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    The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research. Bédard Annabelle,Li Zhen,Ait-Hadad Wassila,Camargo Carlos A,Leynaert Bénédicte,Pison Christophe,Dumas Orianne,Varraso Raphaëlle International journal of environmental research and public health The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the "diet, physical activity and body composition" triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research. 10.3390/ijerph18063013
    Complementary and alternative medicine use in children with asthma. Yildiz Yasin,Yavuz Ayten Yilmaz Complementary therapies in clinical practice OBJECTIVE:Complementary and Alternative Medicine (CAM) is increasingly used in the treatment of asthma in children. In the studies conducted, it was stated that there was a standardization problem in CAM methods. Moreover, this situation raises the question of "Which is the most widely used CAM method?" in asthma treatment. This study aimed to determine the use of CAM methods in children who are followed up with the diagnosis of asthma. MATERIAL AND METHODS:The patients aged 4-10 years who were diagnosed with asthma by a physician in the past and who admitted to the Child Health and Diseases Polyclinic of a hospital issuing tertiary health service in Turkey were included in the study. The demographic data of patients and CAM methods used were examined. RESULTS:The median age of a total of 164 asthmatic children included in the study was 6.3 (4-10) years, and 58.3% of them were observed to be male. The median time to diagnosis of the patients was 2.0 (1; 105) months, mostly having multiple cough attacks per day (33.1%), and the rate of children with cough attacks at least once a month to awaken from sleep at night was 47.6%. Honey (36.6%) was found to be one of the most preferred biological-based therapies for families and was followed by molasses (16.9%), which were derived from herbal and natural products. CONCLUSIONS:There are varying rates of CAM use in asthmatic children all over the world, and it was found that honey was used the most in our study. Atopy can be found in the etiology of asthmatic patients. Therefore, it should not be forgotten that using different CAM methods at the same time may pose a risk. 10.1016/j.ctcp.2021.101353
    The association of co-morbid asthma and overweight/obese status with healthcare utilization and caregiver perception of health in children 4-17 years, an NHANES study. Hong Houlin,Hou Wei,Kaur Sharanjit,Bianchi-Hayes Josette M The Journal of asthma : official journal of the Association for the Care of Asthma OBJECTIVE:Asthma and obesity are two of the most common chronic childhood illnesses. The purpose of this study was to better understand the relationship between co-morbid asthma and obesity in children aged 4 to 17 and whether it impacts the caregiver's perception of health and/or healthcare utilization. METHODS:This was a secondary analysis of the National Health and Nutrition Examination Surveys (NHANES) datasets from 2007-2018. Cumulative logistic regression models were used to analyze the caregiver's perception of health, received healthcare, and overnight hospital stay as dependent variables. Asthma and weight status were included as covariates, with adjustment for age, income, head of the household's education, gender, race, and insurance. RESULTS:The sample included 15,386 children. When looking at weight status in addition to asthma, compared to caregivers of children with current asthma and normal weight, caregivers of children with current asthma and with obesity are more likely to perceive their children as having worse health (OR =1.73, 95%CI = [1.30, 2.32], p = 0.0003), and are more likely to have more frequent healthcare utilization but the results did not reach a statistical significance. CONCLUSIONS:Caregiver's perception of overall health was worse in caregivers of those with co-morbid obesity/asthma than in caregivers of children with asthma alone. This indicates that caregivers of children with co-morbid asthma and obesity have insight into their children's condition and may be primed for discussion and counseling in the healthcare setting. 10.1080/02770903.2021.1914651
