Parents underestimate fatigue in younger children aged 5-7 years with asthma but not in older children.

AIM: To assess fatigue in children aged 2-17 years with asthma from both child and parent perspectives and describe associated factors. METHODS: Fatigue scores were self-reported by children aged 5-17 years old and proxy-reported by parents or carers for all children. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale was used. Fatigue scores ranged from 0 to 100, higher scores meant less fatigue. RESULTS: There were 527 children and parents enrolled. The mean overall fatigue score by self-report was 72.7 ± 15.8 and by proxy report was 75.8 ± 16.3. Self-reported fatigue score was lower in children aged 5-7 years (71.5 ± 15.9) compared to proxy-reported score (76.3 ± 15.5). Proxy and self-reported fatigue scores were similar between parents and older children. Fatigue scores were lower in association with poor asthma control and receipt of social support. Lower self-reported, but not proxy-reported, fatigue score was related to asthma severity. Lower proxy-reported, but not self-reported, fatigue score was related to the child being older and having shortness of breath. CONCLUSION: Parents underestimated the fatigue of younger children aged 5-7 years, but fatigue scores were similar between parents and older children. Both clinical and social factors are associated with fatigue in children with asthma.

Indoor air pollution effects on pediatric asthma are submicron aerosol particle-dependent.

The school environment is crucial for the child's health and well-being. On the other hand, the data about the role of school's aerosol pollution on the etiology of chronic non-communicable diseases remain scarce. This study aims to evaluate the level of indoor aerosol pollution in primary schools and its relation to the incidence of doctor's diagnosed asthma among younger school-age children. The cross-sectional study was carried out in 11 primary schools of Vilnius during 1 year of education from autumn 2017 to spring 2018. Particle number (PNC) and mass (PMC) concentrations in the size range of 0.3-10 µm were measured using an Optical Particle Sizer (OPS, TSI model 3330). The annual incidence of doctor's diagnosed asthma in each school was calculated retrospectively from the data of medical records. The total number of 6-11 years old children who participated in the study was 3638. The incidence of asthma per school ranged from 1.8 to 6.0%. Mean indoor air pollution based on measurements in classrooms during the lessons was calculated for each school. Levels of PNC and PMC in schools ranged between 33.0 and 168.0 particles/cm3 and 1.7-6.8 µg/m3, respectively. There was a statistically significant correlation between the incidence of asthma and PNC as well as asthma and PMC in the particle size range of 0.3-1 µm (r = 0.66, p = 0.028) and (r = 0.71, p = 0.017) respectively. No significant correlation was found between asthma incidence and indoor air pollution in the particle size range of 0.3-2.5 and 0.3-10 µm.   Conclusion: We concluded that the number and mass concentrations of indoor air aerosol pollution in primary schools in the particle size range of 0.3-1 µm are primarily associated with the incidence of doctor's diagnosed asthma among younger school-age children. What is Known: • Both indoor and outdoor aerosol pollution is associated with bronchial asthma in children. What is New: • The incidence of bronchial asthma among younger school age children is related to indoor air quality in primary schools. • Aerosol pollutants in the size range of 0.3-1 µm in contrast to larger size range particles can play major role in the etiology of bronchial asthma in children.

Quality of life of the family of children with asthma is not related to asthma severity.

