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Objective: Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations. Methods: The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: ≥4 times, medium: 2–3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers. Results: The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5–11 years (OR = 0.57, 95%CI = 0.35–0.93), longer LOS (2 days: OR = 1.80, 95%CI = 1.15–2.84; ≥3 days: OR = 3.38, 95%CI = 2.10–5.46), warm season at index admission (OR = 1.49, 95%CI = 1.01–2.20), and higher average ozone level in children's residential neighborhoods (OR = 1.78, 95%CI = 1.01–3.14) were significantly associated with a higher number of asthma hospitalizations. Conclusions: The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources. [ABSTRACT FROM AUTHOR]

Background: Fractional concentration of exhaled nitric oxide (FeNO) is recommended by the American Thoracic Society (ATS) as a noninvasive biomarker of airway inflammation. In addition to inflammation, many factors may be associated with FeNO, particularly tobacco exposure; however, only age has been included as an influential factor for children below 12 years. Numerous studies have demonstrated negative associations between tobacco exposure and FeNO levels with self-reported data, but few with an objective assessment of smoking. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012 were analyzed to examine the association between FeNO and active/passive tobacco. Exposure was assessed by both self-report and serum cotinine levels among 11,160 subjects aged 6–79 years old with asthma, or without any respiratory disease. Results: Study results indicated 28.8% lower FeNO, 95% CI [25.2%, 32.3%] and 38.1% lower FeNO, 95% CI: [28.1, 46.2] was observed among healthy and asthmatic participants with serum cotinine in the highest quartile compared to those in the lowest quartile, respectively. Self-reported smoking status and recent tobacco use were also associated with decreased FeNO. Self-reported passive smoking was significantly associated with a 1.0% decrease in FeNO 95% CI [0.0, 2.0] among asthmatic subjects but not among healthy subjects. Conclusions: Active smoking, whether measured by self-report or serum cotinine, was associated with decreased FeNO levels. In addition to age, increased attention should be given to tobacco exposure when using FeNO as a biomarker in clinical practice. Additional research is needed to establish reference value of FeNO considering the impact of tobacco exposure. [ABSTRACT FROM PUBLISHER]

An investigation of the relationship of air pollution and emergency department (ED) visits for asthma was an opportunity to assess environmental risks for asthma exacerbations in an urban population. A total of 6,979 individuals with a primary discharge diagnosis of asthma presented to 1 of 6 EDs in the Pittsburgh, Pennsylvania, area between 2002 and 2005. Using a case-crossover methodology, which controls for the effects of subject-specific covariates such as gender and race, a 2.5% increase was observed in asthma ED visits for each 10 ppb increase in the 1-hour maximum ozone level on day 2 (odds ratio [OR] = 1.025, p < .05). Particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) had an effect both on the total population on day 1 after exposure (1.036, p < .05), and on African Americans on days 1, 2, and 3. PM2.5 had no significant effect on Caucasian Americans alone. The disparity in risk estimates by race may reflect differences in residential characteristics, exposure to ambient air pollution, or a differential effect of pollution by race. [ABSTRACT FROM AUTHOR]