    Asthma in children and adolescents: the ControL'Asma project. Licari Amelia,Ciprandi Giorgio,Marseglia Gian Luigi,Silvestri Michela,Tosca Maria Angela,Anastasio Elisa,Brambilla Ilaria,Caffarelli Carlo,Castagnoli Riccardo,Chini Loredana,Ciprandi Riccardo,De Vittori Valentina,Duse Marzia,Di Cicco Maria Elisa,Indinnimeo Luciana,Kantar Ahmad,Leone Maddalena,Marinelli Guido,Moschese Viviana,Olcese Roberta,Peroni Diego G,Pistorio Angela,Salmaso Claudia,Zicari Anna Maria Acta bio-medica : Atenei Parmensis The control of asthma is the objective of asthma management. However, it is difficult to obtain in clinical practice. The Italian Society of Allergy and Clinical Immunology promoted the nationwide project "ControL'Asma" to investigate the real situation in a group of children and adolescents with asthma. The preliminary outcomes demonstrated that many asthmatic subjects do not achieve adequate asthma control. Moreover, asthma in Italian children and adolescents was usually more frequent in males, had an early onset and allergic phenotype with very frequent rhinitis comorbidity, uncontrolled and partly controlled asthma affected about the half of subjects. However, this project suggested that the assessment of asthma symptom perception by VAS could be a reliable tool in the asthma management. 10.23750/abm.v91i11-S.10295
    Childhood Allergies: The Role of Maternal Depression and Anxiety, and Family Strain. Wan Ming Wai,Janta-Lipinski Molly,Osam Cemre Su Children (Basel, Switzerland) Maternal mental disorder and a negative family emotional climate are a great source of stress for many children, yet their role in the childhood development or expression of asthma and allergies remains poorly understood, particularly beyond the first 1-2 years of life. The current study tested whether childhood allergy onset and symptomatology would be predicted by (1) perinatal and any time exposure to maternal depression or anxiety and (2) current family emotional strain (whole family, mother-child). UK mothers of children aged 2-12 years (N = 328) living with them completed an online survey of measures. Children exposed to maternal depression were almost twice as likely to be diagnosed and almost five times as likely to screen positive for an allergic disorder. Perinatal depression was linked to childhood allergies, but more moderately. Any anxiety exposure, and not specific to the perinatal period, predicted allergy status. Family emotional strain contributed independently to variance in concurrent child allergic symptomatology. All results were independent of potential confounders and current mental distress. The findings highlight the importance of maternal mental health and family function in the child's neuro-immune development, and that these factors need to be addressed in the treatment of childhood allergic disorders. 10.3390/children8030185
    Sleep and Asthma Management in Youth with Poorly-Controlled Asthma and Their Caregivers: A Qualitative Approach. Evans Corinne,Fidler Andrea,Baker Dawn,Wagner Mary,Fedele David The Journal of asthma : official journal of the Association for the Care of Asthma Youth with poorly-controlled asthma are at increased risk for sleep disturbances caused by nocturnal symptoms like coughing. Asthma-related sleep disturbances can have downstream consequences for youth with asthma and their families. This study aims to describe 1) sleep disturbances in adolescents with poorly-controlled asthma and their caregivers and 2) the relationship between sleep and asthma management.Adolescents with poorly-controlled asthma and their caregivers completed the Family Asthma Management System Scale (FAMSS), a semi-structured interview that assesses youth asthma management within the family context. Interviews were audio-recorded and transcribed. Two authors coded each transcript for sleep-related data in NVivo using descriptive content analysis.Thirty-three adolescents ages 12-15 years old ( = 13.2,  = 1.2) with poorly-controlled asthma and their caregivers participated in this study. Four main themes emerged: sleep difficulties, sleep environment, sleep and self-management, and fatigue and self-management. 42% of youth and caregivers reported worse nocturnal asthma symptoms (e.g., coughing) that caused frequent nighttime awakening. Approximately 27% of caregivers expressed distress over their child's nocturnal asthma and described their management strategies (e.g., co-sleeping, nighttime symptom monitoring). Adolescents described sleepiness as a barrier to asthma self-management tasks (e.g., medication adherence, response to exacerbation).Interview responses demonstrated the considerable interrelationship of sleep and asthma management in adolescents with poorly-controlled asthma. Asthma providers should consider discussing sleep difficulties with their adolescent patients and their families. Addressing these difficulties may help adolescents improve their asthma self-management and help caregivers better cope with their child's disease. 10.1080/02770903.2021.1914650
