scholarly journals Cockroach exposure and childhood asthma:  Is the effect an artifact of confounding by stress?

2020 ◽  
Author(s):  
Felicia Rabito ◽  
Derek Werthmann ◽  
Hua He ◽  
Aubrey S. Madkour ◽  
Whitney D. Arroyave ◽  
...  
Keyword(s):  
Strong Association ◽  
High Stress ◽  
Asthma Management ◽  
Stress Path ◽  
Mediation Effect ◽  
Asthma Morbidity ◽  
Modifiable Factors ◽  
Children With Asthma ◽  
Ed Visits ◽  
The Impact

Abstract Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.

scholarly journals Cockroach exposure and perceived stress interact to predict clinical outcomes in childhood asthma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Felicia A. Rabito ◽  
Derek Werthmann ◽  
Hua He ◽  
Aubrey S. Madkour ◽  
Whitney D. Arroyave ◽  
...  
Keyword(s):  
Perceived Stress ◽  
Strong Association ◽  
High Stress ◽  
Asthma Management ◽  
Stress Path ◽  
Mediation Effect ◽  
Asthma Morbidity ◽  
Modifiable Factors ◽  
Ed Visits ◽  
The Impact

Abstract Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.

Feasibility study of a communication and education asthma intervention for general practitioners in Australia

2010 ◽  
Vol 16 (1) ◽  
pp. 75 ◽  
Author(s):  
Smita Shah ◽  
Brett G. Toelle ◽  
Susan M. Sawyer ◽  
Jessica K. Roydhouse ◽  
Peter Edwards ◽  
...  
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Communication Strategies ◽  
Asthma Management ◽  
Doctor Patient Communication ◽  
Children With Asthma ◽  
The Usa ◽  
Randomised Controlled ◽  
Communication Behaviours ◽  
The Impact

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.

scholarly journals Caregiver Asthma in Urban Families

2017 ◽  
Vol 34 (2) ◽  
pp. 108-113
Author(s):  
Robin S. Everhart ◽  
Sarah Miller ◽  
Gillian G. Leibach ◽  
Alexandra L. Dahl ◽  
Daphne Koinis-Mitchell
Keyword(s):  
High Frequency ◽  
Urban Families ◽  
School Nurses ◽  
School Absenteeism ◽  
Asthma Morbidity ◽  
Child Asthma ◽  
Asthma Status ◽  
Children With Asthma ◽  
Preliminary Study ◽  
The Impact

Asthma is a significant contributor to missed school days, especially for children living in urban settings. This preliminary study examined the impact of caregiver asthma on school absenteeism in a sample of 102 urban children with asthma from African American, Latino, and non-Latino White backgrounds. Caregivers and children participated in a single research session; 32 caregivers had asthma. Children of caregivers with asthma missed more days of school than children whose caregivers did not have asthma (3.97 vs. 2.43 days, p < .05, Cohen’s d = .40). Other indicators of child asthma morbidity (e.g., hospitalizations) did not differ across caregiver asthma status. Findings highlight that caregiver asthma may be an added risk factor for school absenteeism among children with asthma. For children with a high frequency of asthma-related school absenteeism, school nurses may find it useful to provide educational resources and referrals for caregivers with asthma.

scholarly journals Impact of a Large Fire and Subsequent Pollution Control Failure at a Coke Works on Acute Asthma Exacerbations in Nearby Adult Residents

Toxics ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 147
Author(s):  
Tricia L. Morphew ◽  
Arvind Venkat ◽  
John Graham ◽  
Matthew Mehalik ◽  
Norman Anderson ◽  
...  
Keyword(s):  
Pollution Control ◽  
The United States ◽  
Large Fire ◽  
Asthma Morbidity ◽  
Asthma Exacerbations ◽  
Control Failure ◽  
Ed Visits ◽  
Rate Ratios ◽  
The Impact ◽  
Public Notification

Clairton, Pennsylvania, is home to the largest coke works facility in the United States (US). On 24 December 2018, a large fire occurred at this facility and damaged pollution control equipment. Although repairs were not completed for several months, production continued at pre-fire capacity and daily emissions increased by 24 to 35 times, with multiple exceedances of monitored levels of outdoor air pollution (OAP). The aim of this study was to objectively evaluate the impact of this industrial incident and resultant OAP exceedances on asthma morbidity. We assessed pre-fire and post-fire rate ratios (RR) of outpatient and emergency department (ED) visits for asthma exacerbations among nearby adult residents. Pre-fire versus post-fire RRs increased for both visit types: RR = 1.82 (95% CI: 1.30, 2.53; p < 0.001) and 1.84 (95% CI: 1.05, 3.22; p = 0.032) for outpatient and ED visits, respectively. Additionally, total visit rates increased on days with OAP exceedances: RR = 2.47 (95% CI: 1.52, 4.01; p < 0.0001), 1.58 (95% CI: 1.00, 2.48; p = 0.048) and 1.79 (95% CI: 1.27, 2.54; p = 0.001) for PM2.5, SO2, and H2S exceedance days, respectively. These results show a near doubling of acute visits for asthma exacerbations in nearby adult residents during this industrial incident and underscore the need for prompt remediation and public notification of OAP exceedances to prevent adverse health impacts.