The quality of life for the family is an important outcome of childhood asthma. The aim of the study was to describe the quality of life in families who have a child with asthma. The Pediatric Quality of Life Inventory Family Impact Module was completed by the parents of 527 children with asthma. The median overall score was 75.0 (interquartile range 63.9, 87.5). The following factors were independently associated with lower quality of life: additional difficulties such as anxiety and financial hardship (3.81 [2.45, 5.93]), waking with asthma symptoms one or more nights a week (odds ratio 2.53 [1.34, 4.75]), regular use of symptoms reliever medication (2.47 [1.57, 3.87]), and female gender (1.97 [1.27, 3.05]). Lower socioeconomic status of the family and exposure to molds at home doubled the odds for lower quality of life. Physician's diagnosed asthma severity and control were associated with quality of life in univariate, but not multivariate analysis.Conclusion: Multiple factors, several of which are not related to asthma, contribute to the family burden of having a child with asthma. Clinicians should be mindful of the impact of asthma on the child and the family, and consider exploring factors not directly related to childhood asthma. What is Known: • Childhood asthma as a chronic disease impacts the quality of life of the patient, but there is also an impact on the immediate family. • There are relatively few studies exploring the quality of life of parents of a child with asthma; the results are heterogeneous and none has been carried out in an Eastern European country. What is New: • This is the first study to describe caregiver's quality of life in an Eastern European population in the context of childhood asthma. • The quality of life of the family of asthmatic child depends not only on factors related to asthma, but also non-asthma related factors such as poverty which play even more important role.

The self-reported quality of life of Lithuanian children with asthma was comparable to Western populations.

AIM: Quality of life (QoL) has been widely researched among children with asthma in Western countries, but there is a lack of data from eastern Europe, where the prevalence is relatively low, but hospital admission rates are higher. We evaluated the overall level and major determinants of QoL in Lithuanian children aged 5-11 years with asthma. METHODS: This study was carried out in six asthma outpatient clinics in the two largest cities of Lithuania from January 2015 to July 2016. The children's QoL was measured using the Pediatric Quality of Life Inventory (PedsQL) asthma module, which was completed by the child and one parent. RESULTS: We collected questionnaires from 226 children (68% boys) with a mean age of eight (±2) years: 65% had mild asthma, 31% had moderate asthma and 4% had severe asthma. One in 10 had been hospitalised in the preceding 6 months. The mean self-reported QoL score was 74 and the parent-reported QoL score was 73. QoL was associated with asthma severity and control, shortness of breath and the child's general health, but not socioeconomic factors. CONCLUSION: The overall level and major determinants of QoL in children with asthma in Lithuania were comparable with Western populations.

The incidence of upper respiratory infections in children is related to the concentration of vanadium in indoor dust aggregates.

Background: It has been reported that the disease-initiated and disease-mediated effects of aerosol pollutants can be related to concentration, site of deposition, duration of exposure, as well as the specific chemical composition of pollutants. Objectives: To investigate the microelemental composition of dust aggregates in primary schools of Vilnius and determine trace elements related to acute upper respiratory infections among 6-to 11-year-old children. Methods: Microelemental analysis of aerosol pollution was performed using dust samples collected in the classrooms of 11 primary schools in Vilnius from 2016 to 2020. Sites included areas of its natural accumulation behind the radiator heaters and from the surface of high cupboards. The concentrations of heavy metals (Pb, W, Sb, Sn, Zr, Zn, Cu, Ni, Mn, Cr, V, and As) in dust samples were analyzed using a SPECTRO XEPOS spectrometer. The annual incidence rates of respiratory diseases in children of each school were calculated based on data from medical records. Results: The mean annual incidence of physician-diagnosed acute upper respiratory infections (J00-J06 according to ICD-10A) among younger school-age children was between 25.1 and 71.3% per school. A significant correlation was found between vanadium concentration and the number of episodes of acute upper respiratory infections during each study year from 2016 to 2020. The lowest was r = 0.67 (p = 0.024), and the highest was r = 0.82 (p = 0.002). The concentration of vanadium in the samples of dust aggregates varied from 12.7 to 52.1 parts per million (ppm). No significant correlations between the other trace elements and the incidence of upper respiratory infections were found, which could be caused by a small number of study schools and relatively low concentrations of other heavy metals found in the samples of indoor dust aggregates. Conclusion: A significant and replicable correlation was found between the concentration of vanadium in the samples of natural dust aggregates collected in primary schools and the incidence of acute upper respiratory infections in children. Monitoring the concentration of heavy metals in the indoor environment can be an important instrument for the prevention and control of respiratory morbidity in children.

