Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen.

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0-14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014-1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010-1.013; RR = 1.002, 95% CI = 1.001-1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities

Association Between Fire-Related Particulate Matter Exposure and Childhood Asthma in Peru: A Burden of Disease Assessment

We explore the connection between exposure to particulate matter from forest fire emissions in the Peruvian Amazon and pediatric asthma incidence. The bulk of research and media coverage surrounding the Amazon Rainforest fires has focused on important environmental issues, yet the direct impact that these fires have on the health of children living nearby remains underexplored. We conducted a burden of disease assessment using publicly available data to estimate the number of incident pediatric asthma cases attributable to long term exposure to ambient particulate matter smaller than 2.5 microns (PM2.5) resulting from increased forest fires in the Peruvian Amazon. Our model compares pediatric asthma burden that would have resulted from a more “typical'' fire year, such as 2009, with that from 2016, a severe fire year, by applying PM2.5 concentrations from each of those years to the same 2016 population. We estimate that 75,160 (95 % CI 28,638, 121,682) pediatric asthma cases in 2016 were attributable to PM2.5, whereas counterfactually applying the 2009 PM2.5 concentrations would have resulted in 9,636 (95 % CI 5,657, 13,615) fewer attributable cases. Thus, our results suggest that increased forest fire emissions have led to a notable increase in pediatric asthma burden in Peru

Point of Care Spirometry Assessment for Pediatric Asthma Prevalence in a Family Homeless Shelter in Omaha, Nebraska

Abstract: Introduction: The few studies on pediatric asthma in US homeless shelters describe a 27.9 – 39.8% prevalence, and historically Omaha has had a high incidence of fatal pediatric asthma. Thereby, Clarkson Family Medicine (CFM) residency began a pediatric asthma outreach to a local family-homeless shelter to assess the prevalence of pediatric asthma and follow-up appointment attendance. Methods: We obtained a voluntary parent-child assessment of the child’s respiratory history and an Asthma Control Test (ACT) between ages 4-18 for children residing at the family-homeless shelter. We obtained a pre-albuterol and post-albuterol mobile spirometer assessment using the Global Initiative for Asthma (GINA) guidelines. If spirometry failed, peak-flow measurements were obtained per Global Initiative for Asthma (GINA) guidelines. Results: Nine of 25 children had active reversible airways (36%, Confidence Intervals 22-66%). One-third had a previous asthma diagnosis,20% post-peak-flow reversibility. Six of seven follow-up appointments did not show up. Conclusion: Pediatric asthma in an Omaha homeless shelter mirrors shelters in other major US cities like New York City and Minneapolis. This study may suggest that using the Asthma Control Test with pre-albuterol and post-albuterol peak flow measurements is an acceptable screening method for pediatric asthma in family-homeless shelters. Abbreviations: Open Door Mission (ODM), Asthma Control Test (ACT), Global Initiative for Asthma (GINA), United States (US), pulmonary function tests (PFT), New York City (NYC), peak expiratory flow (PEF)

Pediatric asthma and autism-genomic perspectives.

High-throughput technologies, ranging from microarrays to NexGen sequencing of RNA and genomic DNA, have opened new avenues for exploration of the pathobiology of human disease. Comparisons of the architecture of the genome, identification of mutated or modified sequences, and pre-and post- transcriptional regulation of gene expression as disease specific biomarkers are revolutionizing our understanding of the causes of disease and are guiding the development of new therapies. There is enormous heterogeneity in types of genomic variation that occur in human disease. Some are inherited, while others are the result of new somatic or germline mutations or errors in chromosomal replication. In this review, we provide examples of changes that occur in the human genome in two of the most common chronic pediatric disorders, autism and asthma. The incidence and economic burden of both of these disorders are increasing worldwide. Genomic variations have the potential to serve as biomarkers for personalization of therapy and prediction of outcomes

Association between pediatric asthma and adult polycystic ovarian syndrome (PCOS): a cross-sectional analysis of the UAE healthy future Study (UAEHFS)

