Multiarray screening identifies plasma proteins associated with Th17 cell differentiation and viral defense in coincident asthma and obesity.

BACKGROUND: The immunological mechanisms behind the clinical association between asthma and obesity in adolescence are not fully understood. This study aimed to find new plasma protein biomarkers associated specifically with coincident asthma and obesity in adolescents. METHODS: This was a cross-sectional study in children and adolescents 10-19 years old (N = 390). Relative plasma concentrations of 113 protein biomarkers related to inflammation and immune response were determined by proximity extension assay (Target 96; Olink, Uppsala, Sweden). Differences in protein concentrations between healthy controls (n = 84), subjects with asthma (n = 138), subjects with obesity (n = 107), and subjects with both asthma and obesity (AO; n = 58) were analyzed by ANCOVA, adjusting for age and sex, and in a separate model adjusting also for the sum of specific IgE antibody concentrations to a mix of food allergens (fx5) and aeroallergens (Phadiatop). Proteins elevated in the AO group but not in the obesity or asthma groups were considered specifically elevated in asthma and obesity. RESULTS: Five proteins were elevated specifically in the AO group compared to controls (here sorted from largest to smallest effect of asthma and obesity combined): CCL8, IL-33, IL-17C, FGF-23, and CLEC7A. The effects of adjusting also for specific IgE were small but IL-33, IL-17C, and FGF-23 were no longer statistically significant. CONCLUSION: We identified several new potential plasma biomarkers specifically elevated in coincident asthma and obesity in adolescents. Four of the proteins, CCL8, IL-33, IL-17C, and CLEC7A, have previously been associated with viral mucosal host defense and Th17 cell differentiation.

The implication of infection with respiratory syncytial virus in pediatric recurrent wheezing and asthma: knowledge expanded post-COVID-19 era.

BACKGROUND: Respiratory syncytial virus (RSV) infection has been identified to serve as the primary cause of acute lower respiratory infectious diseases in children under the age of one and a significant risk factor for the emergence and development of pediatric recurrent wheezing and asthma, though the exact mechanism is still unknown. METHODS AND RESULTS: In this study, we discuss the key routes that lead to recurrent wheezing and bronchial asthma following RSV infection. It is interesting to note that following the coronavirus disease 2019 (COVID-19) epidemic, the prevalence of RSV changes significantly. This presents us with a rare opportunity to better understand the associated mechanism for RSV infection, its effects on the respiratory system, and the immunological response to RSV following the COVID-19 epidemic. To better understand the associated mechanisms in the occurrence and progression of pediatric asthma, we thoroughly described how the RSV infection directly destroys the physical barrier of airway epithelial tissue, promotes inflammatory responses, enhances airway hyper-responsiveness, and ultimately causes the airway remodeling. More critically, extensive discussion was also conducted regarding the potential impact of RSV infection on host pulmonary immune response. CONCLUSION: In conclusion, this study offers a comprehensive perspective to better understand how the RSV infection interacts in the control of the host's pulmonary immune system, causing recurrent wheezing and the development of asthma, and it sheds fresh light on potential avenues for pharmaceutical therapy in the future.

A new Cd(II) Complex: Fluorescence Performances, Loading with Budesonide-hydrogels on Pediatric Asthma and Molecular Docking.

By applying the phosphonic acid ligand to the solvothermal reaction of nitrobenzylphosphonic acid (H2L) with Cd(NO3)2·4H2O in a mixed solvent of water and DMF, a novel Cd(II)-based coordination polymer, {[Cd(L)(H2O)2](H2O)}n (1), was successfully synthesized in this study. The excellent fluorescence performance of complex 1 was confirmed through fluorescence spectroscopy testing, and the obtained CIE standard coordinates (0.1599, 0.0786) positioned it in the blue fluorescence region. Transparent hyaluronic acid/carboxymethyl chitosan hydrogels were prepared using chemical synthesis, and their internal microstructure was observed. Using budesonide as a drug model, a new budesonide metal gel was prepared, and its therapeutic efficacy in treating pediatric asthma was evaluated. Molecular docking simulations indicated that the Cd complex formed three hydrogen bonding interactions with the target protein through its nitro group, revealing the potential origin of its biological activity.

