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Background Globally, a surge in electronic cigarette (e-cigarette) use has been observed in recent years, with youth being the most susceptible group. Given their recent emergence, studies assessing the health consequences of using e-cigarettes and exposure to their secondhand aerosols (SHA) are limited. Hence, this study sought to assess associations between e-cigarette use and household exposure to SHA from e-cigarettes with asthma symptoms among adolescents. Methods A school-based cross-sectional study was conducted by enrolling high school students (n = 1565; aged 16–19 years) in Kuwait. Participants self-completed a questionnaire on tobacco products use (e-cigarettes and cigarettes) and asthma symptoms. Current e-cigarette use and cigarette smoking were defined as any use in the past 30 days. Household exposure to SHA from e-cigarettes in the past 7 days was reported as none (0 days), infrequent (1–2 days), and frequent (≥ 3 days). Asthma symptoms included current (past 12 months) wheeze, current asthma (history of clinical diagnosis and current wheeze and/or medication use), and current symptoms of uncontrolled asthma (≥ 4 attacks of wheeze, ≥ 1 night per week sleep disturbance from wheeze, and/or wheeze affecting speech). Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. Results Among the analytical study sample (n = 1345), current e-cigarette use and cigarette smoking was reported by 369 (27.4%) and 358 (26.6%) participants, respectively. Compared to never e-cigarette users and never cigarette smokers, current e-cigarette users with no history of cigarette smoking had increased prevalence of current wheeze (aPR = 1.54, 95% CI 1.01–2.45) and current asthma (aPR = 1.85, 95% CI 1.03–3.41). Moreover, the frequency of exposure to household SHA from e-cigarettes was associated with asthma symptoms. For example, compared to those with no exposure to household SHA, frequent exposure to household SHA was associated with current wheeze (aPR = 1.30, 95% CI 1.04–1.59), current asthma (aPR = 1.56, 95% CI 1.13–2.16), and current uncontrolled asthma symptoms (aPR = 1.88, 95% CI 1.35–2.62). Conclusions E-cigarette use and their household SHA exposure were independently associated with asthma symptoms among adolescents. Hence, such observations indicate that e-cigarette use and passive exposure to their aerosols negatively impact respiratory health among adolescents.

Background The role of diet in the etiology of asthma is still inconclusive. This paper evaluated the longitudinal association between diet quality and chest wheezing in young adults. Methods This is a longitudinal study with follow-up information from 18- and 22-year-olds (18y and 22y) of the 1993 Pelotas (Brazil) Birth Cohort. Chest wheezing occurrence and number of events in the last year were reported at 22y. Diet quality was measured with a revised version of the Healthy Eating Index (IQD-R) for the Brazilian population at 18y and 22y by food frequency questionnaire referring to the last 12 months. The diet quality continuity was classified as good (always 1st IQD-R tertile), intermediate (always 2nd tertile/change tertile) and poor (always 3rd tertile). Results A total of 2986 young individuals were evaluated; 51.4% were female. Prevalence of wheezing at 22y was 10.1% (95% CI: 9.1-11.2), and of these patients, 10% reported at least one event in the past year. Better IQD-R score, both at 18y and at 22y, the lower the odds of wheezing in the past year. Regarding the diet quality continuity from 18y to 22y, staying on a poor diet increased by more than three-fold the odds of chest wheezing (OR=3.28; 95% CI: 1.84-5.84) and of wheezing events (OR=3.32; 95% CI: 1.89-5.85) compared to staying on a good diet, after adjustment for confounding variables. Conclusion The overall quality of the diet seems to be more important than the individual components in the effect on asthma symptoms. Low-quality diet persistence increased the odds of chest wheezing and the number of events.

Sustained exposure to cleaning products can cause airway irritation and chronic inflammation, triggering asthma symptoms and worsening asthma control [1]. The link between cleaning product use and ...

To investigate the efficacy of inspiratory muscle training (IMT) on respiratory functions, respiratory muscle strength, and asthma symptoms in asthmatic children.In a randomized placebo-controlled assessor-blinded study, 34 children with asthma were randomized to receive either the IMT at 40% of the maximal inspiratory pressure (IPAt a significance level adjusted toIncorporation of IMT in the CRR program for children with asthma can improve respiratory function, enhance respiratory muscle strength, and improve children's perception of asthma symptoms.

Comorbid conditions (comorbidities) can complicate the diagnosis and management of asthma. In different age groups, comorbid conditions can present varying challenges, including diagnostic confusion due to mimicking asthma symptoms, exacerbation of asthma symptoms, therapy for comorbid conditions affecting asthma or therapy for asthma affecting these conditions. This review aims to summarise some common comorbid conditions with asthma, such as rhinitis, vocal cord dysfunction, gastro-oesophageal reflux, psychiatric disorders, obesity and obstructive sleep apnoea, and discuss their prevalence, symptoms, diagnosis and treatment, highlighting any differences in how they impact children and adults. Overall, there is a lack of data on the impact of treating comorbid conditions on asthma outcomes and further studies are needed to guide age-appropriate asthma management in the presence of these conditions.

