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Abstract Objectives Asthma can be triggered by various factors due to different etiologies. Environmental factors remain a common trigger of asthma, especially amongst children, and such ambient exposures can be harder to avoid compared to behavioral triggers. As such, the contribution of environmental factors may be enhanced when considering repeat asthma cases compared to initial presentations. To test this hypothesis, we assessed associations between ambient temperature and hospital admissions for asthma in Hong Kong and stratified admission records into first and repeat asthma hospitalizations. Methods The daily number of asthma hospitalizations among children aged 0–5 years in Hong Kong during 2007–2011 was regressed on daily mean temperature using distributed lagged nonlinear models, with adjustment for seasonal patterns, day-of-week effects, and other meteorological factors and air-pollutants. Analyses were stratified by summer/winter and by type of admission (first admission and repeated admission). Results About 33% of the 12284 asthma hospitalizations were repeat admissions. Repeat admissions demonstrated higher sensitivity to high temperature in the summer. During this period, high temperatures were associated with increased risk of repeat admission but not with first admissions: RR (95% CI) comparing 31 °C vs. 29 °C across lags 0–15 days was 3.40 (1.26, 9.18) and 0.74 (0.31, 1.77) for repeat and first admissions respectively. In the cold season, all admissions increased with falls in temperature, with slightly stronger associations apparent for repeat admissions compared to first admission: 1.20 (1.00, 1.44) vs. 1.10 (0.96, 1.26) respectively comparing risk at 15 °C vs. 12 °C across lags 0–5 days. Conclusions To our knowledge, this is the first study to show stronger associations between ambient temperature and repeat asthma admissions compared to first admissions. The higher sensitivity among those experiencing repeat admissions may allow for more personalized disease management. Given the substantial differences in associations by admission type, future studies of ambient exposures on asthma should consider analyzing the two groups separately. Highlights • About 33% of childhood asthma admissions among the study population were repeat admission cases. • Repeat admissions cases were found significantly more sensitive to high temperature than first admissions. • This study suggested combining first- and repeat- asthma cases in temperature-asthma study may bias the association, in particular under high temperature. [ABSTRACT FROM AUTHOR]

Perfluoroalkyl substances (PFASs) are highly persistent chemicals that might be associated with asthma and allergy, but the associations remain unclear. Therefore, this study examined whether pre- and postnatal PFAS exposure was associated with childhood asthma and allergy. Measles, mumps, and rubella (MMR) vaccination in early life may have a protective effect against asthma and allergy, and MMR vaccination is therefore taken into account when evaluating these associations. In a cohort of Faroese children whose mothers were recruited during pregnancy, serum concentrations of five PFASs – Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) – were measured at three timepoints (maternal serum in pregnancy week 34–36 and child serum at ages 5 and 13 years) and their association with immunoglobulin E (IgE) (cord blood and at age 7 years) and asthma/allergic diseases (questionnaires at ages 5 and 13 years and skin prick test at age 13 years) was determined. A total of 559 children were included in the analyses. Interactions with MMR vaccination were evaluated. Among 22 MMR-unvaccinated children, higher levels of the five PFASs at age 5 years were associated with increased odds of asthma at ages 5 and 13. The associations were reversed among MMR-vaccinated children. Prenatal PFAS exposure was not associated with childhood asthma or allergic diseases regardless of MMR vaccination status. In conclusion, PFAS exposure at age 5 was associated with increased risk of asthma among a small subgroup of MMR-unvaccinated children but not among MMR-vaccinated children. While PFAS exposure may impact immune system functions, this study suggests that MMR vaccination might be a potential effect-modifier. [ABSTRACT FROM AUTHOR]

Asthma is a heterogeneous disease characterized by numerous phenotypes relating to age of onset, triggers, comorbidities, severity (assessed by multiple exacerbations, lung function pattern) and finally the inflammatory cells involved in the pathophysiologic pathway. These phenotypes can vary over time in relation to changes in the principal triggers involved in the aetiology of the disease. Nevertheless, in a patient with multiple allergies and early-onset disease (defined as multiple sensitizations and allergic comorbidities), the prognosis of asthma is poor with a high risk of persistence and severity of the disease during childhood. Future research will focus on classifying phenotypes into groups based on pathophysiologic mechanisms (endotypes) and the biomarkers attached to these endotypes, which could predict prognosis and lead to targeted therapy. Currently, these biomarkers are related to inflammatory cells associated with the asthma endotype, essentially eosinophils and neutrophils (and related cytokines) attached to Th-2 and non Th-1 pathways, respectively. The most severe asthma (refractory asthma) is linked to neutrophil-derived inflammation (frequently associated with female sex, obesity and possibly disorganized airway microbiota) encountered in very young children or teenagers. Severe asthma is also linked to or a marked eosinophil inflammatory process (frequently associated with multiple atopy and, more rarely, with non-atopic hypereosinophilic asthma in children) and frequently encountered in teenagers. Severe phenotypes of asthma could also play a role in the origin of chronic obstructive pulmonary disease in adult life. [ABSTRACT FROM AUTHOR]