    Exposure to formaldehyde and asthma outcomes: A systematic review, meta-analysis, and economic assessment. Lam Juleen,Koustas Erica,Sutton Patrice,Padula Amy M,Cabana Michael D,Vesterinen Hanna,Griffiths Charles,Dickie Mark,Daniels Natalyn,Whitaker Evans,Woodruff Tracey J PloS one BACKGROUND:Every major federal regulation in the United States requires an economic analysis estimating its benefits and costs. Benefit-cost analyses related to regulations on formaldehyde exposure have not included asthma in part due to lack of clarity in the strength of the evidence. OBJECTIVES:1) To conduct a systematic review of evidence regarding human exposure to formaldehyde and diagnosis, signs, symptoms, exacerbations, or other measures of asthma in humans; and 2) quantify the annual economic benefit for decreases in formaldehyde exposure. METHODS:We developed and registered a protocol in PROSPERO (Record ID #38766, CRD 42016038766). We conducted a comprehensive search of articles published up to April 1, 2020. We evaluated potential risk of bias for included studies, identified a subset of studies to combine in a meta-analysis, and rated the overall quality and strength of the evidence. We quantified economics benefit to children from a decrease in formaldehyde exposure using assumptions consistent with EPA's proposed formaldehyde rule. RESULTS:We screened 4,821 total references and identified 150 human studies that met inclusion criteria; of these, we focused on 90 studies reporting asthma status of all participants with quantified measures of formaldehyde directly relevant to our study question. Ten studies were combinable in a meta-analysis for childhood asthma diagnosis and five combinable for exacerbation of childhood asthma (wheezing and shortness of breath). Studies had low to probably-low risk of bias across most domains. A 10-μg/m3 increase in formaldehyde exposure was associated with increased childhood asthma diagnosis (OR = 1.20, 95% CI: [1.02, 1.41]). We also found a positive association with exacerbation of childhood asthma (OR = 1.08, 95% CI: [0.92, 1.28]). The overall quality and strength of the evidence was rated as "moderate" quality and "sufficient" for asthma diagnosis and asthma symptom exacerbation in both children and adults. We estimated that EPA's proposed rule on pressed wood products would result in 2,805 fewer asthma cases and total economic benefit of $210 million annually. CONCLUSION:We concluded there was "sufficient evidence of toxicity" for associations between exposure to formaldehyde and asthma diagnosis and asthma symptoms in both children and adults. Our research documented that when exposures are ubiquitous, excluding health outcomes from benefit-cost analysis can underestimate the true benefits to health from environmental regulations. 10.1371/journal.pone.0248258
    Household mold exposure interacts with inflammation-related genetic variants on childhood asthma: a case-control study. Zhang Yu,Hua Li,Liu Quan-Hua,Chu Shu-Yuan,Gan Yue-Xin,Wu Min,Bao Yi-Xiao,Chen Qian,Zhang Jun BMC pulmonary medicine BACKGROUND:A number of studies have examined the association between mold exposure and childhood asthma. However, the conclusions were inconsistent, which might be partly attributable to the lack of consideration of gene function, especially the key genes affecting the pathogenesis of childhood asthma. Research on the interactions between genes and mold exposure on childhood asthma is still very limited. We therefore examined whether there is an interaction between inflammation-related genes and mold exposure on childhood asthma. METHODS:A case-control study with 645 asthmatic children and 910 non-asthmatic children aged 3-12 years old was conducted. Eight single nucleotide polymorphisms (SNPs) in inflammation-related genes were genotyped using MassARRAY assay. Mold exposure was defined as self-reported visible mold on the walls. Associations between visible mold exposure, SNPs and childhood asthma were evaluated using logistic regression models. In addition, crossover analyses were used to estimate the gene-environment interactions on childhood asthma on an additive scale. RESULTS:After excluding children without information on visible mold exposure or SNPs, 608 asthmatic and 839 non-asthmatic children were included in the analyses. Visible mold exposure was reported in 151 asthmatic (24.8%) and 119 non-asthmatic children (14.2%) (aOR 2.19, 95% CI 1.62-2.97). The rs7216389 SNP in gasdermin B gene (GSDMB) increased the risk of childhood asthma with each C to T substitution in a dose-dependent pattern (additive model, aOR 1.32, 95% CI 1.11-1.57). Children carrying the rs7216389 T allele and exposed to visible mold dramatically increased the risk of childhood asthma (aOR 3.21; 95% CI 1.77-5.99). The attributable proportion due to the interaction (AP: 0.47, 95% CI 0.03-0.90) and the relative excess risk due to the interaction (RERI: 1.49, 95% CI 0-2.99) were statistically significant. CONCLUSIONS:In the present study, there was a significant additive interaction between visible mold exposure and rs7216389 SNP on childhood asthma. Future studies need to consider the gene-environment interactions when exploring the risk factors of childhood asthma. 