Feasibility of text message follow-up for pediatric asthma care after an emergency department visit.

Background: Many children seen in the Emergency Department (ED) for asthma do not follow-up with their primary care provider. Text messaging via short message service (SMS) is a ubiquitous, but untested means of providing post-ED asthma follow-up care.Objective: To evaluate responses to an asthma assessment survey via SMS following an ED visit and estimate the likelihood of response by sociodemographic and clinical characteristics. Methods: We recruited 173 parents of children 2-17 years-old presenting for ED asthma care to receive a follow-up text (participation rate: 85%). One month later, parents received via SMS a 22-item survey that assessed asthma morbidity. We assessed response rates overall and by various sociodemographic and clinical characteristics, including age, parental education, and indicators of asthma severity.Results: Overall, 55% of parents (n = 95) responded to the SMS survey. In multivariable logistic regression (MLR), parents who graduated high school had a four-fold higher response rate compared to parents with less than a high school degree (OR: 4.05 (1.62, 10.13)). More parents of children with oral steroid use in the prior 12 months responded to survey items (OR: 2.53 (1.2, 5.31)). Reported asthma characteristics included: 48% uncontrolled, 22% unimproved/worse, 21% with sleep disruption, and 10% who were hospitalized for asthma.Conclusions: Text messaging may be a viable strategy to improve post-ED asthma assessment and to identify children with persistent symptoms in need of enhanced care or modification of care plans.

Detailed characterization and impact of small airway dysfunction in school-age asthma.

BACKGROUND: Small airway dysfunction (SAD) is increasingly recognized as an important feature of pediatric asthma yet typically relies on spirometry-derived FEF25-75 to detect its presence. Multiple breath washout (MBW) and oscillometry potentially offer improved sensitivity for SAD detection, but their utility in comparison to FEF25-75, and correlations with clinical outcomes remains unclear for school-age asthma. We investigated SAD occurrence using these techniques, between-test correlation and links to clinical outcomes in 57 asthmatic children aged 8-18 years. METHODS: MBW and spirometry abnormality were defined as z-scores above/below ± 1.96, generating MBW reference equations from contemporaneous controls (n = 69). Abnormal oscillometry was defined as > 97.5th percentile, also from contemporaneous controls (n = 146). Individuals with abnormal FEF25-75, MBW, or oscillometry were considered to have SAD. RESULTS: Using these limits of normal, SAD was present on oscillometry in 63% (resistance at 5-20 Hz; R5-R20; >97.5th percentile), on MBW in 54% (Scond; z-scores> +1.96) and in spirometry FEF25-75 in 44% of participants (z-scores< -1.96). SAD, defined by oscillometry and/or MBW abnormality, occurred in 77%. Among those with abnormal R5-R20, Scond was abnormal in 71%. Correlations indicated both R5-R20 and Scond were linked to asthma medication burden, baseline FEV1 and reversibility. Additionally, Scond correlated with FENO and magnitude of bronchial hyper-responsiveness. SAD, detected by oscillometry and/or MBW, occurred in almost 80% of school-aged asthmatic children, surpassing FEF25-75 detection rates. CONCLUSIONS: Discordant oscillometry and MBW abnormality suggests they reflect different aspects of SAD, serving as complementary tools. Key asthma clinical features, like reversibility, had stronger correlation with MBW-derived Scond than oscillometry-derived R5-R20.

Online-merge-offline (OMO)-based music therapy for asthmatic children during the COVID-19 pandemic in China.

