nitric oxide guided treatment adjustment. Rhinitis was assessed using a visual analogue scale (VAS) scored from 0 to 10 and classified as current (VAS?>?2.5), moderate/severe versus mild (VAS?>?6 vs <5), atopic versus non-atopic and pregnancy rhinitis. At baseline, women completed the 20-Item Sino-Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) QoL questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Asthma control was assessed using the asthma control questionnaire (ACQ). Perinatal outcomes were collected after delivery. Results: Current rhinitis was present in 142 (65%) women including 45 (20%) women who developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p?=?0.004), SNOT20 (p?<?0.0001) and AQLQ-M (p?<?0.0001) compared to women with no rhinitis. Current rhinitis was associated with increased anxiety symptoms (p?=?0.002), rhinitis severity was associated with higher ACQ score (p?=?0.004) and atopic rhinitis was associated with poorer lung function (p?=?0.037). Rhinitis symptom severity improved significantly during gestation (p?<?0.0001). There was no impact on perinatal outcomes. Improved asthma control was associated with improvement in rhinitis. Conclusion: Rhinitis in pregnant women with asthma is common and associated with poorer asthma control, sino-nasal and asthma-specific QoL impairment and anxiety. In the context of active asthma management there was significant improvement in rhinitis symptoms and severity as pregnancy progressed.     

Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis

Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age?=?41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI?=?24.5–34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p?=?0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p?p?β?=?1.15, standard error (SE)?=?0.49, z?=?2.0, p?=?0.048), a lower body mass index(BMI) (β?=?0.14, SE?=?0.06, z?=?2.16, p?=?0.03), and a lower cardiorespiratory fitness (β?=?0.10, SE?=?0.04, z?=?2.7, p?=?0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.     

Environmental factors affecting seasonality of ambulance emergency service visits for exacerbations of asthma and COPD

Objective: The aim of this study was to assess the association of severe exacerbations of asthma and Chronic Obstructive Pulmonary Disease (COPD) requiring ambulance emergency service (AES) visits with meteorological parameters and influenza outbreaks. Methods: The records of patients calling the AES in 2007 and 2008 in the urban area of Lodz due to dyspnea were analyzed. Information on 25 daily reported meteorological parameters was obtained from the local meteorological service and data on influenza outbreaks obtained from the national surveillance service. Results: During the winter months, a significantly higher mean daily number of AES visits for both COPD and asthma were noticed when compared to the summer. Interestingly, the number of daily AES visits correlated with several weather parameters, and the multiple regression analysis confirmed a negative correlation with minimum temperature, mean temperature and the dew point for both diseases (R?=?0.526; p?<?0.01; R?=?0.577; p?<?0.01 and R?=?0.589; p?<?0.01). Furthermore, the increased number of AES visits also correlated with a new number of cases of influenza infections as reported by local influenza surveillance system (rs?=?77.6%; p?<?0.001 and rs?=?80.8%; p?<?0.001 for asthma and COPD, respectively). Conclusion: Seasonality of AES visits for asthma and COPD are similar and seems to be related to specific weather conditions and to influenza outbreaks.     

Feasibility,acceptability and preliminary effectiveness of patient advocates for improving asthma outcomes in adults

Abstract

Background: Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication. We adapted a patient advocate (PA) intervention to overcome these barriers. Objective: To conduct a pilot study to assess feasibility, acceptability and preliminary evidence of effectiveness. Methods: A prospective randomized design was employed with mixed methods evaluation. Adults with moderate or severe asthma were randomized to 16 weeks of PA or a minimal intervention (MI) comparison condition. The PA, a non-professional, modeled preparations for a medical visit, attended the visit and confirmed understanding. The PA facilitated scheduling, obtaining insurance coverage and overcoming barriers to implementing medical advice. Outcomes included electronically-monitored inhaled corticosteroid (ICS) adherence, asthma control, quality of life, FEV1, emergency department (ED) visits and hospitalizations. Mixed-effects models guided an intention-to-treat analysis. Results: 100 adults participated: age 47?±?14 years, 75% female, 71% African–American, 16% white, baseline FEV1 69%?±?18%, 36% experiencing hospitalizations and 56% ED visits for asthma in the prior year. Ninety-three subjects completed all visits; 36 of 53 PA-assigned had a PA visit. Adherence declined significantly in the control (p?=?0.001) but not significantly in the PA group (p?=?0.30). Both PA and MI groups demonstrated improved asthma control (p?=?0.01 in both) and quality of life (p?=?0.001, p?=?0.004). Hospitalizations and ED visits for asthma did not differ between groups. The observed changes over time tended to favor the PA group, but this study was underpowered to detect differences between groups. Conclusion: The PA intervention was feasible and acceptable and demonstrated potential for improving asthma control and quality of life.     

Wheezes and desert breezes: when asthma and valley fever collide

Objective: To evaluate interactive effects of pulmonary coccidioidomycosis and asthma.

Methods: We identified three groups of 33 age- and sex-matched patients: Group 1 (both asthma and coccidioidomycosis), Group 2 (asthma only), and Group 3 (pulmonary coccidioidomycosis only). Predetermined end points included: rate of disseminated coccidioidomycosis, duration of symptoms and antifungal therapy, hospitalization, death, and escalation of asthma therapies.

