Integration of Genomic Risk Scores to Improve the Prediction of Childhood Asthma Diagnosis

Genome-wide and epigenome-wide association studies have identified genetic variants and differentially methylated nucleotides associated with childhood asthma. Incorporation of such genomic data may improve performance of childhood asthma prediction models which use phenotypic and environmental data. Using genome-wide genotype and methylation data at birth from the Isle of Wight Birth Cohort (n = 1456), a polygenic risk score (PRS), and newborn (nMRS) and childhood (cMRS) methylation risk scores, were developed to predict childhood asthma diagnosis. Each risk score was integrated with two previously published childhood asthma prediction models (CAPE and CAPP) and were validated in the Manchester Asthma and Allergy Study. Individually, the genomic risk scores demonstrated modest-to-moderate discriminative performance (area under the receiver operating characteristic curve, AUC: PRS = 0.64, nMRS = 0.55, cMRS = 0.54), and their integration only marginally improved the performance of the CAPE (AUC: 0.75 vs. 0.71) and CAPP models (AUC: 0.84 vs. 0.82). The limited predictive performance of each genomic risk score individually and their inability to substantially improve upon the performance of the CAPE and CAPP models suggests that genetic and epigenetic predictors of the broad phenotype of asthma are unlikely to have clinical utility. Hence, further studies predicting specific asthma endotypes are warranted.

Prenatal and postnatal exposure to ambient air pollution and asthma in neonatal jaundice infants

Background: Both air pollutants and neonatal jaundice (NJ) have known effects on childhood asthma, but higher total serum bilirubin (TSB) level was associated with lung protection. This study aimed to assess whether prenatal/postnatal exposure to air ambient pollutants is related to the inception of asthma in NJ infants. Material and methods: A nested case-control retrospective study of NJ infants was performed on the Kaohsiung Medical University Hospital Research Database between 2009 and 2019. The average concentration of particulate matter (PM2.5), sulfur dioxide (SO2), nitric dioxide (NO2) for six months, first and second years after the birth, and first, second and third trimesters prenatally were analyzed. The mild and significant NJ infants were categorized as TSB level < and ≧12 mg/dl, respectively. Asthma was defined as a diagnosis with medication. The adjusted odds ratio (aOR) and 95% confidence interval (CI) present the relationship between study periods and childhood asthma. Results: SO2 and NO2 exposure during prenatal periods were significantly associated with increased risk of childhood asthma in mild NJ infants (aOR (95% CI)), SO2: 1.20-1.34 (1.05-1.56); NO2: 1.06-1.07 (1.01-1.13)). Effects were more pronounced in postnatal exposure to three ambient air pollutants in mild jaundice infants. (aOR (95% CI), SO2: 1.33-1.41 (1.14-1.69); NO2: 1.07-1.31 (1.01-1.49; PM2.5:1.05 (1.00-1.10) Conclusion: Both SO2 and NO2 during prenatal and postnatal exposure in mild NJ infants were associated with childhood asthma. Whether taken phototherapy or not, significant NJ infants were spared by three ambient air pollutants.

Perceptions Towards Childhood Asthma and Barriers To Its Management Among Patients, Caregivers and Healthcare Providers: A Qualitative Study From Ethiopia

Background The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia. Methods A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach. Results The study findings revealed that the children and their caregivers were facing physical, emotional and social burdens related with asthma and reported low adherence to their recommended treatment regimens. Factors affecting childhood asthma management were found to be limited awareness about asthma and its management and inadequate education received from healthcare professionals. Non-adherence to especially inhaled corticosteroids appears to be influenced by necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general bad attitude towards it, in addition to their low availability and affordability. Conclusions Varied perceptions about asthma and its management were reported by children with asthma and their caregivers compared to the biomedical recommendation that were related to different factors. This in turn may contribute to the low adherence of the children to their recommended regimens and suboptimal health outcomes. The findings support the need for strong asthma care and education programs that are sensitive to local and individual patients’ and family perceptions and experiences including emotional distress and of the need to institute chronic care approach.