The purpose of this study is to evaluate online-merge-offline (OMO)-based music therapy (MT) as a complementary option for asthma management in pediatric patients. A total of 86 children diagnosed with mild asthma were enrolled and treated with the same drug therapy. They were assigned into three groups: Music I group (standard medical care plus a single individualized MT session along with singing training and breathing exercise), Music II group (similar as Music I as well as further wind instrument playing), and Control group (standard medical care). Primary endpoints included pulmonary function tests FEV1, FVC, FEV1/FVC, MMEF 75/25, and PEF, c-ACT, PAQLQ, and PACQLQ. After 6 months of continuous intervention of MT, significant differences in FEV1, FVC, MMEF75/25, PEF, c-ACT score, PAQLQ, PACQLQ (p < 0.001), and FEV1/FVC (p < 0.05) were observed among Music I, Music II, and Control groups. Besides, FEV1, FVC, FEV1/FVC, MMEF75/25, and PEF showed positive trends in Music I and Music II groups compared to those in Control group (p < 0.05). The c-ACT score of children was significantly increased in Music I (p < 0.001) and II (p < 0.001) groups in contrast with Control group. Children in Music I and II groups had better quality of life than those in Control group (PAQLQ, p < 0.001), and the parents in Music I and II groups also showed better quality of life than those in Control group (PACQLQ, p < 0.001).     Conclusion: As a child-friendly, low-risk, and convenient intervention, the OMO-based MT has a positive impact on pediatric asthma management during the COVID-19 pandemic. What is Known: • A few findings proved the positive effect of MT on pediatric asthma. What is New: • Our study further proving the validation and effectiveness of MT with OMO-based model on pediatric asthma, wind instrument playing has a greater impact on pediatric asthma control via small airways and might be recommended to mix to singing and breathing to improve effectiveness of MT for asthmatic children.

Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation.

To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2-18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.

Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas.

BACKGROUND: Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE: We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS: We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS: Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION: Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.

Validation of the Asthma Severity Scoring System (ASSESS) in the ALLIANCE Cohort.

BACKGROUND: The Asthma Severity Scoring System (ASSESS) quantifies asthma severity in adolescents and adults. Scale performance in children younger than 12 years is unknown. OBJECTIVE: To validate the ASSESS score in the All Age Asthma Cohort and explore its use in children younger than 12 years. METHODS: Scale properties, responsiveness, and known-group validity were assessed in 247 children (median age, 11 years; interquartile range, 8-13 years) and 206 adults (median age, 52 years; interquartile range, 43-63 years). RESULTS: Overall, measures of internal test consistency and test-retest reliability were similar to the original data of the Severe Asthma Research Program. Cronbach α was 0.59 in children aged 12 to 18 years and 0.73 in adults, reflecting the inclusion of multiple and not-always congruent dimensions to the ASSESS score, especially in children. Analysis of known-group validity confirmed the discriminatory power, because the ASSESS score was significantly worse in patients with poor asthma control, exacerbations, and increased salbutamol use. In children aged 6 to 11 years, test-retest reliability was inferior compared with that in adults and adolescents (Cronbach α, 0.27) mostly because of a less lung function impairment in children with asthma of this age group. Known-group validity, however, confirmed good discriminative power regarding severity-associated variables similar to adolescents and adults. CONCLUSIONS: Test-retest reliability and validity of the ASSESS score was confirmed in the All Age Asthma Cohort. In children aged 6 to 11 years, internal consistency was inferior compared with that in older patients with asthma; however, test validity was good and thus encourages age-spanning usage of the ASSESS score in all patients 6 years or older.

Indoor environmental exposures and obstructive lung disease phenotypes among children with asthma living in poor urban neighborhoods.

BACKGROUND: Air trapping is an obstructive phenotype that has been associated with more severe and unstable asthma in children. Air trapping has been defined using pre- and postbronchodilator spirometry. The causes of air trapping are not completely understood. It is possible that environmental exposures could be implicated in air trapping in children with asthma. OBJECTIVE: We investigated the association between indoor exposures and air trapping in urban children with asthma. METHODS: Children with asthma aged 5 to 17 years living in Baltimore and enrolled onto the Environmental Control as Add-on Therapy for Childhood Asthma study were evaluated for air trapping using spirometry. Aeroallergen sensitization was assessed at baseline, and spirometry was performed at 0, 3, and 6 months. Air trapping was defined as an FVC z score of less than -1.64 or a change in FVC with bronchodilation of ≥10% predicted. Logistic normal random effects models were used to evaluate associations of air trapping and indoor exposures. RESULTS: Airborne and bedroom floor mouse allergen concentrations were associated with air trapping but not airflow limitation (odds ratio 1.19, 95% confidence interval 1.02-1.37, P = .02 per 2-fold increase in airborne mouse allergen; odds ratio 1.23, 95% confidence interval 1.07-1.41, P = .003 per 2-fold increase in bedroom floor mouse allergen). Other indoor exposures (cockroach, cat, dog, dust mite, particulate matter, and nicotine) were not associated with air trapping or airflow limitation. CONCLUSION: Mouse allergen exposure, but not other indoor exposure, was associated with air trapping in urban children with asthma.