On the additional risk for human health in the use of sandblasting of building walls.

In 2021, concentrations of heavy metals (Ba, Cr, Fe, Mn, Pb, Ru, Sr, Zn, Zr) and radiocesium (137Cs) were measured in 13 locations in Vilnius in surface samples of walls and facades of buildings built of yellow bricks in order to evaluate possible aerosol air pollution due to sandblasting. The activity concentrations of 137Cs appeared there as a result of global fallout and precipitation of the products of the accident at the Chernobyl Nuclear Power Plant, and the concentration of Pb, as a component of road transport emissions. Other trace elements turned out to be impurities in the material of yellow bricks. In spring 2018, sandblasting of the walls of the building adjacent to the school led to the long-term significant aerosol contamination of school premises (up to 660 µg/m3). Due to sandblasting, the surface of the school sport yard was covered with a thin layer of scraped particles, which were transported by gusts of wind into the school premises. Sandblasting of walls and facades can also be a source of aerosols with 137Cs activity concentrations reaching ~ 40 Bq/kg and Pb - up to 98 ppm. Estimates show that along with 137Cs, the formation of aerosols with activity concentrations of 239, 240Pu reaching 1.6 Bq/kg is possible. Isotopes of 239, 240Pu are analogues of calcium and, when ingested, are deposited in the bones. The ingress of radioactive aerosols into the respiratory tract, especially of children of primary school age, creates additional risks of malignant diseases.

Unfriendly Fire: How the Tobacco Industry is Destroying the Future of Our Children.

Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned by European Union legislation. Accelerating numbers of young people are vaping, and this does not reflect an exchange of vapes for cigarettes. The acute toxicity of e-cigarettes is greater than that of tobacco, and includes acute lung injury, pulmonary haemorrhage and eosinophilic and lipoid pneumonia. Given the worse acute toxicity, it should be impossible to be complacent about medium and long term effects of vaping. Laboratory studies have demonstrated changes in lung proteomics and the innate immune system with vaping, some but not all of which overlap with tobacco. It would be wrong to consider vapes as a weaker form of tobacco, they have their own toxicity. Children and young people are being targeted by the vaping industry (which is largely the same as the tobacco industry), including on-line, and unless an efficient legislative program is put in place, a whole new generation of nicotine addicts will result.

Global Alliance against Chronic Respiratory Diseases demonstration project: aerosol pollution and its seasonal peculiarities in primary schools of Vilnius.

BACKGROUND: The growing public health concern caused by non-communicable diseases in urban surroundings cannot be solved by health care alone; therefore a multidisciplinary approach is mandatory. This study aimed to evaluate the airborne aerosol pollution level in primary schools as possible factor influencing origin and course of the diseases in children. METHODS: Seasonal aerosol particle number concentration (PNC) and mass concentration (PMC) were studied in the randomly selected eleven primary schools in the Lithuanian capital, Vilnius, as model of a middle-size Eastern European city. Total PNC in the size range from 0.01 to >1.0 µm in diameter was measured using a condensation particle counter. Using an optical particle sizer, PNC was measured and PMC estimated for particles from 0.3 to 10.0 µm. A descriptive statistics was used to estimate the aerosol pollution levels. RESULTS: During all seasons, local cafeterias in the absence of ventilation were the main sources of the elevated levels of indoor PMC and PNC (up to 97,500 particles/cm). The other sources of airborne particulates were the children's activity during the lesson breaks with PMC up to 586 µg/m. Soft furniture, carpets in the classrooms and corridors were responsible for PMC up to 200 µg/m. Outdoor aerosol pollution (up to 18,170 particles/cm) was higher for schools in city center. Elevated air pollution in classrooms also resulted from intermittent sources, such as construction work during classes (200-1000 µg/m) and petrol-powered lawn trimmers (up to 66,400 particles/cm). CONCLUSION: The results of our survey show that even in a relatively low polluted region of Eastern Europe there are big differences in aerosol pollution within middle-sized city. Additional efforts are needed to improve air quality in schools: more frequent wet cleaning, monitoring the operation of ventilation systems, a ban on construction works during school year, on a use of sandblasting mechanisms in the neighborhood of schools.

