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Objectives: The purpose of this study was to provide a picture of asthma disparities and the contributions of social and environmental factors to asthma exacerbations in the north central region of Texas, where intense, rapid development is a feature of contemporary life., Design and Sample: Cross-sectional analysis of data associated with 66 hospitals in the 8 counties containing and surrounding the Dallas/Fort Worth metropolitan area. Census blocks containing adult asthma patients admitted to emergency departments (ED) or inpatient units for asthma exacerbations in 2014., Measures: Data for secondary analysis were collected from the Dallas Fort Worth Hospital Council Foundation., Results: Sex, family income, education, race, age of housing, speed, and traffic density on neighborhood roads affected asthma admissions. Proximity to urban drilling sites had only a small effect on admissions in this sample. Minorities were significantly more likely to obtain services in the ED than whites., Conclusions: Attributes associated with poor and underserved patients predicted asthma exacerbations in the target region. These are vulnerable patients who can ill afford further erosion of health care insurance or additional environmental insults., (© 2019 Wiley Periodicals, Inc.)

Background: Exercise in air polluted by traffic emissions may aggravate airway inflammation in children with asthma, particularly those who produce decreased glutathione-S transferase (GST) as a result of GSTM1 gene deletion., Objectives: This pilot crossover study investigated whether children with asthma experience more airway changes when exercising outdoors near roadways than when exercising indoors. It also examined differences in risk between children with and without GSTM1 deletion., Method: Children between the ages of 5 and 12 years were assigned to groups and walked daily for 1 week in each exercise condition. Airway inflammation indicated by exhaled nitric oxide (eNO) and pulmonary functions measured as forced expiratory volume in 1 s (FEV1) and mid-expiratory flow rate were measured at baseline and at three intervals during the walking program. Independent variables of interest included walking condition (place), time of walking, genotype, and particulate matter (PM) exposure., Results: A linear mixed models approach was used to investigate the contributions of targeted variables to respiratory outcomes. Results indicated that walking location and ambient level of ultrafine particulates during walking influenced function of small airways. Absence of one or both alleles for the GSTM1 gene did not influence airway function acutely., Discussion: Mid-expiratory flow (FEF(25-75)) may be more informative than FEV1 in studies of acute lung function changes in children with asthma. Further study of the effects of varied environmental conditions on lower airway function of children is needed to optimize exercise experiences for urban children with asthma.

Purpose: This retrospective study is an investigation of the relationship between traffic exposure and childhood asthma exacerbations in a previously unstudied geographic area. We hypothesized that, controlling for selected demographic and social factors, exposure to traffic emissions would allow the prediction of hospital utilization for children with asthma., Design: Using hospital and emergency department (ED) records, we investigated the relationship between proximity to major roadways and admissions for asthma exacerbations in the Fort Worth metropolitan area, designated as not attaining federal air health standards. The sample included 2,357 children from 1 to 12 years of age admitted for emergency or inpatient treatment in a 288-bed, nonprofit children's medical center in Fort Worth, Texas from January 1, 2004 to December 31, 2005. Data were analyzed using GIS mapping and logistic regression., Methods: Deidentification data were collected from hospital databases after IRB approval and waiver of parental permission or patient consent. Student's t test was used to compare groups with and without primary asthma diagnosis on admission in respect to distance from major roadways. Logistic regression was used to model relationships between asthma admission and patients' characteristics, exposure to traffic, and social environment., Findings: Controlling for several demographic factors, asthma occurrences were positively related to traffic exposures. On average, patients with asthma lived closer to major roadways than did patients who did not have asthma. Patients with asthma also tended to live in neighborhoods with more roads than did those who did not have asthma; 3/4 of the children admitted for asthma during the study period and less than 1/3 of the children admitted for nonasthma diagnoses lived within 1,500 meters of a major roadway (p=.0001). Controlling for other factors, every meter increase in proximity to major roadways produced 0.1% increase in likelihood of admission., Clinical Relevance: Knowledge of risk factors and their relative magnitudes enable nurses to better tailor symptom management for individual patients.

Asthma, one of the most common chronic diseases of adults and children, is an important public health concern. The cause of asthma is thought to be a combination of genetic and environmental factors, and a growing body of research has investigated the possible geographic and contextual factors that contribute to asthma prevalence. However, few studies have incorporated geographic and environmental variables into their designs, despite evidence that geography is associated with asthma exacerbation. Additionally, studies of asthma exacerbations among adults are limited. The situation regarding asthma is particularly concerning in North Central Texas (NCT) compared to the national context. In light of this, we analyzed the geographic variation of approximately 12,000 adult patients hospitalized for asthma in the North Central Texas Region, and their association with built environmental features such as land use types, dwelling characteristics, exposure to traffic parameters at the Census Block Group (CBG) level, and pollutant concentrations in the relevant counties for the year 2014. We applied the Hierarchical Linear Model (HLM), and our analysis indicates that there are significant health disparities in the region. We found that the adult asthma hospitalization rate is significantly higher in low-income, low-education neighborhoods with a significant Black population. Furthermore, factors such as increased travel distance to work and substandard dwelling conditions have been found to trigger an increase in hospital visits for asthma patients. Conversely, the presence of greenspace in the surrounding area has been found to help reduce the frequency of asthma-related hospital visits. It is worth noting that both indoor and outdoor environmental quality contribute to adult asthma hospitalizations. Overall, our study highlights the importance of considering geographic and environmental factors in understanding the prevalence and exacerbation of asthma. Our findings suggest that targeted interventions, such as improving indoor and outdoor environmental quality and increasing access to greenspace, may help reduce the burden of asthma in high-risk communities. [ABSTRACT FROM AUTHOR]