The Management of Pediatric Asthma Using Telehealth: An Integrative Review.

Introduction: Asthma is one of the most chronic noncommunicable diseases of childhood, affecting 1 in 12 children in the United States. The use of telemedicine for the management of pediatric asthma has shown improved health outcomes; however, it is important to understand what can impact its acceptance. The purpose of this review was to identify the facilitators and barriers to pediatric asthma management, as viewed by stakeholders. Methods: An electronic literature search was performed using PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete. Articles included in the review contained perceptions of the use of telemedicine for the management of pediatric asthma, as viewed by stakeholders. The socioecological model was used as the theoretical framework to extract data based on its five levels. Results: After reviewing full texts of 143 articles, 118 were excluded, leaving 25 articles included in this review. A majority of included articles focused on mobile health (m-Health) studies for the management of pediatric asthma, with the remaining articles studying synchronous telemedicine or a combination of modalities. Common themes were identified; however, most were focused on the use of m-Health and few studies contained the viewpoints of the caregiver, children, or providers regarding synchronous telemedicine. Discussion: This integrative review identified a number of facilitators and barriers for the management of asthma using telemedicine. However, more qualitative studies are needed to evaluate the perceptions of caregivers, patients, and primary providers regarding synchronous telehealth. It was also recognized that telemedicine may increase instead of reduce health care disparities.

Impact of family socioeconomic position on childhood asthma outcomes, severity, and specialist referral - a Danish nationwide study.

BACKGROUND: Asthma is the most common chronic illness in children, carrying a major burden. Socioeconomic position (SEP) affects adult asthma outcomes, but its impact on childhood asthma, particularly in primary versus specialist care, has not been studied thoroughly. METHODS: In a Danish cohort consisting of all children aged 2-17 years redeeming inhaled corticosteroids in 2015, parental SEP impact on asthma outcomes was investigated. Workforce attachment, income, education, and metropolitan residence were chosen as covariates in logistic regression. Outcomes were uncontrolled (excessive use of short-acting beta2-agonists), exacerbating (oral corticosteroid use or hospitalization), and severe asthma (according to GINA 2020). RESULTS: The cohort comprised 29,851 children (median age 8.0, 59% boys). 16% had uncontrolled asthma, 8% had ≥1 exacerbation. Lower income and metropolitan residence correlated with higher odds of poor control, exacerbations, and severe asthma. Lower education correlated with worse asthma outcomes. Education and income were protective factors in primary care, but not in specialist care. Metropolitan residence was the sole factor linked to specialist care referral for severe asthma. CONCLUSION: Low parental SEP and metropolitan residence associated with poor asthma outcomes. However, specialist care often mitigated these effects, though such care was less likely for at-risk children in non-metropolitan areas.

Effects of Allergen Exposure and Environmental Risk Factors in Schools on Childhood Asthma.

PURPOSE OF REVIEW: This review aims to assess the prevalence of common allergen exposures and environmental risk factors for asthma in schools, examine the underlying mechanisms of these environmental risk factors, and explore possible prevention strategies. RECENT FINDINGS: Cockroach, mouse, dust mites, fungi, viral infections, ozone pollution, and cleaning products are common allergen exposures and environmental risk factors in schools which may affect asthma morbidity. Novel modifiable environmental risk factors in schools are also being investigated to identify potential associations with increased asthma morbidity. While several studies have investigated the benefit of environmental remediation strategies in schools and their impact on asthma morbidity, future studies are warranted to further define the effects of modifiable risk factors in schools and determine whether school mitigation strategies may help improve asthma symptoms in students with asthma.

Psychometric properties and predictive validity of the PP-ACT.

OBJECTIVE: The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT. METHODS: We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes. RESULTS: We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1-4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers' global subjective assessment of their child's asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not. CONCLUSION: Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2022.2036755 .