Background Asthma is the most common chronic respiratory disorder in childhood with worldwide increasing in its prevalence and global burden. The International Study of Asthma and Allergies in Childhood (ISAAC) provides a standardized methodology to describe the prevalence and severity of childhood asthma symptoms all over the world using simple standardized questionnaires that allow comparisons across geographic and linguistic boundaries. This study aimed to find a suitable application of ISAAC asthma questionnaire to improve the perception and response of the middle (preparatory) school students in Al-Sharkiya Governorate as a step to update the Egyptian prevalence of asthma among children through the translation of the ISSAC written questionnaire into Arabic and to compare the student’s response to the translated questionnaire with their response to the same questionnaire after showing ISAAC videos. Results The percentage of student’s positive answers for asthma symptoms in the written questionnaire after watching ISAAC videos was significantly lower when compared to their written questionnaire answers without watching videos with no significant agreement between the student’s answers in the two methods. Conclusion Using ISAAC videos before filling the written questionnaire improved the students’ understanding of and dealing with the written questionnaire.

Objective: To assess the level of adherence to medical prescriptions and recommendations by patients with bronchial asthma (BA), in order to achieve control over the symptoms of the disease; to identify the most common factors of low adherence to BA therapy; to suggest strategies for optimizing treatment compliance. Methods: 92 children with a verified diagnosis of BA were examined. All patients underwent a general clinical, laboratory and instrumental examination, as well as an additional screening test with a mixture of respiratory allergens – the ImmunoCapPhadia® 250 method. The control of BA symptoms was assessed using ACT and ACQ tests. Adherence to BA therapy was assessed using a questionnaire. Results: Analysis of gender differences revealed that the proportion of male patients was 58%; female – 42%. The median age was 11 years. The average age of diagnosis of BA in children was 9 years. All patients were hospitalized during the period of exacerbation of the disease, the proportion of children with an attack of moderate BA – 87%; severe – 13%. An intermittent course of BA was observed in 28%; a persistent course in 72%. Analysis of ImmunoCap Phadia®250 data revealed that in 17.2% of cases class V sensitization prevailed, and the average values of allergen-specific IgE antibodies were 69.82 kU/L. Assessment of the level of control over asthma symptoms and the use of AST and ACQ tests revealed that partially controlled the course of BA was noted by 56% and uncontrolled over 46% of children. Analysis of the «Questionnaire of adherence to treatment of bronchial asthma (BA) in children», differences were found in the response to questions: «Do you experience difficulties in using the inhaler?» (χ2=8.952; p=0.003), «Was there any reluctance to take medications?» (χ2=4.715; p=0.03); «Does it happen that you forget to take drugs one/several days?» (χ2=5.093; p=0.025), «Are you satisfied with the prescribed therapy for BA?» (χ2=5.093; p=0.025). Conclusions: In order to achieve success in long-term control of the symptoms of BA in a patient, a comprehensive approach to the treatment and prevention of exacerbation of BA is required with an individual approach to each child, both from the doctor and from an adult who participates in the conduct and adherence to doctors appointments. Keywords: Asthma, children, adherence, compliance, symptom control.

OBJECTIVE: It is unclear whether research participation effects contribute to an improvement in asthma symptoms during clinical trials in the absence of any active intervention. We examined the impact of additional follow-up surveys on caregiver-reported symptoms among control subjects in a series of randomized controlled asthma trials. METHODS: We analyzed baseline and follow-up data for children (3–10 yrs.) with poorly controlled persistent asthma that participated as control subjects in 1 of 3 randomized trials of urban school-based asthma care (study duration: 7–10 months). We compared mean symptom-free days (SFD) per 2 weeks between baseline and final follow-up; performed bivariate regressions to explore associations between demographics and changes in SFD; and performed multivariate random-effects generalized least square regression to examine the relationship between number of follow-ups beyond baseline (range: 1–10) and changes in SFD over time. RESULTS: 516 children were enrolled as controls across the 3 trials (mean age 7.5 yrs., 61% Black, 28% Hispanic, 81% Medicaid). Mean SFDs increased significantly from baseline to final follow-up (7.8 to 11.4 days, P

Severe asthma is often associated with numerous comorbidities that complicate disease management and affect patient's outcomes. They contribute to poor disease control and mimic asthma symptoms. Although some comorbidities such as obstructive sleep apnea, bronchiectasis, and chronic obstructive pulmonary disease are generally well recognized, many other may remain undiagnosed but may be detected in an expert specialist setting. The management of comorbidities seems to improve asthma outcomes, and optimizes therapy by avoiding overtreatment. The present review provides recent knowledge regarding the most common comorbidities which are associated with severe asthma.Comorbidities are more prevalent in severe asthma than in mild-to-moderate disease or in the general population. They can be grouped into two large domains: the pulmonary domain and the extrapulmonary domain. Pulmonary comorbidities include upper respiratory tract disorders (obstructive sleep apnea, allergic and nonallergic rhinitis, chronic rhinosinusitis, nasal polyposis) and middle/lower respiratory tract disorders (chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis and fungal sensitization, bronchiectasis, dysfunctional breathing). Extrapulmonary comorbidities include anxiety, depression, gastro-esophageal reflux disease, obesity, cardiovascular, and metabolic diseases.The identification of comorbidities via multidimensional approach is needed to initiate appropriate multidisciplinary management of patients with severe asthma.

