Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution

Objective: Phase three of the International Study of Asthma and Allergy in Children (ISAAC) was carried out at various sites in India. The prevalence of asthma symptoms in school children and the effect of environmental tobacco smoke and traffic pollution on the occurrence of asthma were analysed. Methods: Two groups of school children, aged 6–7?yr and 13–14?yr, participated according to the ISAAC protocol. Schools were randomly selected and responses to the ISAAC questionnaire were recorded. Results: The prevalence of asthma was 5.35% in the 6–7?yr age group and 6.05% in the 13–14?yr age group. The odds ratios (ORs) for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI: 1.43, 1.85), 1.71 (95% CI: 1.49, 1.96) and 1.53 (95% CI: 1.31, 1.78), respectively, in the younger group. Similarly, in the older group, they were 1.19 (95% CI: 1.04, 1.36), 1.51 (95% CI: 1.31, 1.75) and 1.51 (95% CI: 1.29, 1.76). Asthma was associated with maternal smoking [6–7?yr group: OR?=?2.72 (2.05, 3.6); 13–14?yr group: OR?=?2.14 (1.72, 2.66)] and paternal smoking [6–7?yr group: OR?=?1.9 (1.70, 2.11); 13–14?yr group: OR?=?1.21 (1.09, 1.34)]. Conclusions: The prevalence of asthma was lower in the 6–7 than the 13–14?yr age group. Environmental tobacco smoke and traffic pollution were the factors most strongly associated with asthma in Indian children.     

Bedroom air quality and vacuuming frequency are associated with repeat child asthma hospital admissions

Objective: Indoor environment factors have been associated with risk of asthma exacerbations in children but little is known about their role on asthma hospital readmissions. As children in Western societies continually spend more time indoors, understanding the influence of these factors on asthma exacerbation is important. We examined the role of indoor environmental and lifestyle characteristics on child asthma readmissions. Methods: A hospital-based case–control study recruited 22 children readmitted for asthma and 22 controls not readmitted for asthma. Logistic regression models were used to examine the association between aeroallergens and fungi in the bedroom and indoor lifestyle characteristics factors for asthma readmissions. To determine the best possible set of predictors among a large set of risk factors, we used random forests (RF) techniques. Results: Higher levels of airborne Cladosporium and yeast in the child’s bedroom increased risk of readmission (OR?=?1.68, 95% CI 1.04–2.72 and OR?=?1.52, 95% CI 0.99–2.34, respectively). Carpeted floors in the bedroom and synthetic doonas were also associated with increase in asthma readmissions (OR?=?4.07, 95% CI 1.03–16.06 and OR?=?14.6, 95% CI 1.26–169.4, respectively). In the home, frequent vacuuming using bagged cleaners increased risk of asthma readmission OR?=?15.7 (95% CI 2.82–87.2). Conclusions: Factors in the child’s bedroom play an important role in increasing the risk of asthma hospital readmissions. These findings have major clinical implications as the identified potential risk factors may be modifiable. Further epidemiological studies with larger samples are necessary to evaluate these associations further.     

Body mass index,adipokines and insulin resistance in asthmatic children and adolescents

Objective: This study aimed to describe the body mass index, insulin resistance, levels of adipokines and inflammatory markers in Brazilian asthmatic children and adolescents and to investigate their possible association with the severity and control of asthma. Methods: Cross-sectional study (n?=?92; age: 3–18 years). Assessed data: Body weight and height, used to calculate the body mass index (BMIZ) and height-for-age (HAZ). Laboratory measurements: Lipid profile; glycemia and insulin for homeostasis model assessment (HOMA); adipokines; tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1); total immunoglobulin E (IgE) and specific IgE against aeroallergens. Results: The median age was 9.6 years (3.0–16.6); most participants were male (n?=?52, 56.5%), pre-pubertal (n?=?54, 58.6%) and had atopic asthma (n?=?85, 92.4%). Overweight/obesity (38%) showed an inverse correlation with age (adjusted odds ratio [OR]?=?0.781; 95% confidence interval [CI] 0.66–0.92) and a direct correlation with the leptin concentration (adjusted OR?=?1.13; 95% CI 1.04–1.22). Insulin concentration was independently associated with moderated persistent asthma (adjusted OR?=?1.31; 95% CI 1.09–1.52). HOMA showed a direct correlation with the leptin (β?=?0.475; 95% CI 0.117–0.268) and total IgE (β?=?0.197; 95% CI 0.002–0.096) levels and an inverse correlation with the TNF-α levels (β?=??0.255; 95% CI;?0.366–0.055). Conclusions: Asthma was associated with insulin resistance and a systemic inflammatory response possibly mediated by adipokines, with leptin levels standing out among the participants with excess weight.     