Comprehensive home environmental intervention did not reduce allergen concentrations or controller medication requirements among children in Baltimore.

OBJECTIVE: To determine if the addition of home environmental control strategies (ECSs) to controller medication titration reduces asthma controller medication requirements and in-home allergen concentrations among children with persistent asthma in Baltimore City. METHODS: 155 children ages 5-17 with allergen-sensitized asthma were enrolled in a 6-month randomized clinical trial of multifaceted, individually-tailored ECS plus asthma controller medication titration compared to controller medication titration alone. Participants had to meet criteria for persistent asthma and have had an exacerbation in the previous 18 months. Allergen sensitization (mouse, cockroach, cat, dog, dust mite) was assessed at baseline and home dust allergen concentrations were measured at baseline, 3 and 6 months. ECS was delivered 3-4 times over the trial. Asthma controller medication was titrated using a guidelines-based algorithm at baseline, 2, 4, and 6 months. The primary outcome was controller medication treatment step at 6 months (0-6, as-needed albuterol to high-dose ICS + LABA). RESULTS: The population was predominately Black (90%), on public insurance (93%), and male (61%). The mean age was 10.1 years (SD 3.3). More than 70% were sensitized to a rodent, >50% to cockroach, and 70% were polysensitized. At 6 months, there were no differences in either treatment step (3.8 [SD 1.4] vs. 3.7 [SD 1.5]) or allergen concentrations between groups. CONCLUSION: Among this predominantly low-income, Black pediatric asthma population, the addition of ECS to controller medication titration reduced neither indoor allergen concentrations nor controller medication requirements compared to controller medication titration alone.

Evaluation of the effect of an education program using cartoons and comics on disease management in children with asthma: a randomized controlled study.

OBJECTIVE: The aim of this study was to determine the effect of an education program, the Health Promotion Program for Children with Asthma (HPPCA), on disease control and quality of life in children aged between 7 and 11 and diagnosed with asthma. The program was developed using cartoons and color-in materials and was based on the health promotion model developed by Nola J. Pender and brain-based learning theories. MATERIALS AND METHODS: The sample of the study consisted of 74 children between the ages of 7 and 11 who presented to the respiratory diseases' unit of a university hospital in Istanbul. All participants were given basic asthma education by their physicians, and were then randomly assigned to a group that received the HPPCA program or a control group that received no further education. After the HPPCA education was applied to the experimental group alone, both groups were administered two post-tests as a follow-up and retest at the end of the first and fourth month after the intervention. The standardized Sociodemographic Question Form, the Childhood Asthma Control Test (C-ACT) and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used for the follow-up. RESULTS: The asthma control and quality of life scores of the children included in the experimental group were found to be significantly higher compared to the control group at the first- and fourth-month follow-ups (p<.001). The rate of school absenteeism decreased significantly in children who received HPPCA education at the first follow-up compared to the children who did not receive the education (p<.05). PRACTICE IMPLICATIONS: The present study found that the HPPCA education, whose design was based on the health promotion model, and which was supported by cartoons in order to attract the attention of the children, was effective. The HPPCA was proven to create a sense of control over asthma and to improve the quality of life in the children. It is recommended that there be an asthma nurse in pediatric allergy and immunology outpatient clinics who can specifically provide an HPPCA. Further studies should be conducted to demonstrate the effectiveness of this program, which was examined in the present study for the first time with a randomized controlled method.HighlightsAsthma control is extremely important for the quality of life in children with asthma.Asthma education provided to school-age children yields the best results when new teaching techniques and multimedia content are used.Asthma education for children must be based on a good theoretical methodology.Children can best manage asthma when they learn about it directly.Asthma education conducted according to the guidelines is of great importance during the COVID-19 pandemic.

Associations between pediatric asthma and age at menarche: evidence from the Indonesian Family Life Survey.