Asthma and polycystic ovarian syndrome (PCOS) are linked in several possible ways. To date, there has been no study evaluating whether pediatric asthma is an independent risk factor for adult PCOS. Our study aimed to examine the association between pediatric asthma (diagnosed at 0-19 years) and adult PCOS (diagnosed at ≥20 years). We further assessed whether the aforementioned association differed in two phenotypes of adult PCOS which were diagnosed at 20-25 years (young adult PCOS), and at \u3e25 years (older adult PCOS). We also evaluated whether the age of asthma diagnosis (0-10 vs 11-19 years) modified the association between pediatric asthma and adult PCOS. This is a retrospective cross-sectional analysis using the United Arab Emirates Healthy Future Study (UAEHFS) collected from February 2016 to April 2022 involving 1334 Emirati females aged 18-49 years. We fitted a Poisson regression model to estimate the risk ratio (RR) and its 95% confidence interval (95% CI) to assess the association between pediatric asthma and adult PCOS adjusting for age, urbanicity at birth, and parental smoking at birth. After adjusting for confounding factors and comparing to non-asthmatic counterparts, we found that females with pediatric asthma had a statistically significant association with adult PCOS diagnosed at ≥20 years (RR=1.56, 95% CI: 1.02-2.41), with a stronger magnitude of the association found in the older adult PCOS phenotype diagnosed at \u3e25 years (RR=2.06, 95% CI: 1.16-3.65). Further, we also found females reported thinner childhood body size had a two-fold to three-fold increased risk of adult PCOS diagnosed at ≥20 years in main analysis and stratified analyses by age of asthma and PCOS diagnoses (RR=2.06, 95% CI: 1.08-3.93 in main analysis; RR=2.74, 95% CI: 1.22-6.15 among those diagnosed with PCOS \u3e 25 years; and RR=3.50, 95% CI: 1.38-8.43 among those diagnosed with asthma at 11-19 years). Pediatric asthma was found to be an independent risk factor for adult PCOS. More targeted surveillance for those at risk of adult PCOS among pediatric asthmatics may prevent or delay PCOS in this at-risk group. Future studies with robust longitudinal designs aimed to elucidate the exact mechanism between pediatric asthma and PCOS are warranted

Pediatric Asthma

Effective management of asthma will improve pediatric patient quality of life. This may be achieved through the prevention of asthma exacerbations by continuous pediatric and guardian/parent education to proper inhaler technique, appropriate medication management and the avoidance of environmental triggers. These modalities may prevent trips to the emergency department, hospital admissions and the pediatric patient can avoid missing days from school

Massachusetts Prevention and Wellness Trust Fund

The Prevention and Wellness Trust Fund (PWTF) of Massachusetts healthcare reform legislation (Section 60 of Chapter 224of the Acts of 2012) seeks to "reduce health care costs by preventing chronic conditions." It is designed to address four priority chronic conditions including pediatric asthma. The pediatric asthma program activities include Care Management for High-Risk Asthma Patients; Home-Based Multi-Trigger, Multi-Component Intervention (minimum of three home visits, asthma self-management and education, trigger remediation supplies, environmental services); Comprehensive SchoolBased Asthma Management Programs; Comprehensive Head Start-Based Asthma Management Programs; and Asthma Self-Management in Primary Care. In 2014, nine communities have been funded to be PWTF sites: Six offer pediatric asthma interventions, and five have initiated home-based asthma visits.

Implementing pediatric inpatient asthma pathways.

ObjectivePathways are succinct, operational versions of evidence-based guidelines. Studies have demonstrated pathways improve quality of care for children hospitalized with asthma, but we have limited information on other key factors to guide hospital leaders and clinicians in pathway implementation efforts. Our objective was to evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways.MethodsThis was a mixed-methods study of hospitals participating in a national collaborative to implement pathways. Data sources included electronic surveys of implementation leaders and staff, field observations, and chart review of children ages 2-17 years admitted with a primary diagnosis of asthma. Outcomes included adoption by hospitals, pathway implementation factors, and reach of pathways to children hospitalized with asthma. Quantitative data were analyzed using descriptive statistics and multivariable regression. Qualitative data were analyzed using thematic content analysis.ResultsEighty-five hospitals enrolled; 68 (80%) adopted/completed the collaborative. These 68 hospitals implemented pathways with overall high fidelity, implementing a median of 5 of 5 core pathway components (Interquartile Range [IQR] 4-5) in a median of 5 months (IQR 3-9). Implementation teams reported a median time cost of 78 h (IQR: 40-120) for implementation. Implementation leaders reported the values of pathway implementation included improvements in care, enhanced interdisciplinary collaboration, and access to educational resources. Leaders reported barriers in modifying electronic health records (EHRs), and only 63% of children had electronic pathway orders placed.ConclusionsHospitals implemented pathways with high fidelity. Barriers in modifying EHRs may have limited the reach of pathways to children hospitalized with asthma

Impact of COVID-19 on Pediatric Asthma : Practice Adjustments and Disease Burden

BACKGROUND: It is unclear whether asthma may affect susceptibility or severity of coronavirus disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic. OBJECTIVE: To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients. METHODS: An online survey was sent to members of the Pediatric Asthma in Real Life think tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden, and the clinical course of confirmed cases of COVID-19 infection among children with asthma. RESULTS: Ninety-one respondents, caring for an estimated population of more than 133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, and 75% limited patients' visits. Consultations were almost halved to a median of 20 (interquartile range, 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10%-40%) of patients, whereas control was negatively affected in only 10% (7.5%-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts. CONCLUSIONS: Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters. (C) 2020 American Academy of Allergy, Asthma & Immunology.Peer reviewe