Background: asthma is a highly variable disease, with changes in the severity over months and years. In addition to achieving asthma control, many patients experience challenges in the long-term maintenance of this condition. Good symptom control is a volatile entity even in mild asthma. The loss of asthma control is accounted for by poor adherence to treatment due the fears of taking hormonal therapy, contact with an allergen, respiratory viral infections, and the inconvenience of using the inhaler resulting in incorrect inhaler technique. Aim: to assess the control over asthma and adherence to treatment in young patients with mild-to-moderate asthma. Patients and Methods: 146 patients with verified mild-to-moderate asthma were examined. All patients were divided into two groups based on disease severity. Results: at the time of examination, the lack of the control over asthma symptoms was reported in 89% of the patients. In mild asthma, mean Asthma Control Test (AST) score was 17 [15; 21] and АCQ-5 (Asthma Control Questionnaire) score was 1.8 [1.4; 2.2]. Meanwhile, in moderate asthma, mean AST score was 15 [12; 21] and АCQ-5 score was 1.8 [1.4; 2.2]. Poor medication adherence measured by the Morisky Green Levine Medication Adherence Scale was revealed in 94% of the patients with mild asthma and 91% of the patients with moderate asthma. Conclusion: poor patient’s knowledge on asthma and little awareness of the long-term importance of regular basic therapy are the critical factors contributing to poor medication adherence. Therefore, novel approaches to patient education as well as optimized and personalized therapeutic strategies are currently important for achieving and maintaining the control over asthma symptoms. KEYWORDS: asthma, asthma control, stable course, young patients, adherence to treatment. FOR CITATION: Leont’eva N.M., Demko I.V., Sobko E.A., Ishchenko O.P. Level of asthma symptom control and adherence to treatment in young patients. Russian Medical Inquiry. 2020;4(4):180–185. DOI: 10.32364/2587-6821-2020-4-4-180-185.

Aim. To study indicators of quality of life and adherence to treatment of patients with severe bronchial asthma. Materials and methods . The study included 120 patients with severe bronchial asthma with uncontrolled course of the disease, taking basic anti-inflammatory therapy. Adherence to the therapy was assessed using a modified MoriskyGreen questionnaire and a questionnaire «Test of the Adherence to Inhalers – TAI». The quality of life was assessed using an AQLQ questionnaire. Results. The study showed: according to the Morisky–Green adherence questionnaire in patients with severe asthma there was low intentional adherence to the basic anti-inflammatory therapy, which is formed mainly due to the missing of the drug in good health inattention to the clock medication and skipping of the medication. According to the questionnaire «Test of the Adherence to Inhalers» it was found out that most patients are committed to therapy and ere was no unintentional non-commitment to the doctor’s therapy. Conclusion . In assessing the quality of life of patients with severe bronchial asthma it was revealed that the greatest impact asthma symptoms have on the emotional state, daily activity of the patient and the overall quality of life.

Background: Effective and reliable monitoring of asthma at home is a relevant factor that may reduce the need to consult a doctor in person.Aim: We analyzed the possibility to determine intensities of pathological breath phenomena based on artificial intelligence (AI) analysis of sounds recorded during standard stethoscope auscultation.Methods: The evaluation set comprising 1,043 auscultation examinations (9,319 recordings) was collected from 899 patients. Examinations were assigned to one of four groups: asthma with and without abnormal sounds (AA and AN, respectively), no-asthma with and without abnormal sounds (NA and NN, respectively). Presence of abnormal sounds was evaluated by a panel of 3 physicians that were blinded to the AI predictions. AI was trained on an independent set of 9,847 recordings to determine intensity scores (indexes) of wheezes, rhonchi, fine and coarse crackles and their combinations: continuous phenomena (wheezes + rhonchi) and all phenomena. The pair-comparison of groups of examinations based on Area Under ROC-Curve (AUC) was used to evaluate the performance of each index in discrimination between groups.Results: Best performance in separation between AA and AN was observed with Continuous Phenomena Index (AUC 0.94) while for NN and NA. All Phenomena Index (AUC 0.91) showed the best performance. AA showed slightly higher prevalence of wheezes compared to NA.Conclusions: The results showed a high efficiency of the AI to discriminate between the asthma patients with normal and abnormal sounds, thus this approach has a great potential and can be used to monitor asthma symptoms at home.