Exposure to indoor allergens plays an important role in the etiology of asthma. This study was designed to quantify indoor allergens from homes of families that had at least one case of childhood asthma at home in a southwestern city of Iran. The relationship between the indoor allergen levels and home characteristics was also investigated. Dust samples were collected from the bedrooms and the kitchens of 35 homes where children with persistent asthma were living. The levels of indoor allergens were measured by enzyme linked immunosorbent assay (ELISA). Detectable amounts of mite, mouse and cockroach allergens were found in all evaluated places. None of our patients were exposed to a threshold concentration of indoor allergen for sensitizing at home. Regarding of mite allergens, the levels of Der f1 were significantly higher than Der p1 and a direct correlation was observed between living in an apartment and Der f1 levels. Moreover, Fel d1 (cat) and Bla g1 (cockroach) allergens were found in the children's bedrooms more frequently than those in the kitchens. In this study, direct associations were obtained between Bla g1 allergen and the duration of occupancy and between Fel d1 and average home size. A total of 34.2% of the patients showed positive skin reactions to at least one of the tested allergens as 17.1% of them showed reactivity to D. pteronyssinus. Proper controlling of cockroaches and mice by public health officials would be a practical approach to avoid inducing asthma or worsening the symptoms. [ABSTRACT FROM AUTHOR]

Asthma in the inner city contributes to high morbidity and mortality, and, in school children, reduced school attendance and alteration in academic performance. There is a need to improve asthma care in the inner city by reducing asthma exacerbations. Methods are currently available to predict and prevent seasonal exacerbations of asthma. In addition, new medications are being developed that will be effective in improving pulmonary function and reducing asthma exacerbations. School-centered asthma programs can also be helpful to assist children and clinicians in applying asthma treatment plans and assuring optimal adherence to these plans. [ABSTRACT FROM AUTHOR]

Background: The prevalence of asthma and allergy has recently risen among children. This increase in prevalence might be related to various factors, particularly diet. The aim of this study is to assess the prevalence and association of asthma and allergic sensitization with dietary factors in the French Six Cities Study.Methods: Cross-sectional studies were performed among 7432 schoolchildren aged 9-11 years in Bordeaux, Clermont-Ferrand, Créteil, Marseille, Reims, and Strasbourg. Parental questionnaires, based on the International Study on Asthma and Allergies in Childhood (ISAAC), were used to collect information on allergic diseases and potential exposure factors including a food frequency questionnaire to evaluate dietary habits. Skin prick testing to common allergens for allergic sensitization and bronchial hyper-responsiveness (BHR) testing to exercise were performed. Confounders control was performed with multiple logistic regressions.Results: Asthma symptoms, asthma and allergic sensitization were more prevalent in boys than in girls and were more prevalent in the South than in the North of France. After adjustment for confounders, fruit juice intake was associated with a low prevalence of lifetime asthma (ORa [95 % CI]; 0.73 [0.56-0.97]), butter intake was positively associated with atopic wheeze (1.48 [1.07-2.05]) and having lunch at the canteen 1-2 times/week compared to never or occasionally was associated with a lower prevalence of past year wheeze (0.71 [0.52-0.96]), lifetime asthma (0.76 [0.60-0.96]) and allergic sensitization (0.80 [0.67-0.95]). Meat intake was inversely related to past year wheeze among atopic children (0.68 [0.50-0.98]) while fast food consumption and butter intake were associated with an increase prevalence of asthma (2.39 [1.47-3.93] and 1.51 [1.17-2.00] respectively). Fish intake was associated with a lower prevalence of asthma among non-atopic children (0.61 [0.43-0.87]. None of the dietary factors was associated with BHR.Conclusions: Diet is associated with wheeze, asthma and allergic sensitization but not with BHR in children. These results provide further evidence that adherence to a healthy diet including fruits, meat and fish seems to have a protective effect on asthma and allergy in childhood. However, prospective and experimental studies are needed to provide causal evidence concerning the effect of diet on asthma and atopy. [ABSTRACT FROM AUTHOR]

The article focuses on the management of acute asthma among children in primary care. Topics discussed include an overview of asthma in children, the diagnosis of the disease, its causes and symptoms, the assessment of the affected children, the consideration of its features, and the approaches for its treatment.

Paediatric asthma hospitalisation trends in Finland and Sweden over the past 10 years are unclear. We investigated the incidence of paediatric asthma hospitalisations in both countries from 2005 to 2014, using Finland's National Hospital Discharge Register and Sweden's National Patient Register which cover all hospitalisations in the respective countries. During the study period, the incidence of paediatric asthma hospitalisations decreased by 51% in Finland, but remained stable in Sweden. In both countries, asthma hospitalisations decreased over time among children aged 0-4 years, with unclear trends for older ages. The reasons for these intercountry differences are unclear, thus warranting future research. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to compare the effects of inhaled beclomethasone with oral montelukast in long term management of moderate persistent asthma in children. Design: Quasi experimental study. Period: 6 months, from July 20,2007 to January 20, 2008. Settings: Out patient paediatric department at Fauji Foundation hospital, Rawalpindi. Material and Methods: 80 children between 5-12yrs of age presenting with moderate persistent asthma, divided in two groups of 40 each. Group A treated with beclomethasone inhaler while Group B was started on oral montelukast. Drugs effect was recorded on a 2 wkly proforma for 8 weeks. Results: There were 54(67.5%) male and 26(33%) female. Most common triggering factor seen in 54(67.5%) patients was recent history of respiratory tract infection, exposure to carpet dust in 43(53.75%), cigarette smoke in 42(52.5%),recent psychological stress in 28(35%) , pollen allergy in 26 (32.5%) , pets exposure in 8 (10%) and to mite was noticed in 5(6.25%) children. Marked improvement was observed in day time cough in group A with 10(25%) patients being free of cough with inhaler, while 20(50%) showed mild intermittent symptoms. 1(2.5%) showed mild persistent symptoms. In Group B 3(7.5%) patients were symptom free, 23(57.5%)with mild intermittent and 4(10%) with mild persistant symptoms while 6(15%) continued to have moderate persistent symptoms. P value was 0.01. Regarding day time breathlessness, P value was significant of 0.258. Similarly marked improvement was observed in night symptoms of breathlessness, cough and sleeplessness in both groups. P value was less than 0.05 in majority of the variables showing statistically significant improvement with inhaled beclomethasone than with oral montelukast. Conclusions: Inhaled beclomethasone is superior to oral montelukast in controlling chronic symptoms of childhood asthma. [ABSTRACT FROM AUTHOR]

Dampness and visible mold in homes are associated with asthma development, but causal mechanisms remain unclear. The goal of this research was to explore associations among measured dampness, fungal exposure, and childhood asthma development without the bias of culture-based microbial analysis. In the low-income, Latino CHAMACOS birth cohort, house dust was collected at age 12 months, and asthma status was determined at age 7 years. The current analysis included 13 asthma cases and 28 controls. Next-generation DNA sequencing methods quantified fungal taxa and diversity. Lower fungal diversity (number of fungal operational taxonomic units) was significantly associated with increased risk of asthma development: unadjusted odds ratio ( OR) 4.80 (95% confidence interval ( CI) 1.04-22.1). Control for potential confounders strengthened this relationship. Decreased diversity within the genus Cryptococcus was significantly associated with increased asthma risk ( OR 21.0, 95% CI 2.16-204). No fungal taxon (species, genus, class) was significantly positively associated with asthma development, and one was significantly negatively associated. Elevated moisture was associated with increased fungal diversity, and moisture/mold indicators were associated with four fungal taxa. Next-generation DNA sequencing provided comprehensive estimates of fungal identity and diversity, demonstrating significant associations between low fungal diversity and childhood asthma development in this community. [ABSTRACT FROM AUTHOR]

Abstract: It has been suggested that mitochondrial dysfunction plays a role in the pathogenesis of asthma. To test whether mitochondrial variants influence the risk of asthma, we analyzed 16,158 mtSNPs in a sample of 372 asthmatic children and 395 healthy children using the DNA pooling technique and genome wide association analysis. Stratified analysis by sex was performed to explain the differences observed between sexes in the etiology of asthma. Different variants were detected to be significant in the sample of girls and boys with the smallest adjusted p values being 1.4×10−09 (mt5295) and 3.6×10−12 (mt16158), respectively. Most of the significant locations found in boys are within the CYB gene and the non-coding region. For girls, most of the significant mtSNPs lie within NADH-dehydrogenase-subunits. The variants reported here have not previously been described in connection with asthma. Although further studies in other cohorts are needed to confirm these findings our study highlights the importance of the mitochondria among the factors that contribute to the risk of asthma. [Copyright &y& Elsevier]

: In a systematic review and meta-analysis, Jasper Been and colleagues investigate the association between preterm birth and the development of wheezing disorders in childhood. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Background: Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors. Objective: This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care. Methods: Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care. Results: Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures. Conclusions: Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity. [ABSTRACT FROM AUTHOR]

Background: Asthma-associated morbidity is rising, especially in inner city children. Objective: We evaluated the allergen sensitivities, allergen exposures, and associated morbidity for participants in the Inner City Asthma Study. We also determined geographic variations of indoor allergen levels. Methods: Nine hundred thirty-seven inner city children 5 to 11 years old with moderate to severe asthma underwent allergen skin testing. Bedroom dust samples were evaluated for Der p 1, Der f 1, Bla g 1, Fel d 1, and Can f 1. Results: Skin test sensitivities to cockroach (69%), dust mites (62%), and molds (50%) predominated, with marked study site–specific differences. Cockroach sensitivity was highest in the Bronx, New York, and Dallas (81.2%, 78.7%, and 78.5%, respectively), and dust mite sensitivity was highest in Dallas and Seattle (83.7% and 78.0%, respectively). A majority of homes in Chicago, New York, and the Bronx had cockroach allergen levels greater than 2 U/g, and a majority of those in Dallas and Seattle had dust mite allergen levels greater than 2 μg/g. Levels of both of these allergens were influenced by housing type. Cockroach allergen levels were highest in high-rise apartments, whereas dust mite allergen levels were highest in detached homes. Children who were both sensitive and exposed to cockroach allergen had significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who were not sensitive or exposed. Conclusion: Geographic differences in allergen exposure and sensitivity exist among inner city children. Cockroach exposure and sensitivity predominate in the Northeast, whereas dust mite exposure and sensitivity are highest in the South and Northwest. Cockroach allergen appears to have a greater effect on asthma morbidity than dust mite or pet allergen in these children. [ABSTRACT FROM AUTHOR]

The article presents the key points related to the management of acute asthma among children in primary care. Topics discussed include the number of children under asthma treatment in Great Britain, its features that parents need to consider, and the requirement for asthma patients to have a personalised asthma action plan.

Several charts are presented depicting classification of asthma severity, its initial treatment, a stepwise approach for asthma management, and assessment of asthma control along with adjusting therapy in children.

The author reflects on the study conducted by C. D. Thomson and colleagues regarding asthma in children. The author states that there had been no evidence in the relationship of dietary selenium levels with asthma which was tackled in the study and the effect of nutritional antioxidants to the development of asthma in children. An overview of the occurrence of allergic asthma in children is presented.

Background: The specific cause or causes of asthma development must be identified to prevent this disease. Objective: Our hypothesis was that specific mold exposures are associated with childhood asthma development. Methods: Infants were identified from birth certificates. Dust samples were collected from 289 homes when the infants were 8 months of age. Samples were analyzed for concentrations of 36 molds that comprise the Environmental Relative Moldiness Index (ERMI) and endotoxin, house dust mite, cat, dog, and cockroach allergens. Children were evaluated at age 7 years for asthma based on reported symptoms and objective measures of lung function. Host, environmental exposure, and home characteristics evaluated included a history of parental asthma, race, sex, upper and lower respiratory tract symptoms, season of birth, family income, cigarette smoke exposure, air conditioning, use of a dehumidifier, presence of carpeting, age of home, and visible mold at age 1 year and child''s positive skin prick test response to aeroallergens and molds at age 7 years. Results: Asthma was diagnosed in 24% of the children at age 7 years. A statistically significant increase in asthma risk at age 7 years was associated with high ERMI values in the child''s home in infancy (adjusted relative risk for a 10-unit increase in ERMI value, 1.8; 95% CI, 1.5-2.2). The summation of levels of 3 mold species, Aspergillus ochraceus, Aspergillus unguis, and Penicillium variabile, was significantly associated with asthma (adjusted relative risk, 2.2; 95% CI, 1.8-2.7). Conclusion: In this birth cohort study exposure during infancy to 3 mold species common to water-damaged buildings was associated with childhood asthma at age 7 years. [Copyright &y& Elsevier]