Is elective cesarean section associated with a higher risk of asthma? A meta-analysis

Abstract

Background: Recent meta-analyses indicate that children delivered by cesarean section have increased risk for asthma. However, the studies included in these previous meta-analyses showed significant heterogeneity. Furthermore, no previous meta-analysis has distinguished the association of elective and emergency CS, spontaneous and instrumental vaginal deliveries (VD) with the odds of asthma. Objective: To examine the association between specific mode of delivery and the prevalence of asthma. Methods: PUBMED, Google Scholar, EMBASE, and MEDLINE were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated from the prevalence of asthma in children born by elective CS, emergent CS, instrumental VD and spontaneous VD. Meta-analysis was then used to derive a combined OR. Heterogeneity between studies was also tested in the findings. Results: A total of 26 studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by CS (OR?=?1.16, 95% CI 1.14, 1.29), and no evidence of heterogeneity was found (I²?=?24.6%). Elective and emergency CS moderately increased the risk of asthma (OR?=?1.21, 95% CI 1.17, 1.25; I²?=?39.9%; OR?=?1.23, 95% CI 1.19–1.26). The risk of asthma was also higher in the children born by instrumental VD (OR?=?1.07, 95% CI, 1.04–1.11) but with evidence of heterogeneity (I²?=?54.9%). Conclusion: About 20% increase in the subsequent risk of asthma was both found in children delivered by elective and emergency CS. The increasing rates of CS worldwide might partly explain the concomitant rise in asthma during the same time period.     

Trends in prevalence and risk factors of childhood asthma in Fuzhou,a city in Southeastern China

Abstract

Objective: The prevalence of asthma in children age 0–14 years in Fuzhou, a city in Southeast China, was 1.57% in 1990 and 3.28% in 2000. The aim of this study was to investigate the asthma prevalence and risk factors in children in the same city in 2010. Methods: This was a cross-sectional study with a two-stage, clustered, stratified random sample design. Parents of 12?235 children 0–14 years of age in Fuzhou were surveyed using a questionnaire. Children with history and/or symptoms of asthma were then interviewed by pediatricians in a nearby clinic to confirm the diagnosis of asthma, and a second questionnaire listing reported risk factors of asthma was completed by the parents in the clinic. Results: About 11?738 questionnaires were completed with a response rate of 95.9%. Among the responders, 648 children had history and/or symptoms of asthma but only 485 (4.13%) were confirmed with asthma. The prevalence was 1.83%, 7.64% and 6.27% in the age groups of 0–1 years, 3–4 years and 13–14 years, respectively. The most significant (binary logistic regression test) factors associated with asthma were presence of atopic or allergic diseases (OR?=?21.5, 95% CI: 12–38.5), family history of allergy or asthma (OR?=?29.4, 95% CI: 12.6–68.6), use of at least one course of antibiotics in the first year of life (OR?=?7.61, 95% CI: 3.4–17.06), supplementary protein feedings before 6 months (OR?=?1.90, 95% CI: 1.23–2.95). Natural ventilation at home (versus frequent use of air-conditioning) appeared to be a protective factor (OR?=?0.5, 95% CI: 0.3–0.8). Conclusion: The prevalence of asthma in childhood has increased significantly during the past 20 years in Fuzhou.     