Background Smoking and occupational airborne exposures are known to increase asthma symptoms, but less is known about their influence by the age of asthma diagnosis. Objective To evaluate the effect of exposures to VGDF (vapors, gases, dusts and fumes), tobacco smoke and their combination for asthma symptoms comparing subjects with asthma diagnosed in childhood and adulthood. Methods A random sample of 16 000 adults aged 20–69 years were invited to a postal survey on obstructive pulmonary diseases in Finland in 2016. Those reporting physician-diagnosed asthma and age at diagnosis were included in the analysis and their reported VGDF-exposure and smoking habits were analyzed. Age 18 years was chosen to delineate child- and adult-diagnosed asthma. Results 8199 (51.5%) responded. Of the responders, 831 reported physician-diagnosed asthma. 41% of asthmatics reported child-diagnosed and 59% adult-diagnosed asthma. Current smoking was reported by 25.2% and 20.2% and VGDF exposure by 31.3% and 44.7% in child -diagnosed and adult-diagnosed asthma, respectively. Combined VGDF-exposure and current smoking was reported by 9.7% and 10.6%, respectively. Compared to the unexposed, those with asthma diagnosed in childhood and with combined current smoking and VGDF exposure, had higher prevalence of wheeze (69.7% vs 39.5%, p=0.009), sputum production (39.4% vs 11.4%, p=0.001) and morning dyspnea (42.4% vs 21.9%, p=0.002). Corresponding pattern was seen in those with asthma diagnosed in adulthood; for wheeze (78.8% vs 53.6%, p=0.007), sputum production (40.4% vs 25.0%, p=0.014) and morning dyspnea (65.4% vs 42.0%, p=0.008). Child-diagnosed asthmatics both without exposure history (46.5% vs 69.6%, p=0.001) and with combined exposure to smoking and VGDF (66.7% vs 94.2%, p=0.003) reported less often ≥3 symptoms compared to adult-diagnosed asthmatics, even though they reported less frequently use of asthma medication (60.7% vs 82.0%, p>0.001). Smoking asthmatics with adult-diagnosis and exposure to VGDF had the highest prevalence estimates of having multiple symptoms (94.2%) in our study. Conclusion Although asthmatics diagnosed in child- and adulthood reported symptoms related to exposure to smoking and VGDF, symptoms were reported more often by those with adult diagnosis. The results indicate the importance of targeted asthma treatment and follow-up by patient’s exposure history and asthma diagnosis age.

It is poorly understood why asthma symptoms are often discordant with objective medical tests. Differences in interoception (perception of internal bodily processes) may help explain symptom discordance, which may be further influenced by mood and attention. We explored inter-relationships between interoception, mood and attention in 63 individuals with asthma and 30 controls. Questionnaires, a breathing-related interoception task, two attention tasks, and standard clinical assessments were performed. Questionnaires were analysed using exploratory factor analysis, and linear regression examined relationships between measures. K-means clustering also defined asthma subgroups. Two concordant asthma subgroups (symptoms related appropriately to pathophysiology, normal mood) and one discordant subgroup (moderate symptoms, minor pathophysiology, low mood) were found. In all participants, negative mood correlated with decreased interoceptive ability and faster reaction times in an attention task. Our findings suggest that interpreting bodily sensations relates to mood, and this effect may be heightened in subgroups of individuals with asthma., Biological Psychology, 165, ISSN:0301-0511, ISSN:1873-6246

Objective: Children and young people living with asthma have an increased risk of overweight/obesity, leading to increased severity of asthma symptoms. Weight management has been recommended to improve asthma symptoms, however, there is limited understanding of how this is experienced or how children and young people with asthma and their families wish to be supported. The aim of this study was to explore parents and children/young people’s views and experiences of managing weight while living with asthma, and to identify acceptable strategies for support. Methods: A qualitative methodological approach was taken to facilitate rich understanding of families’ insights into weight management while living with asthma. In-depth interviews were conducted with nine families living with pediatric asthma (n = 9 parents, 9 young people). Data were analyzed using a Framework approach. Results: Findings indicated that family engagement with weight management behaviors was primarily influenced by perceptions of risk regarding asthma outcomes and beliefs about asthma control. Families also reported weight management engagement to be influenced by perceptions of the food environment, perceptions of the exercise environment (e.g. weather, anticipated social outcomes) and the availability of weight management support. Participants sought tailored support which gave consideration to the asthma-obesity interaction. It was suggested that this would help reduce perceptions of weight stigma in consultations, thereby supporting behavioral changes. Conclusions: Individualized weight management plans that consider families concerns about asthma-related risk are needed to manage weight in children and young people living with asthma.

Respiratory disease and its complication are the cause of children deaths worldwide every year. Several epidemiological studies pointed out an association between quality of residential in inner city and risk of children health. Few studies had been focused on respiratory and asthma symptoms in high-polluted urban area in low to middle income countries. We conducted a cross-sectional study to investigate the association between residential environments and respiratory symptoms including asthma among 658 primary school children aged between 6 to 10 years who have been living in high-polluted urban area of Bangkok Thailand. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was modified and used for symptom self-report during the past 12 months. Binary logistic regression model was performed to find the associations. The results showed that living near garment and clothing shop is associated with shortness of breath (AOR = 1.846; 95%CI 1.034, 3.297). Vectors in home is related to dry cough at night (AOR = 1.505; 95%CI 1.052, 2.153) and phlegm (AOR = 1.414; 95%CI 1.014, 1.973). Wall dampness is increased odd of having wheezing or whistling (asthma) in the chest (AOR = 1.921; 95%CI 1.141, 3.235). Housing quality and living environments to reduce respiratory and asthma symptoms among urban children must be improved to address these risks.

