Environmental risk factors for respiratory infection and wheeze in young children:A multicentre birth cohort study

introduction: Respiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood.Methods: Environmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO-CHILD multicentre prospective birth cohort study. Follow-up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.Results: Follow-up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04-5.49), bronchiolitis (OR = 1.40, 1.02-1.90), otitis media (OR = 1.68, 1.32-2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17-2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39-0.77) and otitis media (OR = 0.75, 0.59-0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18-2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02-1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11-3.19), and risk of reliever inhaler (RR = 1.73, 1.04-2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03-6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11-2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08-2.29).Conclusion: Environmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.</p

Filaggrin gene defects are associated with eczema, wheeze, and nasal disease during infancy:Prospective study

This prospective cohort study describes associations between the presence of filaggrin gene mutations and eczema, rhinitis and wheeze from as early as age six months, raising new questions regarding underlying mechanisms and timing of interventions

Pharmacogenomic associations of adverse drug reactions in asthma: systematic review and research prioritisation

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

Visible damp in a child’s bedroom is associated with increased respiratory morbidity in early life: a multicentre cohort study

Peer reviewed: TrueFunder: SparksFunder: Brighton and Sussex Medical SchoolFunder: Rockinghorse Children's CharityObjectiveHousehold damp exposure is an important public health issue. We aimed to assess the impact of the location of household damp on respiratory outcomes during early life.MethodsHousehold damp exposure was ascertained in children recruited to the GO-CHILD multicentre birth cohort study. The frequency of respiratory symptoms, infections, healthcare utilisation and medication prescription for wheezing were collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.ResultsFollow-up was obtained in 1344 children between August 2010 and January 2016. Visible damp was present in a quarter of households (25.3%) with 1 in 12 children’s bedrooms affected (8.3%). Damp in the bathroom, kitchen or living room was not associated with any respiratory or infection-related outcomes. Damp in the child’s bedroom was associated with an increased risk of dry cough (8.7% vs 5.7%) (adjusted relative risk 1.56, 95% CI 1.07 to 2.27; p=0.021) and odds of primary care attendance for cough and wheeze (7.6% vs 4.4%) (adjusted OR 1.37, 95% CI 1.07 to 1.76; p=0.009). There were also increased risk of inhaled corticosteroid (13.3% vs 5.9%) (adjusted RR 2.22, 95% CI 1.04 to 4.74; p=0.038) and reliever inhaler (8.3% vs 5.8%) (adjusted RR 2.01, 95% CI 1.21 to 2.79; p=0.018) prescription.ConclusionDamp in the child’s bedroom was associated with increased respiratory morbidity. In children presenting with recurrent respiratory symptoms, clinicians should enquire about both the existence and location of damp, the presence of which can help prioritise those families requiring urgent household damp assessment and remediation works.</jats:sec

Environmental risk factors for respiratory infection and wheeze in young children: A multicentre birth cohort study

Funder: Brighton and Sussex University Hospitals NHS TrustFunder: Brighton and Sussex Medical SchoolFunder: SparksFunder: Rockinghorse Children's CharityAbstractIntroductionRespiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood.MethodsEnvironmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO‐CHILD multicentre prospective birth cohort study. Follow‐up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.ResultsFollow‐up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04−5.49), bronchiolitis (OR = 1.40, 1.02−1.90), otitis media (OR = 1.68, 1.32−2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17−2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39−0.77) and otitis media (OR = 0.75, 0.59−0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18−2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02−1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11−3.19), and risk of reliever inhaler (RR = 1.73, 1.04−2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03−6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11−2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08−2.29).ConclusionEnvironmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.</jats:sec

Mannose-binding lectin genotype is associated with respiratory disease in young children:a multi-centre cohort study

Background Mannose binding lectin (MBL) is an important component of the innate immune system. Polymorphisms in the MBL2 gene and promoter region are directly associated with MBL-deficiency. We sought to determine the association between MBL genotype on the frequency of common childhood respiratory infections, respiratory symptoms, and atopic outcomes in early childhood. Methods MBL2 gene variants were analysed in newborns recruited to the GO-CHILD multi-centre prospective cohort study. Follow-up for respiratory infection and atopy diagnoses and symptoms, healthcare utilisation and medication prescription were conducted by postal questionnaires at 12 and 24-months. Results Genotyping and follow-up were completed in 1004 children. Genotypes associated with MBL-deficiency were associated with an increased risk of bronchiolitis (relative risk (RR) 1.95, 95%CI 1.33-2.85)) and pneumonia (RR 2.46, 95%CI 1.16-5.22). MBL-deficient genotypes were associated with an increased risk of wheeze with shortness of breath episodes (RR 1.22, 95%CI 1.04-1.43), emergency department attendance (RR 1.90 95%CI 1.13-3.19) and hospital admission (RR 2.01, 95%CI 1.04-3.89) for wheeze. MBL-deficient genotypes were associated with a reduced risk of developing atopic dermatitis (RR 0.72, 95%CI 0.53-0.98). Conclusion The positive association between MBL-deficient genotypes and bronchiolitis and pneumonia, as well as a severe wheeze phenotype in some young children, supports the hypothesis that MBL is an important component of innate immunity in the vulnerable period prior to the maturation of the adaptive immune system. Identification of disease modifying genotypes may help target preventative strategies in high-risk infants. This article is protected by copyright. All rights reserved

Environmental risk factors for respiratory infection and wheeze in young children: a multi-centre birth cohort study

IntroductionRespiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood.MethodsEnvironmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO-CHILD multicentre prospective birth cohort study. Follow-up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data.ResultsFollow-up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04−5.49), bronchiolitis (OR = 1.40, 1.02−1.90), otitis media (OR = 1.68, 1.32−2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17−2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39−0.77) and otitis media (OR = 0.75, 0.59−0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18−2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02−1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11−3.19), and risk of reliever inhaler (RR = 1.73, 1.04−2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03−6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11−2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08−2.29).ConclusionEnvironmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.</p

Correction: Pharmacogenomic associations of adverse drug reactions in asthma: systematic review and research prioritization (The Pharmacogenomics Journal, (2020), 10.1038/s41397-019-0140-y)

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