Irreversible airway obstruction in asthma: A risk factor for severe exacerbations in spite of proper treatment

Objectives: To evaluate whether irreversible airway obstruction (IAO) related to asthma is a risk factor for lack of symptoms control, poor quality of life and exacerbations. Methods: We evaluated consecutive outpatients with asthma in a one-year cohort study. We excluded subjects with smoke history > 9 pack-years. Definition of IAO was post bronchodilator FEV₁/CVF ratio below the lower limit of normality. Subjects received high dose of inhaled medications for asthma. We used logistic regression models, adjusted for the treatment offered during the study, to evaluate whether IAO related to asthma is a risk factor for symptoms control, quality of life, any emergency room visit, number of emergency room visits and hospital admission. Results: We enrolled 248 subjects in the study. IAO was not a risk factor for poor symptoms control [OR 1.354, 95 CI (0.632–2.899)] or worse asthma related quality of life [OR 0.705, 95 CI (0.413–1.204)]. Subjects with IAO had higher odds of any emergency room visit [OR 2.214, 95 CI (1.300–3.768)] and hospital admission [OR 8.530, 95 CI (1.517–47.978)] and lower odds to reduce emergency room visits in the course of the follow-up period [OR 0.452, 95 CI (0.265–0.769)]. IAO did not predict the number of emergency room visits [OR 1.53, 95 CI (0.71–3.30). Conclusion: IAO is not a risk factor for poor symptoms control or poor quality of life, in a setting of proper treatment. It is a risk factor for emergency room visit and hospital admission. Subjects with IAO have poor response to treatment.     

Determinants of asthma control among children in Saudi Arabia

Objective: Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children. Methods: A cross-sectional study was conducted among children with asthma aged 4–11?years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables. Results: Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR?=?0.31, 95% CI?=?0.10–0.96) and by 87% with four or more siblings (OR?=?0.13, 95% CI?=?0.04–0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR?=?0.87, 95% CI?=?0.81–0.93). Household incomes less than SAR 15?000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI?=?1.02–5.21) and 3.33 (95% CI?=?1.33–8.35), respectively. Conclusions: In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.     

Frequency of health service use in the year prior to asthma death

Objective: High frequency health service use (HSU) is associated with poorly controlled asthma, and is a recognized risk factor for near-fatal or fatal asthma. The objective of this study was to describe the frequency of HSU in the year prior to asthma death. Methods: Individuals aged 0–99 years who died from asthma from April 1996 to December 2011 in Ontario, Canada were identified as cases. Cases were matched to 4–5 live asthma controls by age, sex, rural/urban residence, socioeconomic status, duration of asthma and a co-diagnosis of COPD. HSU records in the year prior to death [hospitalization, emergency department (ED) and outpatient visits] were assembled. The association of prior HSU and asthma death was measured by conditional logistic regression models. Results: From 1996 to 2011, 1503 individuals died from asthma. While the majority of cases did not have increased HSU as defined in the study, compared to matched live asthma controls, the cases were 8-fold more likely to have been hospitalized two or more times (OR?=?7.60; 95% CI: 4.90, 11.77), 13-fold more likely to have had three or more ED visits (OR?=?13.28; 95% CI: 7.55, 23.34) and 4-fold more likely to have had five or more physician visits for asthma (OR?=?4.41; 95% CI: 3.58, 5.42). Conclusions: Frequency of HSU in the year prior was substantially higher in those died from asthma. Specifically, more than one asthma hospital admission, three ED visits or five physician visits increased the asthma mortality risk substantially and exponentially.     

Work-related asthma and employment status – 38 states and District of Columbia, 2006–2009

Abstract

Objectives: To examine differences in current employment status between persons with health professional-diagnosed work-related asthma and non-work-related asthma and to examine factors associated with unemployment in these groups. Methods: We analyzed the 2006–2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults (excluding those who were retired, homemakers and students at the time of the interview) with current asthma in 38 states and District of Columbia (N?=?25?680). We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education and income. Results: Among adults with current asthma, individuals with work-related asthma were less likely to be currently employed for wages (PR?=?0.89; 95% confidence interval [CI]?=?0.84–0.95) and more likely to be unable to work (PR?=?1.44; 95% CI?=?1.24–1.67) than those with non-work-related asthma. Among adults with current asthma who were unemployed at the time of the interview, adults with work-related asthma did not differ from those with non-work-related asthma in naming disability as reason for unemployment (PR?=?1.09; 95% CI?=?0.94–1.26). However, those with work-related asthma were more likely to be unable to work for health reasons other than disability (PR?=?1.46; 95% CI?=?1.01–2.12) than adults with non-work-related asthma. Conclusions: Additional studies are needed to determine what health reasons prevent individuals with work-related asthma from working and if the health reasons are asthma-related.     

Does initial length of stay impact 30-day readmission risk in pediatric asthma patients?

Abstract

Objectives: Accountable care puts pressure on hospitals to manage care episodes. Initial length of stay (ILOS) and readmission risk are important elements of a care episode and measures of care quality. Understanding the association between these two measures can guide hospital efforts in managing care episodes. This study was designed to explore the association between ILOS and readmission risk in a cohort of pediatric asthma patients. Materials and methods: The sample cohort (n?=?4965) consisted of all asthma patients discharged from Children’s Hospitals and Clinics of Minnesota (CHC MN) from January 2008 through August 2012. Asthma discharges included cases with a principal diagnosis of asthma or certain respiratory cases with asthma listed as a secondary diagnosis. Multiple logistic regression was used to test associations, adjusting for covariates. Results: Adjusting for covariates, we found no significant association between ILOS and readmission (OR: 1.04 [95% CI: 0.98–1.10]). Analyzing ILOS categorically by length of stay, one-day stays did not have a significantly higher readmission risk (OR:1.27 [95% CI: 0.87–1.85]) than two-day stays, which had the lowest observed readmission risk. Risk increased as ILOS exceeded two days but was not significantly different by day. We found no association when comparing the difference in actual versus expected ILOS and readmission risk (shorter than expected OR: 1.13 [95% CI: 0.74–1.71]; longer than expected OR: 0.97 [95% CI: 0.69–1.38]). Conclusions: Attempts to prolong ILOS would dramatically increase costs with little impact on readmissions. For example, increasing one-day visits to two-day visits would increase hospital patient days 38% (1870?d) in this cohort while decreasing total readmissions by 3.8% [95% CI: 3.6–4.0%]. Understanding the mechanisms that impact readmissions is essential in evaluating cost-effective approaches to improving patient outcomes and lowering the cost of care.     

The impact of limited English proficiency on asthma action plan use

Objective: The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. Methods: A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than “very well”. Data were analyzed using Fisher’s exact test and odds ratios (OR). Results: One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p?=?.01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3–6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7–7.0]), age of child >7 years (OR 1.0 [95% CI 0.5–2.4]), caregiver education?≥?associate degree (OR 1.4 [95% CI 0.6–3.0]), private insurance (OR 0.7 [95% CI 0.3–1.8]), White race (OR 0.7 [95% CI 0.2–2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2–1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3–2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child’s asthma as mild/well controlled. Conclusion: Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.     

MDR1 gene C3435T polymorphism and cancer risk: a meta-analysis of 34 case–control studies

Background

P-glycoprotein, the product of the MDR1 gene, is a transmembrane active efflux pump for a variety of environmental toxins and xenobiotics. Epidemiological studies have evaluated the association between MDR1 C3435T polymorphism and cancer susceptibility. However, published data are still inconclusive.

Methods

To derive a more precise assessment of this relevance, we performed a meta-analysis, up to September 2010, of 5,196 cases with different cancer types and 6,827 controls from 34 published case–control studies. Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for MDR1 C3435T polymorphism and cancer were estimated using fixed- and random-effects models when appropriate.

Results

The overall results suggested that the variant was associated with a moderately increased cancer risk in all comparison models tested (OR?=?1.26, 95% CI: 1.06–1.50 for TT vs. CC; OR?=?1.19, 95% CI: 1.04–1.37 for CT vs. CC; OR?=?1.15, 95% CI: 1.01–1.32 for recessive model; OR?=?1.21, 95% CI: 1.06–1.38 for domain model, and OR?=?1.14, 95% CI: 1.04–1.26 for allele contrast). In the subgroup analysis by cancer types, significant associations were found in breast cancer (OR?=?1.66, 95% CI: 1.24–2.21 for TT vs. CC; OR?=?1.44, 95% CI: 1.14–1.82 for recessive model; OR?=?1.41, 95% CI: 1.10–1.81 for domain model; and OR?=?1.31, 95% CI: 1.13–1.52 for allele contrast) and renal cancer (OR?=?1.99, 95% CI: 1.37–2.90 for TT vs. CC; OR?=?1.74, 95% CI: 1.25–2.42 for domain model; OR?=?1.43, 95% CI: 1.09–1.88 for recessive model; and OR?=?1.40, 95% CI: 1.17–1.68 for allele contrast). However, no significant associations were found in colorectal cancer, gastric cancer, and acute lymphoblastic leukemia for all genetic models. In the ethnicity subgroup analysis, a significant association with cancer among Caucasians was found under the dominant model, homozygote comparison, CT versus CC comparison, and allele comparison.