scholarly journals A Single-Institution Experience in the Use of Chest Radiographs for Hospitalized Children Labelled as Asthma Exacerbation

2021 ◽  
Author(s):  
Ela Beyyumi ◽  
Mohamed Tawil ◽  
Huda AlDhanhani ◽  
Sara Jameel ◽  
Manal Mouhssine ◽  
...  
Keyword(s):  
Asthma Exacerbation ◽  
Asthma Management ◽  
Antibiotic Use ◽  
Chest Radiographs ◽  
Eligibility Criteria ◽  
Tertiary Center ◽  
Lower Oxygen ◽  
Children With Asthma ◽  
Model Coefficient ◽  
The Impact

Background: Risks of cancer have become more notable lately, especially for young children with a chronic condition such as atopy. This study reports on cumulative radiation from chest radiographs in children with asthma. Its main aims were to consider our current practice, and suggest minimizing chest radiograph use in this vulnerable people. Methods: The study was retrospective and conducted at tertiary center. Eligibility criteria included children 2-15 y who were admitted between January-2017 and December-2018 for asthma management. Results: Of 643 children who were admitted as ‘asthma exacerbation’, 243 (40% females; age [mean±SD] 5.4±3.3 y) met the study criteria for inclusion. Ninety-two (38%) children had temperature 38.8±0.7oC on the day of admission. Antibiotics were prescribed for 148 (61%) children, mainly for presumed pneumonia. Chest radiographs were requested for 214 (88%) children, mainly on the day of admission. Only 38 (18%) chest radiographs showed focal/multifocal pneumonia justifying antibiotic use. Significant predictors for requesting chest radiographs were antibiotic use for presumed pneumonia, lower oxygen saturation at presentation, and requesting blood culture. Rate of chest radiographs per year was negatively related to child’s age; the younger the child the higher the rate (model coefficient -0.259, P<0.001). For children <5 y, rate of chest radiographs was 1.39±1.21/y and radiation dose 0.028±0.025 mSV/y. The corresponding rates for children ≥5 y were 0.78±0.72/y and 0.008±0.007 mSV/y, respectively (P<0.001). Conclusion: Chest radiographs were commonly requested for children with asthma, especially the young ones. Prospective studies are necessary to measure the impact of this practice on their health.

scholarly journals Impact of a Diagnostic Therapeutic Educational Pathway (DTEP) Self-Management Program for Asthma Management in Preschool Children

2020 ◽  
Author(s):  
Sebastiano Guarnaccia ◽  
Cristina Quecchia ◽  
Andrea Festa ◽  
Michele Magoni ◽  
Giuseppe Zenoni ◽  
...  
Keyword(s):  
Preschool Children ◽  
Asthma Management ◽  
Population Based ◽  
Incidence Rates ◽  
Management Program ◽  
Emergency Department Visits ◽  
Outpatient Services ◽  
Older Children ◽  
Children With Asthma ◽  
The Impact

Abstract BACKGROUND: Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years so far. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center.METHODS: This is a retrospective population-based cohort study performed in children with asthma aged 0-5 years, attending at “Io e l’Asma center”, Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention.RESULTS: A total of 741 patients, aged 0-5 years completed the DTEP, including 391 and 350 children aged 0-2 and 3-5 years, respectively. The percentage of children aged 0-2 and 3-5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5% to 60.9% and from 25.5% to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to -80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage.CONCLUSIONS: The results suggest that, an integrated DTEP program for preschool children not only can provide a real-world assessment for improved wheezing control, but also a measure for reduction of adverse therapeutic related outcomes.