Background: The present study was carried out to observe the relationship between total IgE levels and spirometry in asthma. Methodology: The study was carried out in KBN Hospital Respiratory clinics OPD. Total 100 patients with asthma symptoms were taken in study, with no other systemic disorder. Serum IgE levels were measured by ELISA technique, value >100IU/ml were taken as positive, spirometry was conducted on all patient by using USB spirometer according to ATS standard data were analyzed. Results: We included 100 patients of asthma in our study, serum IgE levels varied markedly showing IgE levels-90% (50% >100IU/l and 40% >400IU/l) of IgE levels were more than 100IU/l and 10% were less than 100IU/l spirometery showed 60% were having FEV1/FVC%>80% and 40% were

Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units. Resumen: El asma es una de las principales enfermedades crónicas de la infancia, por su elevada prevalencia y por su coste sociosanitario. Este artículo es un resumen de la guía de consenso alcanzada por 6 sociedades pediátricas relacionadas con el asma y avalada por la Asociación Española de Pediatría. El asma es fácilmente identificable por criterios clínicos en la mayoría de los pacientes. La espirometría y otras pruebas son de gran ayuda, especialmente en los casos atípicos. La crisis de asma es una manifestación frecuente de la enfermedad y debe ser identificada y tratada con prontitud. Cuando los síntomas de asma son frecuentes y afectan a la calidad de vida es preciso instaurar un tratamiento de mantenimiento para conseguir el control de la enfermedad. Los glucocorticoides inhalados a dosis bajas son eficaces y seguros para su uso prolongado. La educación del paciente con asma es esencial para obtener un buen control. El principal motivo de mal control del asma es el incumplimiento del tratamiento, ya sea por su administración errática e insuficiente, o por la mala técnica de administración de los fármacos inhalados. Si no se obtiene el control pese a un tratamiento adecuado es preciso reconsiderar el diagnóstico, así como los factores o comorbilidades que dificultan el control. Se pueden añadir otros fármacos para evitar las dosis altas de los glucocorticoides inhalados, principalmente el montelukast o los agonistas β2 adrenérgicos de acción prolongada. El asma grave o de difícil control, que no responde a las medidas habituales, debe ser atendida en unidades especializadas.

Global industrialization and urbanization have led to increased levels of air pollution. Those with respiratory diseases, such as asthma, are at the highest risk for adverse health effects and reduced quality of life. Studying the relationship between pollutants and symptoms is usually achieved with data from government air quality monitoring stations, but these fail to report the spatial and temporal resolution required to track a person’s true exposure, especially when the majority of their time is spent indoors. We develop and build eight wrist-worn wearable devices, weighing only 64 g, to measure known asthma symptom triggers: ozone, total volatile organic compounds, temperature, humidity, and activity level. The devices use commercial off-the-shelf components, costing under $150 each to build. This report focuses on the design, calibration, and testing of the devices. Emphasis is placed on the calibration of a metal–oxide–semiconductor gas sensor for detecting ozone, which is a difficult task because of the large variations in ambient temperature and humidity found when using a wearable device. Examples of testing the devices in four real environments are also discussed: 11 days inside a well-ventilated laboratory, ten days outdoors during the summer, alternating the devices between indoor and outdoor environments to examine their response to quickly changing environments, and a field test where scripted activities are performed for a full day. The work demonstrates a wearable device for environmental health studies and addresses the challenges of existing sensors for real-world applications.

Trajectories of airway remodeling and functional impairment in asthma are consistent with the notion that airway pathology precedes or coincides with the onset of asthma symptoms and may be present at birth. An association between intrauterine growth restriction (IUGR) and asthma development has also been established, and there is value in understanding the underlying mechanism. This review considers airway pathophysiology as a consequence of IUGR that increases susceptibility to asthma.

Occupational use of cleaning chemicals has been related to asthma in adults. However, little information is available on the effect of non-occupational use of cleaning products during pregnancy on childhood asthma. This study examines the association between prenatal exposure to cleaning and scented products with childhood asthma, asthma symptoms, and mental and developmental comorbidities among low-income families in Karachi, Pakistan.Four hundred children from the Koohi Goth Women's Hospital were included in the study. Parents' or guardians reported current asthma, asthma-related symptoms, mental health problems, and behavioral problems among the children. Multivariable logistic regression analysis was used to examine the association between the use of cleaning and scented products during pregnancy and seven different outcome variables.The odds of nocturnal cough were significantly elevated among children whose mothers reported the use of cleaning productsThe study results indicate prenatal exposure to cleaning and scented products is associated with nocturnal cough among children. The study also suggests an association between prenatal use of scented products and mental health comorbidities among children.

The Australian AusPollen Partnership provides respiratory allergy patients with accurate, relevant and localised pollen information via smartphone Apps. This study aims to evaluate public perceptions of need and benefit of providing local pollen information. Individuals aged 18 years and older were contacted through AusPollen Smartphone Apps (Brisbane, Sydney, Canberra and Melbourne), Australian Society for Clinical Immunology and Allergy, Asthma Australia and social media. A pilot questionnaire was developed in consultation with partner organisations, including select questions drawn from the National Young People and Asthma Survey. The questionnaire consisted of four sections: participant demographics, allergic rhinitis and asthma symptoms, symptom management and App utility. One hundred and twenty-seven people completed the survey, of whom 53% had access to local pollen information. Most (97%) participants without access to local pollen information indicated that they wanted such a service. Pollen information was most commonly perceived by participants to be useful for prevention and avoidance as well as preparation and planning. This preliminary study identified a public demand for local pollen information. Users identified practical ways in which pollen information assisted them. Publicised pollen concentrations and forecasts have the potential to improve awareness of allergy triggers and empower patient self-management, reducing symptoms and burden of disease.