10.1186/s12890-021-01484-9
    Novel Machine Learning Can Predict Acute Asthma Exacerbation. Zein Joe G,Wu Chao-Ping,Attaway Amy H,Zhang Peng,Nazha Aziz Chest BACKGROUND:Asthma exacerbations result in significant health and economic burden, but are difficult to predict. RESEARCH QUESTION:Can machine learning (ML) models with large-scale outpatient data predict asthma exacerbations? STUDY DESIGN AND METHODS:We analyzed data extracted from electronic health records (EHRs) of asthma patients treated at the Cleveland Clinic from 2010 through 2018. Demographic information, comorbidities, laboratory values, and asthma medications were included as covariates. Three different models were built with logistic regression, random forests, and a gradient boosting decision tree to predict: (1) nonsevere asthma exacerbation requiring oral glucocorticoid burst, (2) ED visits, and (3) hospitalizations. RESULTS:Of 60,302 patients, 19,772 (32.8%) had at least one nonsevere exacerbation requiring oral glucocorticoid burst, 1,748 (2.9%) requiring and ED visit and 902 (1.5%) requiring hospitalization. Nonsevere exacerbation, ED visit, and hospitalization were predicted best by light gradient boosting machine, an algorithm used in ML to fit predictive analytic models, and had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.70-0.72), 0.88 (95% CI, 0.86-0.89), and 0.85 (95% CI, 0.82-0.88), respectively. Risk factors for all three outcomes included age, long-acting β agonist, high-dose inhaled glucocorticoid, or chronic oral glucocorticoid therapy. In subgroup analysis of 9,448 patients with spirometry data, low FEV and FEV to FVC ratio were identified as top risk factors for asthma exacerbation, ED visits, and hospitalization. However, adding pulmonary function tests did not improve models' prediction performance. INTERPRETATION:Models built with an ML algorithm from real-world outpatient EHR data accurately predicted asthma exacerbation and can be incorporated into clinical decision tools to enhance outpatient care and to prevent adverse outcomes. 10.1016/j.chest.2020.12.051
    The effect of a cow's milk-free diet on asthma control in children: a quasi-experimental study. Darougar Sepideh,Mansouri Mahboubeh,Hassani Solmaz,Sohrabi Mohammad Reza,Hashemitari Paniz American journal of clinical and experimental immunology BACKGROUND:Food allergy which usually develops in the first year of life is a risk factor for persistent asthma in young children. Cow's milk has been demonstrated to be the most commonly identified food allergen in children. Considering the central role of non-IgE-mediated food allergies in the development of hidden gastroesophageal reflux and consequently asthma, we evaluated the effect of eliminating food allergens to better control asthma. METHOD:A total of eighty infants and children up to the age of 12 referred to the Asthma Clinic of Mofid Children Hospital for a period of one year were enrolled in this study. In those patients whose asthma remained uncontrolled (Childhood Asthma Control Test ≤19) despite a 2-week period of treatment, we advocated a 2-week-diet based on eliminating cow's milk in conjunction with asthma conventional therapy. For breast-fed infants, mothers were requested to eliminate these products from their daily intake regimens and for formula-fed infants, the elemental based formula was started. RESULTS:Three of the patients were lost in follow-up and six of them were excluded from the study because of non-compliance. The Asthma Control Test score which was less than or equal to 19 in the entire study population, increased to 20 or more after we began a diet based on the elimination of cow's milk in all but 13 participants. CONCLUSION:To conclude, the results were promising, demonstrating that a cow's milk protein elimination diet is a prudent approach in the management of patients with recalcitrant asthma, and can be considered as the missing link in asthma treatment.