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Study objective: To examine asthma diagnosis, asthma severity, and the presence of established asthma risk factors in children who reside in nonurban communities. Design: A cross-sectional study was conducted of [...]

Objectives: We describe the system of asthma care in Hartford, CT, an urban, minority community. Methods: The health field concept was used to organize factors influencing asthma prevalence and severity. [...]

SUMMARY AND RECOMMENDATIONS(†) 1. Cough can (a) be an important defense mechanism to help clear excessive secretions and foreign material from airways; (b) be an important factor in the spread [...]

Background: Childhood asthma is the most common chronic illness of childhood. The highest prevalence of childhood asthma in the United States occurs in the Puerto Rican community, and there are many traditional beliefs and practices regarding asthma that coexist with biomedical therapies. Objectives: To describe the ethnomedical treatment practices for childhood asthma in one mainland United States Puerto Rican community and to determine whether any of these practices are effective or potentially harmful. Method: Home interview with caretakers of 118 Puerto Rican children with asthma who seek care at two community health clinics in an inner city in the eastern United States. Results: Common home-based ethnomedical practices include attempts to maintain physical and emotional balance and harmony, religious practices, and ethnobotanical and other therapies. Potentially harmful practices are uncommon, and other remedies are only harmful if not taken as directed. Many remedies are not effective from a biomedical standpoint (ie, bronchodilation or antiinflammation), but if analyzed within the ethnomedical explanatory model--which includes the belief that expulsion of mucus and phlegm from the body is beneficial for the treatment of asthma--these remedies bring about the desired effect and are therefore considered effective to the user. Conclusions: Ethnomedical therapies for asthma in the mainland Puerto Rican community are well known and commonly used. Most practices are not idiosyncratic but fit within a coherent ethnocultural belief system. The health care practitioner can lower the risk for potentially toxic effects of some treatments by discussing these practices with patients and families. Some ethnomedical practices are not discordant with biomedical therapy. Incorporation of these practices into the biomedical plan may help to fit the biomedical therapy into the lifestyle of the patient. (Arch Pediatr Adolesc Med. 1995;149:982-988), Puerto Rican parents appear likely to use folk remedies in conjunction with standard medical care in treating asthma in their children. Researchers conducted interviews with 118 Puerto Rican families who had an asthmatic child attending a Connecticut health clinic. More than half of caregivers reported using prayer, camphor rub, a vaporizer, or massage as asthma therapies. Use of other folk remedies or spiritual practices were reported by 25% or less of respondents. No respondent reported using folk remedies exclusively. Many preventative or treatment strategies reflected folk medicine concepts of maintaining humoral balance between 'hot' and 'cold' and maintaining emotional equilibrium, for example, dressing the child warmly, avoiding overexercise, and keeping the child calm. Most treatments were harmless and many potentially have at least some benefits. If doctors are aware of and respectful of folk remedies, they can reinforce beneficial ones and modify or suggest alternatives to potentially harmful ones.

Congenital cystic adenomatiod malformation is an uncommon congenital anomaly. We present four additional children with CCAM and review the literature. Two of these children had unusual manifestations of CCAM--one presented [...]

In this issue of CHEST (see page 791), Le Bourgeois and colleagues from Hopital Necker-Enfants Malades in Paris, France describe the BAL cell profiles of 83 young children aged 4 [...]

A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in Childhood Asthma (PiCA) consortia members was conducted. Studies were eligible if genetic polymorphisms were compared with suspected ADR(s) in a patient with asthma, as either a primary or secondary outcome. Five studies met the inclusion criteria. The ADRs and polymorphisms identified were change in lung function tests (rs1042713), adrenal suppression (rs591118), and decreased bone mineral density (rs6461639) and accretion (rs9896933, rs2074439). Two of these polymorphisms were replicated within the paper, but none had external replication. Priorities from PiCA consortia members (representing 15 institution in eight countries) for future studies were tachycardia (SABA/LABA), adrenal suppression/crisis and growth suppression (corticosteroids), sleep/behaviour disturbances (leukotriene receptor antagonists), and nausea and vomiting (theophylline). Future pharmacogenomic studies in asthma should collect relevant ADR data as well as markers of efficacy.

Asthma is a common respiratory disorder with a highly heterogeneous nature that remains poorly understood. The objective was to use whole genome sequencing (WGS) data to identify regions of common genetic variation contributing to lung function in individuals with a diagnosis of asthma.