This study assesses the temporal trend of current asthma symptoms prevalence and associated factors in Chilean adolescents from South-Santiago, considering surveys performed in 1994, 2002 and 2015.The prevalence of current asthma symptoms showed a trend to increase from 11.1% in 1994 to 13.4% in 2015 (p0.001); physician-diagnosed asthma increased from 11.5% to 13.8%, (p0.001) whereas severe asthma and asthma with exercise decreased (p0.001). Female adolescents had a higher prevalence of current asthma in the three surveys (p0.001), and was a risk factor for asthma in the three surveys. In 2002, frequent consumption of meat and potatoes were associated with current asthma while frequent vigorous exercise was protective. Frequent exercise and parental tobacco smoking were risk for asthma in 2015 (p0.001). Current active tobacco smoking showed a trend to increase reaching a prevalence of 28.9% in 2015 (p0.001). There was a consistently low proportion of adolescents with current wheezing and asthma diagnosis (32.1% in 2015) and 37.6% of them had no asthma treatment.The prevalence of current asthma in adolescents from the studied area would be still increasing. As in other studies, female adolescents had a higher prevalence of current asthma. Current active tobacco smoking has strikingly increased in the studied children while indoor passive tobacco exposure remains inadmissibly high. Our findings suggest that asthma in children is underdiagnosed and undertreated. More attention should be given to female gender, tobacco exposure, air pollution and local diagnostic preferences when studying and interpreting trends of asthma prevalence in adolescents from developing localities.

Introducao: A asma e a doenca cronica das vias aereas que vem apresentando um aumento na sua prevalencia entre os adolescentes nas ultimas decadas. Os fatores relacionados com o seu desencadeamento sao inumeros, passando por fatores ambientais, geneticos, alimentares dentre outros. Objetivo: Analisar a prevalencia dos sintomas da asma e possiveis fatores de risco associados em adolescentes. Metodo: Trata-se de um estudo transversal, descritivo e quantitativo realizado em 104 adolescentes de 13 e 14 anos, de ambos os sexos, de quatro instituicoes de ensino: tres privadas e uma publica. Os participantes responderam a dois questionarios: um sobre os fatores de risco para doencas alergicas e o outro sobre os sintomas da asma (ISAAC modulo asma). Resultados: Responderam ao questionario 104 adolescentes: 54,8% meninas e 45,2% meninos. Os voluntarios do sexo masculino apresentaram mais asma ativa (64,%) que as voluntarias (20%) (p = 0,01) e tambem tiveram mais asma diagnosticada (34,4%) do que as voluntarias (6,1%) (p = 0,04), alem de mais chiado no peito apos exercicio (34,4%; 12,1%) (p = 0,03). Com relacao a associacao entre os sintomas e os fatores de riscos observou-se uma relacao estatisticamente significante entre presenca de sibilos e hospitalizacoes para as meninas de escolas publicas (p=0,05). Conclusao: Houve maior frequencia de adolescentes do sexo masculino com asma ativa, asma diagnostica e sibilos apos exercicio fisico. Por outro lado, as meninas da escola publica apresentaram um maior risco de hospitalizacao na presenca de sibilos. Os demais fatores de riscos nao apresentaram associacoes estatisticamente significantes com os sintomas da asma.

Introduction There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes associated with asthma. Methods We measured serum IL-4, IL-33, and IL-17, in 44 asthmatic and 26 healthy children, 5–15 years old. Their adherence to MD was estimated with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) score. Results KIDMED score did not differ between the two groups (P = 0.59) and was not correlated with any of the three measured cytokines. However, when the analysis was restricted only to asthmatic children, the KIDMED score was correlated with IL-4, IL-33, and IL-17 (Beta: −0.56, P = 0.007; Beta: 0.57, P = 0.010; Beta: −0.62, P = 0.017, respectively). Conclusion Our results indicate that MD can modulate the production of some of the main inflammatory mediators of asthma, in asthmatic children.

We investigated the possibility that having pharmacists give asthma patients informational sheets on climate and environmental changes at insurance pharmacies during patient counseling might prevent the worsening of asthma symptoms. Patients with hyperlipidemia were comparative subjects. We created informational sheets about climate and environmental changes and their influence on asthma. During patient counseling, pharmacists gave them to all asthma patients who visited insurance pharmacies over a period of 2 months, between November and December 2017. Based on previous studies, we called days which showed certain climate or environmental changes as compared to the previous day "change days". We compared the number of visiting patients on change days after preventative information was provided (between January and March 2018) with the number before information was provided (between January and March 2017). In addition, we compared those numbers with the number of patients who visited the target pharmacies between January and March 2016 in order to examine the influence of yearly climate change. The same procedure was used with hyperlipidemic patients. The number of visiting asthma patients after information was provided significantly decreased (5.1±2.1, p=0.03) compared with the number before information was provided, between January and March 2017 (6.1±2.8). The number of aforementioned visits compared to those between January and March 2016 also significantly decreased (p=0.01). Our results suggest that preventative information about climate and environmental changes provided by pharmacists during patient counseling might influence the number of asthma patient visits and prevent the exacerbation of their symptoms.