Schools’ Capacity to Help Low-Income, Minority Children to Manage Asthma

2005 ◽  
Vol 21 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Elizabeth W. Anderson ◽  
Melissa Valerio ◽  
Manlan Liu ◽  
Dana Jones Benet ◽  
Christine Joseph ◽  
...  
Keyword(s):  
Low Income ◽  
Asthma Management ◽  
School Personnel ◽  
Asthma Prevalence ◽  
Health Providers ◽  
Minority Children ◽  
Parents And Children ◽  
Nursing Services ◽  
Children With Asthma ◽  
The Impact

This article describes the challenges and strengths of asthma management in 14 low-income, predominantly African American urban elementary schools serving more than 5,000 students. Asthma prevalence was 24.5%. Teachers, school principals, parents, and children described how asthma was managed at school. Data from classmates of students with asthma showed that they had moderate to high levels of information about the disease. Data from teachers indicated the great need for practical instruction on how they might effectively support a child with asthma in the classroom and on the playground. Principals raised concerns about expectations for the functioning of school staff and implementation of school policies especially related to asthma emergencies. Parents reported a range of problems their children face at school. Data from children with asthma showed that 75% believed asthma affected their schoolwork. Findings from this study should be useful to school personnel, health providers, and others who assist children and their families to manage asthma at school. Data suggest that making school nursing services available is warranted, given the impact of asthma on the school community.

scholarly journals Child and caregiver experiences and perceptions of asthma self-management

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Lauren Kelada ◽  
Charlotte J. Molloy ◽  
Peter Hibbert ◽  
Louise K. Wiles ◽  
Claire Gardner ◽  
...  
Keyword(s):  
Focus Groups ◽  
Asthma Management ◽  
Self Management ◽  
Emotional Wellbeing ◽  
Social And Emotional ◽  
Asthma Knowledge ◽  
School Aged Children ◽  
Management Interventions ◽  
Children With Asthma ◽  
The Impact

AbstractAsthma is the most common chronic condition of childhood. Self-management is integral to good asthma control. This qualitative paper explores how children with asthma and their parents perceive asthma, their experience with asthma, and how they manage symptoms, preventions and medications within and outside the home. We undertook 15 focus groups with 41 school-aged (6–11 years) children with asthma and 38 parents. Parents and their children attended the same focus groups. We used thematic analysis to analyse the transcripts. Our findings show the impact asthma can have on children’s social and emotional wellbeing and highlight how reliant school-aged children are on their parents to effectively manage their asthma. Parents reported being unsure when their child’s symptoms warranted visiting their doctor or hospital. Schools were identified as a source of difficulty regarding asthma management; families reported that children may be self-conscious about their asthma and using their inhaler at school. School policies and teachers’ lack of asthma knowledge were reported to exacerbate children’s reluctance to use their inhaler at school. Our results have implications for the design and implementation of children’s self-management interventions for their asthma, particularly when they are at school and away from their parents.

scholarly journals Impact of a diagnostic therapeutic educational pathway program for asthma management in preschool children

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Sebastiano Guarnaccia ◽  
Cristina Quecchia ◽  
Andrea Festa ◽  
Michele Magoni ◽  
Giuseppe Zenoni ◽  
...  
Keyword(s):  
Preschool Children ◽  
Asthma Management ◽  
Population Based ◽  
Incidence Rates ◽  
Emergency Department Visits ◽  
Outpatient Services ◽  
Older Children ◽  
Systemic Corticosteroids ◽  
Children With Asthma ◽  
The Impact

Abstract Background Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center. Methods This is a retrospective population-based cohort study performed in children with asthma aged 0–5 years, attending at “Io e l’Asma center”, Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention. Results A total of 741 patients, aged 0–5 years completed the DTEP, including 391 and 350 children aged 0–2 and 3–5 years, respectively. The percentage of children aged 0–2 and 3–5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to − 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage. Conclusions The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.

scholarly journals Telehome monitoring of symptoms and lung function in children with asthma

2021 ◽  
Author(s):  
Audrey Fossati ◽  
Caroline Challier ◽  
Aman Dalhoumi ◽  
Javier Rose ◽  
François Galodé ◽  
...  
Keyword(s):  
Statistical Tests ◽  
Asthma Management ◽  
Smartphone Application ◽  
Kappa Coefficient ◽  
Management Control ◽  
Control Treatment ◽  
Bronchial Obstruction ◽  
Asthmatic Children ◽  
Children With Asthma ◽  
The Impact

Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of a clinical and spirometric telemonitoring device to characterize symptom perception profile in asthmatic children. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Method: 26 asthmatic children aged 6-18 years equipped with a portable spirometer and a smartphone application were monitored remotely for 3 months. Clinical and spirometric data were automatically transmitted to a secure internet platform. A medical team contacted the patient to optimize management. Three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the 3 observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After further discussion, a consensus was reached and resulted in 97% concordance (kappa coefficient: 0.97, 95%CI [0.91; 1.00]). There was a trend towards improvement in the ACT score, and a significant > 40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusion: Clinical and spirometric telehome monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.

Sign in / Sign up

Export Citation Format

Share Document