Pediatric asthma, the most common chronic disease of childhood, remains a significant burden to the health care system. Although there are guidelines for the management of pediatric asthma, there remain several controversies about how best to manage asthma in the primary care setting, and how to prevent asthma exacerbations and subsequent emergency department visits and hospitalizations. In this article, we address four of these controversies: use of written asthma treatment plans, the role of long-acting beta-agonists, spirometry and peak flow measurements in disease management, and engagement of school nurses in the health care team. We provide suggestions and guidance related to these topics for the pediatric primary care provider. Pediatric asthma, the most common chronic disease of childhood, remains a significant burden to the health care system. Although there are guidelines for the management of pediatric asthma, there remain several controversies about how best to manage asthma in the primary care setting, and how to prevent asthma exacerbations and subsequent emergency department visits and hospitalizations. In this article, we address four of these controversies: use of written asthma treatment plans, the role of long-acting beta-agonists, spirometry and peak flow measurements in disease management, and engagement of school nurses in the health care team. We provide suggestions and guidance related to these topics for the pediatric primary care provider. [[Pediatr Ann.2019;48(3):e128–e134.]

Ms Marder is a third-year medical student at the University of Connecticut School of Medicine, Farmington. Dr Cloutier is professor of pediatrics at the University of Connecticut Health Center and [...]

To the Editor: We read with interest the article in CHEST by Celed6n et al (January 2004) (1) on ethnicity and skin test reactivity to aeroallergens. The authors found that [...]

Aim:International collaboration is needed to enable large-scale pharmacogenomics studies in childhood asthma. Here, we describe the design of the Pharmacogenomics in Childhood Asthma (PiCA) consortium. Materials & methods:Investigators of each study participating in PiCA provided data on the study characteristics by answering an online questionnaire. Results:A total of 21 studies, including 14,227 children/young persons (58% male), from 12 different countries are currently enrolled in the PiCA consortium. Fifty six percent of the patients are Caucasians. In total, 7619 were inhaled corticosteroid users. Among patients from 13 studies with available data on asthma exacerbations, a third reported exacerbations despite inhaled corticosteroid use. In the future pharmacogenomics studies within the consortium, the pharmacogenomics analyses will be performed separately in each center and the results will be meta-analyzed. Conclusion:PiCA is a valuable platform to perform pharmacogenetics studies within a multiethnic pediatric asthma population.

Exposure to gun violence and African ancestry have been separately associated with increased risk of asthma in Puerto Rican children.

Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma.

AbstractBackground:The relationship between food insecurity and child obesity is unclear. Few studies have examined dietary patterns in children with regard to household food security and weight status. The aim of this study was to examine the association between household food security, dietary intake, and BMI percentile in low-income, preschool children.Methods:Low-income caregivers (n=222) with children ages 2–4 years were enrolled in a primary-care–based obesity prevention/reversal study (Steps to Growing Up Healthy) between October 2010 and December 2011. At baseline, demographic data, household food security status (US Household Food Security Instrument) and dietary intake (Children's Dietary Questionnaire; CDQ) were collected. BMI percentile was calculated from anthropometric data.Results:Participating children were primarily Hispanic (90%), Medicaid insured (95%), 50% female, 35±8.7 months of age (mean±standard deviation), 19% overweight (BMI 85th–94th percentile), and 29% obese (≥95th percentile). Thirty-eight percent of interviews were conducted in Spanish. Twenty-five percent of households reported food insecurity. There was no association between household food insecurity and child BMI percentile. Dietary patterns of the children based on the CDQ did not differ by household food security status. Food group subscale scores (fruit and vegetable, fat from dairy, sweetened beverages, and noncore foods) on the CDQ did not differ between normal weight and overweight/obese children. Maternal depression and stress did not mediate the relationship between household food insecurity and child weight status. Hispanic children were more likely to be overweight or obese in both food-secure and food-insecure households.Conclusions:Household food insecurity was not associated with child BMI percentile in this study. Dietary intake patterns of children from food-insecure households were not different compared to those from food-secure households.

The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing).

Sensitivity to mold has been associated with asthma incidence, persistence, and severity.

To examine differences in the effectiveness of a program to reduce use of health care services in urban-dwelling black and Hispanic children as a way to understand the origins of disparities.

To determine whether an organized, citywide asthma management program delivered by primary care providers (PCPs) increases adherence to the National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines and whether adherence to the guidelines by PCPs decreases medical services utilization in low-income, minority children.