Conclusions

In summary, this meta-analysis suggests that the MDR1 C3435T polymorphism is associated with cancer susceptibility, increasing the risk of breast and renal cancer.     

Risk Factors for Asthma in Adolescents in a Large Urban Region of Brazil

Background. Identify risk factors for asthma in adolescents from São Paulo, Brazil. Methods. total of 528 adolescents (141 asthmatics, 387 control subjects) from the ISAAC study (phase III) were submitted to a complementary questionnaire to evaluate risk factors, through response to questions regarding personal history, environment, and diet and an agreement to undergo the skin prick test (SPT) for aeroallergens. Results. Positive SPT to at least one allergen occurred in 49.4% adolescents. The risk factors for asthma were: prematurity (OR: 3.84, 95% CI: 1.54–9.64), rhinitis (OR: 3.18, 95% CI: 1.71–5.91), positivity in the SPT (OR: 2.81, 95% CI: 1.48–5.32), eczema in characteristic skin-folds (OR: 2.86, 95% CI: 1.13–7.26), and an allergic mother (OR: 2.01, 95% CI: 1.02–3.93). The consumption of cooked vegetables was a protective factor for asthma (OR: 0.37, 95% CI: 0.18–0.79) Conclusions. Asthma is a multifatorial disease. An allergic mother, aeroallergen sensitization, rhinitis, eczema and prematurity were considered risk factors and the consumption of cooked vegetables was considered a protective factor for asthma in this population.     

Trajectory of use over time of an oral tablet and a rectal gel for HIV prevention among transgender women and men who have sex with men

We examined product adherence among 187 men who have sex with men and transgender women enrolled in a phase II, crossover trial comparing safety and acceptability of an oral tablet and a rectal gel used daily for HIV prevention. Participants reported adherence via daily text messages during 8-week periods. Trajectory analysis identified weekly patterns. Polytomous logistic regression identified characteristics associated with higher probability of trajectory group membership. We identified 3 groups per product: high-adherers (72% daily oral, 70% daily gel); decreasing-adherers (20% daily oral, 22% daily gel); and low-adherers (8% daily oral, 9% daily gel). Daily oral high-adherers (compared with low-adherers) were more likely to self-identify as male (OR?=?4.76, 95% CI:1.35–16.67), to have more sexual partners (OR?=?1.67, 95% CI:1.04–2.63), and to find the tablet easy to swallow (OR?=?2.22, 95% CI:1.08–4.76). Daily gel high-adherers (compared with low-adherers) were more likely to be older (OR?=?1.16, 95% CI:1.05–1.28), to find gel application easier at the last few applications (OR?=?2.27, 95% CI:1.01–5.00), and to report a change in routine if gel was not used (OR?=?5.26, 95% CI:1.23–100.00). Characteristics of participants likely to be high-adherers to product use vary according to product. Evaluation of acceptability prior to phase II/III trials could identify participants likely to maintain high adherence.     

Asthma,Chronic Obstructive Pulmonary Disease,and Mortality in the U.S. Population

Background: COPD and asthma are common diseases in the U.S. population and can coexist. Our goal was to determine the prevalence of self-reported, physician-diagnosed asthma and COPD in a sample of the U.S. population and their association with lung function impairment and mortality. Methods: We used baseline data from NHANES III and the follow-up mortality data. We used logistic regression and Cox Proportional Hazards models, adjusting for age, sex, race/ethnicity, education level, smoking status, and disease stage. Results: The sample consisted of 15,203 subjects, of whom 4,542 died during the follow-up period. Coexisting COPD and asthma was reported by 357 (2.7%), COPD by 815 (5.3%), and asthma by 709 (5.3%). Subjects with both conditions had a higher proportion of obstruction (30.9%) than those with COPD (24.3%), asthma (13.3%), or no lung disease (5.4%). In survival models adjusting for all factors except baseline lung function, coexisting COPD and asthma had the highest risk for mortality (Hazard Ratio [HR] 1.83, 95% confidence interval [CI] 1.34, 2.49), followed by COPD only (HR 1.44, 95% CI 1.28, 1.62), and asthma only (HR 1.16, 95% CI 0.94, 1.42). These affects were attenuated after controlling for baseline lung function: coexisting asthma and COPD (HR 1.45, 95% CI 1.06, 1.98), COPD only (1.28, 95% CI 1.13, 1.45), and asthma only (HR 1.04, 95% CI 0.85, 1.27). Conclusion: In this analysis, subjects who report coexisting asthma and COPD have a higher risk of obstruction on spirometry and a higher risk of death during follow-up.     