Results: Baseline characteristics were similar across groups. Group 1 patients had worsening asthma outcomes (except forced expiratory volume in 1?s) with coccidioidomycosis. They required more asthma medications (median, 2.0 vs 0.0; p?<?0.001), more corticosteroids (mean [SD], 0.9 [4.2] vs 0.3 [0.6]; p?<?0.001), and more healthcare visits (mean [SD], 0.2 [0.4] vs 0.1 [0.3]; p?=?0.03). Groups 1 and 3 had no differences in coccidioidal end points, including rates of dissemination (1 vs 0; p?>?0.99), symptom duration (mean, 15.2 vs 23.6 weeks; p?=?0.24), antifungal treatment (n?=?21 [63.6%] vs n?=?24 [72.7%]; p?=?0.60), and treatment duration (median, 26.5 vs 11 weeks; p?=?0.09). Ten patients in Group 1 versus none in Group 3 required systemic corticosteroids for coccidioidomycosis (p?<?0.001).

Conclusions: Active pulmonary coccidioidomycosis significantly worsens asthma outcomes. Asthma (or its treatment) does not worsen coccidioidal outcomes, despite increasing the likelihood of treatment with systemic corticosteroids.     

Types,frequency and impact of asthma triggers on patients’ lives: a quantitative study in five European countries

Objective: To identify the types, frequency and impact of asthma triggers and the relationship to asthma control among adults with asthma in Europe. Methods: Adults with self-reported physician-diagnosed asthma receiving maintenance asthma treatment and self-reported exposure to known asthma triggers completed an online questionnaire; a subset completed a diary over 3–4 weeks. Information on asthma control (Asthma Control Test? [ACT]), asthma triggers, frequency of exposure and behaviours in response or to avoid asthma triggers and the perceived impact on daily life was captured. A post-hoc analysis evaluated the impact of high trigger burden on the frequency of severe asthma exacerbations, hospitalisations and days lost at work/study. Results: A total of 1202 adults participated and 177 completed the diary. Asthma was uncontrolled for the majority (76%) of participants and most (52%) reported exposure to 6–15 asthma triggers. As trigger burden increased, behavioural changes to manage trigger exposure had a significantly increased impact on daily life (p?p?=?0.002). Participants reporting a high trigger burden (>16) were more likely to report uncontrolled asthma than those with a low trigger burden (1–5). Participants with a high trigger burden had previously experienced on average two more severe asthma attacks during a lifetime (p?p?p?Conclusions: Adults with asthma reporting a high trigger burden (>16 different triggers) experience more severe asthma attacks than those reporting lower trigger burdens.     

Urates in exhaled breath condensate as a biomarker of control in childhood asthma

Objective: The aim of this study was to (1) investigate the possibility to use urates in exhaled breath condensate (EBC) as a biomarker of airway inflammation and control in childhood asthma and (2) explore their association with other biomarkers of airway inflammation and clinical indices of asthma control (Asthma Control Test [ACT], quality of life [PAQLQ], lung function, prn beta-agonist use, time from last exacerbation [TLE]. Methods: This cross-sectional study comprised 103 consecutive patients (age 6–18 years) divided in groups of uncontrolled ([NC], n?=?53) and controlled asthma ([C], n?=?50). Measured lung function and biomarkers included: spirometry, eosinophilic cationic protein (ECP), high-sensitivity C-reactive protein (hs-CRP), exhaled NO (F_ENO), pH and urates in EBC and exhaled breath temperature (EBT). Results: Statistically significant differences were found between groups for EBC urates, EBC pH and EBT (NC versus C: EBC urates, median [IQR], µmol/L; 10 [6] versus 45 [29], p?<?0.001; EBC pH, mean [SD], 7.2 [0.17] versus 7.33 [0.16], p?=?0.002; EBT mean [SD], °C; 34.26 [0.83], versus 33.90 [0.60], p?=?0.014). EBC urates showed significant association with TLE and F_ENO (r?=?0.518, p?<?0.001; r?=?0.369, p?=?0.007, respectively) in NC, and EBC pH (r?=?0.351, p?<?0.001), FEV₁ (r?=?0.222, p?=?0.024), ACT (r?=?0.654, p?<?0.001), PAQLQ (r?=?0.686, p?<?0.001) and prn salbutamol use (r?=??0.527, p?<?0.001) in all asthmatics. Conclusion: In our study, EBC urates were found to be the best single predictor of asthma control and underlying airway inflammation. Our results provide evidence supporting the potential utility to use EBC urates as an additional non-invasive biomarker of control in childhood asthma.     

Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.     

Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids

Objective: Eosinophilic inflammation in the respiratory tract is a hallmark of bronchial asthma. In naïve cases, the inflammatory profile is associated with disease severity and reactivity to inhaled corticosteroids (ICS). Sustained airway eosinophilia has been reported during ICS treatment. However, the immunological characteristics of these cases are not known and it is unclear if this situation contributes to asthma control. This study was performed to determine the answer of these questions. Methods: To compare phenotypes of eosinophilic and non-eosinophilic asthma (EA and NEA, respectively) under ICS treatment, clinical data were obtained from asthmatic subjects (n?=?22) and healthy controls (n?=?10), and the leukocyte compositions of induced sputum and peripheral blood were determined. T lymphocyte profiles in systemic blood were assessed by flow cytometry. Results: A higher frequency of emergency room visits was observed in the NEA group, which had a higher neutrophil count relative to the total inflammatory cell population in induced sputum than the EA group (59.5 versus 36.6%; p?<?0.01). The fraction of helper T (Th)17 lymphocytes as well as the ratio of Th17 to regulatory T cells (Treg) in the peripheral blood was higher in the NEA than in the EA group (0.24 versus 0.13; p?<?0.05). Conclusions: Th17 were more prevalent than Treg cells in the peripheral blood of NEA patients under ICS treatment, corresponding to neutrophil-dominant airway inflammation and a severe asthmatic phenotype. Thus, an imbalance in Th17/Treg may be associated with the pathogenesis of NEA in patients undergoing ICS treatment.