OBJECTIVE: To examine the association between pediatric asthma and age at menarche, and to assess whether early life factors modify the association. METHODS: This is a retrospective cross-sectional study using the Indonesian Family Life Survey Fifth Wave which had a total of 11 822 females aged 15-57 years to evaluate whether those with pediatric asthma were associated with earlier menarche, compared to females without asthma. We performed a weighted linear regression model adjusting for age, urbanicity, parental smoking, infectious disease history during childhood, childhood socioeconomic status, and health status during childhood. We also performed analyses by age at asthma diagnosis, interval length between asthma diagnosis and menarche, urbanicity, parental smoking, and infectious disease history during childhood. RESULTS: In the adjusted model, females with pediatric asthma had an earlier average age at menarche by 5.2 months and those diagnosed with asthma at 5-8 years of age had the fastest acceleration by 14.9 months. The significant association persisted among those with 0-5 years interval between asthma diagnosis and menarche, who resided in urban areas, and those without infectious disease history during childhood. CONCLUSIONS: Our findings showed that females with pediatric asthma were associated with an earlier age at menarche, and some early life factors modified the association. Better asthma management with more targeted strategies at those at risk of earlier menarche may improve the reproductive and future health of children with asthma. Future studies to elucidate the mechanisms between pediatric asthma and age at menarche are warranted.

Changes in caregiver mental health and pediatric asthma control during COVID-19.

OBJECTIVE: This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program. METHODS: The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset. RESULTS: Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms. CONCLUSIONS: Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.

A higher Asthma Medication Ratio (AMR) predicts a decrease in ED visits among African American and Hispanic children.

INTRODUCTION: Higher rates of ED visits and hospitalizations for asthma among African American and Hispanic children may indicate suboptimal management of asthma, leading to a greater financial burden of healthcare. It is not well known if an association of race/ethnicity with controller medication and hospital-based care utilization exists. OBJECTIVE: This study examines whether the Asthma Medication Ratio (AMR) predicts healthcare utilization for asthma by race/ethnicity. METHODS: 4,584 Medi-Cal children (Ages 5-11) with persistent asthma in Los Angeles were identified and their AMRs (2018) were calculated based on the HEDIS criteria. Healthcare utilization data were used, including hospitalizations, ED visits, and pharmacy claims to examine whether a higher AMR predicts decreases in healthcare utilization by race/ethnicity in the subsequent 3,6, and 12 months (2019). RESULTS: The average AMR was lowest among African American children (0.401). In the subsequent 12 months, they were highest in ED visits (0.249) and hospitalizations (0.121), but lowest in outpatient visits (0.793). The results of logistic regression showed that a higher value of AMR (>0.5) contributed to decreases in ED visits in the subsequent 12 months only among African Americans (OR = 0.551, 95% CI 0.364-0.832) and Hispanics (OR = 0.613, 95% CI 0.489-0.770). No association between AMR and hospitalizations was found. CONCLUSIONS: Our findings indicate that increased use of controller medication contributes to a decrease in ED visits among African American and Hispanic children with persistent asthma. Increased use of controller medications and caregiver's efforts for medication adherence may contribute to a reduction in asthma disparities.

Childhood asthma in the Bronx, NY; the impact of pollutants on length of hospital stay.

OBJECTIVE: The length of hospital stay (LOS) is a proxy of asthma exacerbation severity and healthcare cost. The study aims to estimate the effect of ambient air pollution on pediatric asthma LOS in the Bronx, NY. METHODS: A total of 1,920 children admitted to the hospital in Bronx, NY due to asthma during 2017-2019 period were included in the study. Demographic and clinical parameters were obtained from medical records. Daily ozone (O3) and fine particulate matter (PM2.5) measurements were obtained from local air quality networks. Poisson regression adjusting for gender, age, weight status, respiratory infections including influenza, and ambient temperature was applied to determine whether there was an association of air pollution with length of hospital stay. RESULTS: The mean LOS varied by age, sex, weight status, influenza vaccination status, respiratory viral panel (RVP) results, asthma controller use, and asthma classification. After controlling for these factors in Poisson regression, the mean LOS increased up to 10.62% (95%CI: 0.78-21.41; p = 0.03) for an increase of 10 µg/m3 of PM2.5 exposure on admission day, and 3.90% (95%CI = 0.06-7.88; p = 0.05) for an increase of 10 ppbv of O3 concentration during the previous day. CONCLUSION: Ambient particulate and ozone pollution is associated with lengthier hospital stays for pediatric asthma, potentially indicating more severe asthma exacerbations.