Asthma insights from Jordan: cross-sectional observational study

Objective: The burden of uncontrolled asthma on patients in Jordan is largely unknown. This study assessed different aspects of asthma clinical features: the level of asthma control, its correlation with quality of life, and possible predictors of asthma control. Methods: Face-to-face interviews with asthmatic patients (≥16 years old) in north Jordan from 2013 to 2014 were conducted. Outcomes measures were assessed using the asthma control test (ACT), the mini asthma quality of life questionnaire (mini-AQLQ), and the Generic health-related quality of life (EQ-5D). The relationship between asthma control and quality of life was examined using Spearman’s correlation coefficient. Predictors of asthma control were determined using multivariable logistic regression adjusted for confounders. Results: A total of 255 patients were recruited (mean age 45.16 years, 74.5% female). Approximately one-third of subjects (30.6%; n?=?78) had controlled asthma (ACT?≥?20). A strong correlation between asthma control and both mini-AQLQ and EQ-5D scores was identified (p?<?0.001). Subjects who required to step-up treatment (OR?=?0.12, 95% CI: 0.02–0.63, p?=?0.01) and with acute asthma exacerbation (OR?=?0.32, 95% CI: 0.18–0.58, p?<?0.001) were independently associated with poor asthma control. Conclusions: Most of the recruited patients have not achieved optimal asthma control and was associated with low quality of life. The study highlights that even in low-income countries, a simple assessment tool such as the ACT can be utilized to screen and categorize asthma control. This approach would facilitate a better treatment plan and eventually improve asthma control and quality of life in asthma patients.     

The +252A/G polymorphism in the Lymphotoxin‐α gene increases the risk of asthma: A meta‐analysis

Background and Objective: A number of studies have shown that the +252A/G polymorphism (rs909253) in the lymphotoxin‐α (LT‐α) gene is implicated in susceptibility to asthma. However, the findings have been inconclusive. The aim of this study was to investigate the association between the +252A/G polymorphism in the LT‐α gene and the risk of asthma by performing a meta‐analysis. Methods: The Pubmed and Embase databases were searched for all studies relating to this polymorphism and the risk of asthma. Statistical analyses were performed using the Revman4.2 and STATA 10.0 software. Results: Thirteen case‐control studies that included a total of 2220 cases and 6428 controls were included in the meta‐analysis. There was no significant association between this polymorphism and the risk of asthma in the all‐combined analysis (odds ratio (OR) 1.14, 95% confidence interval (CI): 0.89–1.45 for GG+GA vs AA). In a subgroup analysis by ethnicity, no significant association with asthma risk was identified in Asians (OR 1.31, 95% CI: 0.97–1.77) or Europeans (OR 1.08, 95% CI: 0.77–1.53). In a subgroup analysis by age, a significantly increased risk was identified among adults (OR 1.25, 95% CI: 1.03–1.50) but not children (OR 1.04, 95% CI: 0.28–3.89). In a subgroup analysis by atopic status, a significantly elevated risk was identified among atopic (OR 1.55, 95% CI: 1.28–1.87) but not non‐atopic individuals (OR 0.94, 95% CI: 0.53–1.68). Conclusions: This meta‐analysis suggested that the +252A/G polymorphism in the LT‐α gene is a risk factor for asthma in adults and atopic populations.     

The association of prenatal risk factors with childhood asthma

Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR?=?2.87, 95% CI?=?1.60–5.14) and wheezing (aOR?=?5.57, 95% CI?=?2.32–13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR]?=?5.86 (3.03–11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.     

Excessive daytime sleepiness in asthma: What are the risk factors?

Objective: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics. Methods: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16–75 years in four Swedish cities. Results: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs. 28.5%, p < 0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10–4.84); chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53–2.62); current smoking (OR, 1.60; 95% CI, 1.15–2.22) and obesity (OR, 1.53; 95% CI, 1.09–2.13). Conclusions: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.