The electrophysiological properties of cultured tracheal cells (CTCs) were examined in a murine (C57BL/6J), ovalbumin (OVA)-induced model of allergic airway disease (AAD) at early (3-day OVA-aerosol) and peak (10-day OVA-aerosol) periods of inflammation. Transepithelial potential difference, short-circuit current (Isc), and resistance (RT) were lower in CTCs from 10-day OVA-aerosol animals compared to CTCs from naïve mice. In cells cultured for 5 weeks, RTwas greater in naive CTCs than in 10-day OVA-aerosol CTCs at all times (P< 0.01). The Isc response to mucosal amiloride (10−4mol/L) was increased in CTCs from 10-day OVA-aerosol mice compared to naïve mice (6.0 ± 0.37 μA/cm2versus1.8 ± 0.56 μA/cm2; P< 0.001) with intermediate values for CTCs from 3-day OVA-aerosol mice. The cAMP-induced increase in Isc was blunted in 10-day OVA-aerosol animals compared to CTCs from naïve mice (9 ± 12%versus39 ± 7%; P< 0.01) with intermediate values for CTCs from 3-day OVA-aerosol mice. There was no difference in mannitol flux in naïve compared to 10-day OVA-aerosol CTCs. Similar results were found using intact tracheas mounted in a perfusion chamber. These data demonstrate changes in airway epithelial cell function in the OVA-induced model of AAD that may contribute to the pathogenesis of airway inflammation.

Critics of the use of clinical practice guidelines (CPGs) in an emergency department (ED) setting believe that they are too cumbersome and time‐consuming, but to the best of the authors' knowledge, potential barriers to CPG adherence in the ED have not been prospectively evaluated.

Cough is one of the most common presenting symptoms that parents and children bring to those who provide care. An acute cough is usually due to a viral upper respiratory infection. Chronic cough, a more challenging problem, may be due to infection, postnasal drip syndrome, asthma, gastroesophageal reflux, or other less common diagnoses. The history is often not helpful in discerning the more likely causes. Frequently, however, the history is all that is available to develop a focused, investigative, and therapeutic plan. Laboratory studies of greatest utility are allergy testing and pulmonary function testing. Many children will respond to empirical therapy for postnasal drip syndrome andor asthma.

The relatively high incidence off roentgenographic abnormalities in patients hospitalized for acute asthma has led some to recommend that all such patients receive chest x-ray examination upon admission to the hospital. We studied the incidence and clinical predictability off the roentgenographic findings by asking the admitting physician to indicate, prior to obtaining a roentgenogram, whether he thought pneumonia, pneumothorax, pneumomediastinum or other significant abnormality was present. A treatment plan was also outlined at that time. Seven off 128 patients (5.5 percent) had roentgenograms suggestive off pneumonia or pneumothorax; three off these were suspected clinically. In 14 cases the clinical suspicion off pneumonia or pneumothorax was not borne out roentgenographicaDy. The initial treatment plan was altered in only three cases. The low incidence off roentgenographic abnormalities and the failure off these minor abnormalities to substantially influence treatment suggest that routine chest roentgenograms may not have to be performed on all children hospitalized for acute asthma.

The use of a single inhaler containing the combination of an inhaled corticosteroid (ICS) and formoterol, a specific long-acting bronchodilator, for both maintenance and quick relief therapy (single maintenance and reliever therapy [SMART or MART]) is recommended by both the Global Initiative for Asthma and the National Asthma Education and Prevention Program Coordinating Committee in steps 3 and 4 of asthma management. This article provides practical advice about implementing SMART in clinical practice based on evidence and clinical experience. Fundamental to SMART is that ICS-formoterol provides quick relief of asthma symptoms similar to that of short-acting β2-agonists such as albuterol, while reducing the risk for severe asthma exacerbations and at an overall lower ICS exposure. Most SMART clinical trials were in adults and adolescents (aged ≥12 years), using budesonide-formoterol 160/4.5 μg (delivered dose), one inhalation once or twice daily (step 3) and two inhalations twice daily (step 4). For both steps 3 and 4, patients take additional inhalations of budesonide-formoterol 160/4.5 μg, one inhalation whenever needed for symptom relief, up to a maximum for adults and adolescents of 12 total inhalations in any single day (delivering 54 μg formoterol). The efficacy and safety of SMART with budesonide-formoterol and beclometasone-formoterol have been confirmed, but other ICS–long-acting bronchodilator combinations have not been studied. The SMART regimen should be introduced with a careful explanation of its role in self-management, preferably with a customized written asthma action plan. The cost to patients and the availability of SMART treatment will depend on the prescribed dose and national or local payer agreements.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Little is known about specialist-specific variations in guideline agreement and adoption.

The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines.