Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort

ABSTRACTImportanceImportance: The interplay between COVID-19 pandemic and asthma in children is still unclear.ObjectiveWe evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.DesignThe PeARL multinational cohort included children with asthma and non-asthmatic controls recruited during the COVID-19 pandemic and compared current disease activity with data available from the previous year.SettingPediatric outpatient clinics.ParticipantsThe study included 1,054 children with asthma and 505 non-asthmatic controls, aged between 4-18 years, from 25 pediatric departments, from 15 countries globally.ExposuresCOVID-19 pandemic first wave, starting from the date of the first fatality in the respective country.Main outcomes and measuresWe assessed the pandemic’s impact on the frequency of respiratory infections, emergency presentations and hospital admissions in asthmatic versus non-asthmatic participants, controlling for confounding factors including the pandemic’s duration and the frequency of such acute events during 2019. Using paired analyses, we evaluated the impact of the pandemic on the annualized frequency of asthma attacks and the previously mentioned acute events, asthma control, and pulmonary function in children with asthma, compared to their baseline disease activity, during the preceding year.ResultsDuring the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks and hospitalizations due to asthma, in comparison to the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimally clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were also improved during the pandemic.When compared to non-asthmatic controls, children with asthma were not found to be at increased risk of LRTIs, episodes of pyrexia, emergency visits or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.Conclusions and relevanceChildhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.Key PointsQuestionWhat was the impact of COVID-19 pandemic on childhood asthma outcomes?FindingsDuring the first wave of the pandemic, children with asthma have experienced improved outcomes, as evidenced by fewer asthma attachks, hospitalizations, improved scores in validated asthma control measures and improved pulmonary function.MeaningThis is the first study to show a positive impact of COVID-19 pandemic on childhood asthma activity. This is probably the result of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the hypothesis that childhood asthma may be a risk factor for COVID-19.

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Allergic Comorbidity Is a Risk Factor for Not Attending Scheduled Outpatient Visits in Children with Asthma

Children ◽

10.3390/children8121193 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1193

Author(s):

Kalle Garpvall ◽

Marie Hauerslev ◽

Mads Marckmann ◽

Mette N. Hermansen ◽

Kirsten S. Hansen ◽

...

Keyword(s):

Risk Factor ◽

Asthma Control ◽

Treatment Adherence ◽

Allergic Sensitization ◽

Significant Risk ◽

Significant Risk Factor ◽

Asthma Severity ◽

Outpatient Visits ◽

Increased Risk ◽

Children With Asthma

Asthma is one of the most common chronic diseases in children globally. Previous studies have shown that not attending asthma primary care consultations is associated with poorer treatment adherence and increased risk of loss of asthma control on a short-term basis. Here, we investigated long-term patterns and predictors of not attending scheduled asthma outpatient visits during 5-years of follow-up in 146 children with asthma. Of the 146 children, 67 (46%) did not attend at least one scheduled appointment, amounting to a total of 122 (10.8%) missed of 1133 scheduled appointments. In a multivariate analysis adjusting for total scheduled visits in the 5-year period any allergic sensitization was a significant risk factor for not attending ≥1 scheduled appointment (aOR = 6.6 (95% CI, 1.3–39.7), p = 0.03), which was not the case for asthma treatment step or lung function. Furthermore, atopic predisposition decreased the risk of non-attendance (aOR = 0.36 (0.13–0.92), p = 0.04). We found no association between non-attendance, treatment adherence or loss of asthma control. This study highlights that allergic comorbidity, but not degree of asthma severity, identifies a group of children with asthma who are prone to not attend scheduled outpatient appointments.

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Correlations Between Pulmonary Function and Childhood Asthma Control Test Results in 5–11-year-old Children with Asthma

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2013.10.003 ◽

2014 ◽

Vol 55 (3) ◽

pp. 218-224 ◽

Cited By ~ 6

Author(s):

Ming-Sheng Lee ◽

Jun-Kai Kao ◽

Cheng-Han Lee ◽

Lon-Yen Tsao ◽

Han-Yao Chiu ◽

...

Keyword(s):

Pulmonary Function ◽

Asthma Control ◽

Childhood Asthma ◽

Test Results ◽

Control Test ◽

Asthma Control Test ◽

Children With Asthma

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Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽

10.1161/str.45.suppl_1.tp136 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

David C Goff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Multivariable Analysis ◽

The Elderly ◽

Stroke Risk Factors ◽

Age Related ◽

Increased Risk ◽

The Impact ◽

Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

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Impact of cancer on the risk of unplanned 30-day readmissions.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6581 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6581-6581

Author(s):

Alexander Qian ◽

Edmund Qiao ◽

Vinit Nalawade ◽

Nikhil V. Kotha ◽

Rohith S. Voora ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Hospital Admissions ◽

Reference Group ◽

Cancer Site ◽

Cancer Type ◽

Logistic Regression Models ◽

Increased Risk ◽

Initial Hospitalization ◽

The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

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COPD, Depression and COVID-19 Pandemic: A Harrowing, Demoralizing and Deleterious Triad

Clinical Medical Reviews and Reports ◽

10.31579/2690-8794/095 ◽

2021 ◽

Vol 3 (8) ◽

pp. 01-06

Author(s):

Iqbal Akhtar Khan ◽

Hamza Iltaf Malik

Keyword(s):

Hospital Admissions ◽

Hospital Readmissions ◽

Public Health Problem ◽

Well Being ◽

Care Utilization ◽

Global Public Health ◽

Increased Risk ◽

Co Morbidity ◽

Pulmonary Manifestations ◽

The Impact

COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

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Obstructive Sleep Apnoea and Type 2 Diabetes

US Endocrinology ◽

10.17925/use.2014.10.01.35 ◽

2014 ◽

Vol 10 (01) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Abd A Tahrani ◽

Asad Ali ◽

◽

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Medical Condition ◽

Diabetes Type 2 ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

Osa Treatment ◽

The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnea (OSA) is a very common medical condition that is associated with increased risk for cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

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Secondhand smoke exposure and asthma outcomes among African-American and Latino children with asthma

Thorax ◽

10.1136/thoraxjnl-2017-211383 ◽

2018 ◽

Vol 73 (11) ◽

pp. 1041-1048 ◽

Cited By ~ 10

Author(s):

Andreas M Neophytou ◽

Sam S Oh ◽

Marquitta J White ◽

Angel C Y Mak ◽

Donglei Hu ◽

...

Keyword(s):

African American ◽

Asthma Control ◽

Dose Response ◽

Secondhand Smoke ◽

Oral Steroid ◽

Continuous Exposure ◽

Asthma Exacerbations ◽

Children With Asthma ◽

Asthma Outcomes ◽

American Children

BackgroundSecondhand smoke (SHS) exposures have been linked to asthma-related outcomes but quantitative dose–responses using biomarkers of exposure have not been widely reported.ObjectivesAssess dose–response relationships between plasma cotinine-determined SHS exposure and asthma outcomes in minority children, a vulnerable population exposed to higher levels of SHS and under-represented in the literature.MethodsWe performed analyses in 1172 Latino and African-American children with asthma from the mainland USA and Puerto Rico. We used logistic regression to assess relationships of cotinine levels ≥0.05 ng/mL with asthma exacerbations (defined as asthma-related hospitalisations, emergency room visits or oral steroid prescription) in the previous year and asthma control. The shape of dose–response relationships was assessed using a continuous exposure variable in generalised additive logistic models with penalised splines.ResultsThe OR for experiencing asthma exacerbations in the previous year for cotinine levels ≥0.05 ng/mL, compared with <0.05 ng/mL, was 1.40 (95% CI 1.03 to 1.89), while the OR for poor asthma control was 1.53 (95% CI 1.12 to 2.13). Analyses for dose–response relationships indicated increasing odds of asthma outcomes related with increasing exposure, even at cotinine levels associated with light SHS exposures.ConclusionsExposure to SHS was associated with higher odds of asthma exacerbations and having poorly controlled asthma with an increasing dose–response even at low levels of exposure. Our results support the conclusion that there are no safe levels of SHS exposures.

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The Influence of Preoperative Hematocrit Levels on Early Outcomes in Patients undergoing Cardiac Surgery

10.53350/pjmhs2115102817 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2817-2819

Author(s):

Ajwad Farogh ◽

Asma Hassan ◽

Saira Gull ◽

Muhammad Irfan Khan ◽

Gohar Bashir ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Hospital Stay ◽

Heart Surgery ◽

Common Risk Factor ◽

Duration Of Hospital Stay ◽

Increased Risk ◽

The Impact ◽

Written Informed Consent ◽

Preoperative Anaemia

Background: Anemia is a common risk factor for cardiovascular disease. The impact of preoperative anaemia is unclear in cardiac surgery. Preoperative anaemia affects early findings in patients undergoing cardiac surgery. Aim and Objective: The main objective of current research was to investigate the impact of preoperative anaemia on early outcomes in heart surgery patients. Material and Methods: A prospective randomized clinical research was undertaken after obtaining written informed consent from patients for cardiac surgery at the PIC, Lahore between Apr 2020 and Feb 2021. A total of 120 individuals between the ages of 20 and 60 were chosen for the research. Preoperative anaemia was described as Hb levels of <13 g/dl for males and <12 g/dl in female patients undergoing cardiac surgery. Results: Total 120 patients were enrolled and stratified into two groups (60 patients each) with average age 5 ± 5.75 years. Early outcomes after surgery such as postoperative stroke (6.67 % versus 1.6 %), AF (37 % versus32 %), and duration of hospital stay > 7 days (50 % vs 41.67 %) were found to be different between anaemic and normal Hb groups. Conclusion: Preoperative anaemia can be increased risk of morbidity and mortality in patients after surgery. Low preoperative Hb found as advanced risk factor for death, renal impairment, stroke, AF and long hospital stay in our research. Keywords: Anemia, CABG, AF, MI, IABP, CPB

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Impact of COVID-19 on the Hong Kong Youth Quitline Service and Quitting Behaviors of Its Users

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228397 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8397

Author(s):

Laurie Long Kwan Ho ◽

William Ho Cheung Li ◽

Ankie Tan Cheung ◽

Wei Xia ◽

Man Ping Wang ◽

...

Keyword(s):

Smoking Cessation ◽

Risk Factor ◽

Hong Kong ◽

Tobacco Use ◽

Telephone Survey ◽

Quit Smoking ◽

Quit Rate ◽

Increased Risk ◽

Young Smokers ◽

The Impact

Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants′ quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.

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