Background Fat intake has been associated with respiratory diseases, with conflicting results. Objective We studied the association between asthma and rhinitis with dietary fats, and their food sources in an Italian population. Methods Clinical and nutritional information was collected for 871 subjects (aged 20-84) from the population-based multi-case-control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles. Results Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR = 0.68, 95%CI: 0.48; 0.96; RRR = 0.69; 95%CI: 0.49; 0.97, per 10 g, respectively) and per-quartile analyses (p for trend = 0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR = 0.80; 95%CI: 0.65; 0.98 per 10 g). An increased risk of rhinitis was associated with moderate total fat and SFA intake. Conclusions High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.

The diagnosis of asthma in children under five years has been controversial due to changing concepts of what true asthma is in this age group. Previous diagnostic algorithms that used clinical indices to predict the persistence of asthma symptoms or phenotypes based on asthma triggers do not predict which children will benefit from asthma medication. A pragmatic approach to asthma diagnosis in this age group is based on identifying signs and symptoms of reversible airflow obstruction and documenting their response to asthma medication. Hopefully, this approach will provide clearer guidance to clinicians and improve asthma morbidity in these young children.

OBJECTIVE. Among high-risk, underserved populations, such as children living along the US-México border, suffering from asthma-like symptoms without an asthma diagnosis can result in a high burden of illness. We estimated the prevalence of physician-diagnosed and possible undiagnosed asthma among students with histories of wheezing in the US-México border community of El Paso, Texas and evaluated their burden of illness, primary care use, and medication utilization. METHODS. We analyzed cross-sectional survey data collected in May 2012. The survey included validated International Study of Asthma and Allergies in Childhood (ISAAC) items. We performed bivariate and logistic regression analyses on data from 307 students who wheezed. RESULTS. 42% of students had possible undiagnosed asthma and 58% had physician-diagnosed asthma based on primary caretaker reports. Children of Mexican origin were more likely to report undiagnosed vs. diagnosed asthma (p

Environmental exposure to endotoxin, Fel d I (cat) allergen and Der p I (house dust mite) allergen have been associated with asthma symptoms and have been measured in the environment using various sampling methods, including the electrostatic dust collector. The objectives of this study were to investigate whether levels of endotoxin and allergens were detectable in electrostatic dust collectors and to examine the correlation of allergen and endotoxin levels between electrostatic dust collectors and vacuum sampling methods (floor dust and mattress dust). Electrostatic cloths, bedroom floor dust and mattress dust samples from a subset of 60 homes were randomly selected from the Health of Occupants of Mouldy Homes study for allergen and endotoxin analysis. Fel d I and Der p I allergens were analyzed by double monoclonal antibody ELISA and endotoxin by the kinetic Limulus amoebocyte lysate assay. An enhanced ELISA method was used to analyze Der p I in the electrostatic cloths. Endotoxin was detected in all samples, however Fel d I and Der p I were not detected in all electrostatic dust collector samples (detection in 53% and 15% of cloths respectively). No correlations were found between cloth and dust samples for endotoxin or Der p I, but moderate-to-strong correlations were found between all three sampling methods for Fel d I (r

Particulate matter (PM) is a ubiquitous air pollutant that is a growing public health concern. Previous studies have suggested that PM is associated with asthma development and exacerbation of asthma symptoms. Although several studies have suggested increased risks of atopic dermatitis, allergic rhinitis, and allergic sensitization in relation to PM exposure, the evidence remains inconsistent. The plausible mechanisms underlying these effects are related to oxidative stress, enhancement of sensitization to allergens, inflammatory and immunological responses, and epigenetics. This review discusses the effect of PM on childhood allergic diseases, along with plausible mechanisms. Further studies are required to understand the role of PM exposure on childhood allergic diseases, to reduce these diseases in children.

Background Although bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management. Material and methods The study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included. Results In total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p, Bronchoalveolar lavage can help characterise severe asthma in children. However, it can be poorly tolerated and, in most cases, its impact on the patient's management remains limited. https://bit.ly/39XOlMt

Asthma symptoms impact children’s sleep quality. However, it is unclear how families’ daily management of their child’s asthma is associated with sleep quality. We examine associations between family asthma management components and sleep duration and quality for urban children (ages 7–9 years). Additionally, we examine these associations by racial/ethnic group. Data were collected as part of a longitudinal study that examined the co-occurrence of asthma, allergic rhinitis, sleep quality, and academic functioning for urban children diagnosed with persistent asthma ( N = 196). A semi-structured interview assessed family asthma management practices. Sleep quality data were collected via actigraphy. Our visual depiction of sleep outcomes show that those with higher family asthma management ratings present with longer sleep duration and better sleep quality. Among specific family asthma management components, we found a significant association between children’s adherence to asthma medications and number of nighttime awakenings. For non-Latino Black (NLB) children, we found a significant association between environmental control and sleep duration. For urban children with asthma, clinical strategies to enhance overall family asthma management have the potential to support improved sleep quality. Additionally, for NLB children, asthma management interventions that provide environmental control practices may increase sleep duration.

Background: Quantifying age trends in healthcare costs of pediatric asthma leads to better understanding of the natural history of the disease and informed decision-making on the allocation of healthcare resources. Methods: We identified children with incident asthma from the health administrative data of British Columbia, Canada (Jan 1998 to Dec 2015), and followed them from their first diagnosis of asthma or wheezing until age 18. We estimated direct medical costs (in 2016 Canadian dollars [$]), including inpatient and outpatient encounters and pharmacy costs, attributed to asthma (primary outcome) and other respiratory diseases (secondary outcome). We assessed the impact of sex and socioeconomic status on age trends, adjusting for calendar effect. Results: The final analysis included 44,552 children with asthma (62% boys). From age 0 to 18, costs of asthma/wheezing and other respiratory conditions decreased from $1,036 to $29/child-year, and from $1,145 to $31/child-year, respectively. Children under 3 years of age incurred 4–fold higher costs for asthma/wheezing and other respiratory conditions. In particular, costs of asthma hospitalizations were 10 times higher in this age group compared to older children. Age trends were generally similar between sex groups and across socioeconomic status. However, medication costs for asthma/wheezing decreased in boys, whereas those in girls declined during childhood but increased during adolescence. Conclusions: The highest costs of pediatric asthma are concentrated in children younger than 3. Age trends were generally consistent between sex and across socioeconomic status.

RESUMO:OBJETIVO: Comparar o controle postural de meninas adolescentes com e sem sintomas de asma, estudantes de uma escola pública, em um município da Fronteira Oeste do Rio Grande do Sul, Brasil. MÉTODOS: As meninas foram selecionadas através do questionário ISAAC (International Study of Asthma and Allergies in Childhood), que visa mostrar a prevalência de sintomas de asma, alergias e rinite. O mesmo é composto de 8 perguntas referentes aos sinais e sintomas e a última sobre diagnóstico, ao atingir a pontuação 5, o indivíduo pode ser considerado com sintomas de asma. O controle postural foi avaliado através de posturografia dinâmica computadorizada, por meio dos Testes de Organização Sensorial (TOS), divididos em seis condições sensoriais. RESULTADOS: Participaram do estudo 20 meninas de 10 anos de idade, sendo 10 do grupo controle (GC) e 10 crianças com sintomas de asma (GA). É possível observar que em ambos os grupos, o excesso de peso (sobrepeso+obesidade) esteve presente na maioria das avaliadas. As meninas com sintomas de asma apresentaram pior equilíbrio na condição II dos TOS (P=0,048), quando comparadas ao grupo assintomático, evidenciando assim, maior déficit no sistema proprioceptivo e vestibular. CONCLUSÃO: Meninas adolescentes com sintomas de asma apresentam déficit no controle postural, principalmente no sistema proprioceptivo e vestibular.

Background\ud Asthma is the most common chronic disease in children globally. The Global Asthma Network (GAN) Phase I study aimed to determine if the worldwide burden of asthma symptoms is changing.\ud Methods\ud This updated cross-sectional study used the same methods as the International study of Asthma and Allergies in Childhood (ISAAC) Phase III. Asthma symptoms were assessed from centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both. We included individuals from two age groups (children aged 6–7 years and adolescents aged 13–14 years) who self-completed written questionnaires at school. We estimated the 10-year rate of change in prevalence of current wheeze, severe asthma symptoms, ever having asthma, exercise wheeze, and night cough (defined by core questions in the questionnaire) for each centre, and we estimated trends across world regions and income levels using mixed-effects linear regression models with region and country income level as confounders.\ud Findings\ud Overall, 119 795 participants from 27 centres in 14 countries were included: 74 361 adolescents (response rate 90%) and 45 434 children (response rate 79%). About one in ten individuals of both age groups had wheeze in the preceding year, of whom almost half had severe symptoms. Most centres showed a change in prevalence of 2 SE or more between ISAAC Phase III to GAN Phase I. Over the 27-year period (1993–2020), adolescents showed a significant decrease in percentage point prevalence per decade in severe asthma symptoms (–0·37, 95% CI –0·69 to –0·04) and an increase in ever having asthma (1·25, 0·67 to 1·83) and night cough (4·25, 3·06 to 5·44), which was also found in children (3·21, 1·80 to 4·62). The prevalence of current wheeze decreased in low-income countries (–1·37, –2·47 to –0·27], in children and –1·67, –2·70 to –0·64, in adolescents) and increased in lower-middle-income countries (1·99, 0·33 to 3·66, in children and 1·69, 0·13 to 3·25, in adolescents), but it was stable in upper-middle-income and high-income countries.\ud Interpretation\ud Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.\ud Funding\ud International Union Against Tuberculosis and Lung Disease, Boehringer Ingelheim New Zealand, AstraZeneca Educational Grant, National Institute for Health Research, UK Medical Research Council, European Research Council, and Instituto de Salud Carlos III.