Correction to: Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases.

An amendment to this paper has been published and can be accessed via the original article.

SERPINA1 gene polymorphisms in a population-based ALSPAC cohort.

BACKGROUND: There is an association between persistent preschool wheezing phenotypes and school-age asthma. These wheezing/asthma phenotypes likely represent clinical entities having specific genetic risk factors. The SERPINA1 gene encodes α 1 -antitrypsin (AAT), and mutations in the gene are important in the pathophysiology of pulmonary diseases. We hypothesized that there might be an association between SERPINA1 gene polymorphisms and the risk of developing wheezing/school age asthma. OBJECTIVE: To examine 10 single nucleotide polymorphisms (SNPs) of SERPINA1 (rs6647, rs11832, rs17580, rs709932, rs1243160, rs2854254, rs8004738, rs17751769, rs28929470, and rs28929474) and relate them to childhood wheezing phenotypes and doctor-diagnosed asthma in the population-based Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. METHODS: Wheeze data, reports of physician-diagnosed asthma and data on the SERPINA1 gene SNPs, were available for 7964 children. Binary logistic regression was used to assess the associations between allele prevalence and wheezing and asthma phenotypes. P values were adjusted to account for multiple hypotheses using the Benjamini-Hochberg false discovery rate. RESULTS: Only within a subgroup of children with asthma who had no prior diagnosis of preschool wheeze was there a trend for association between rs28929474 (Glu342Lys, Pi*Z causing AAT deficiency; P = .0058, adjusted P = .058). No SNP was associated with wheezing and asthma in those with preschool wheeze. CONCLUSION: Analyzed SNPs in SERPINA1 are not associated with wheezing/asthma phenotypes. Only rs28929474, the most common pathologic SNP (Pi*Z) in the SERPINA1 gene, might be associated with a risk of developing school-age asthma without exhibiting preschool wheeze.

Introducing standards of the best medical practice for patients with inherited alpha-1-antitrypsin deficiency in Central Eastern Europe.

The Leonardo da Vinci project "Introducing standards of the best medical practice for patients with inherited alpha-1-antitrypsin Deficiency in Central Eastern Europe" belongs to a sub-programme of the European Commission's Lifelong Learning Programme. It started in November 2011 and is conducted in cooperation with eight European partners. The project's main goal is to support development of a Central-Eastern European Network (CEE) for alpha-1-antitrypsin Deficiency (AATD) early diagnostics and treatment. Alpha-1-antitrypsin (AAT) is one of the major serine protease inhibitors in the human circulation, and is an acute phase protein produced predominantly by hepatocytes. Severe inherited AATD deficiency occurs in about 1 in 2.500 individuals; most commonly in those of European ancestry. AATD considerably increases the risk of liver disorder in infants, children and adults, while respiratory complications are observed mainly in adults. The average concentration of AAT in plasma in healthy individuals is 1.3 mg/ml. The concentration of AAT during acute phase processes rises 3- to 4-fold above normal. Alpha1-Antitrypsin deficiency (AATD) is a disorder inherited in an autosomal co-dominant fashion. The mutant Z AAT protein differs from the normal M variant by a single amino acid substitution (Glu 342 Lys). Severe ZZ AAT deficiency was first recognized as a hereditary condition predisposing to disease on the basis of 90% lower plasma levels of the protein arising not from the lack of AAT synthesis, but from a defect in its secretion. Most Caucasians of North European descent are homozygous for the normal M variant of AAT, but some carry the Z allele, which is associated with an increased risk of early-onset emphysema and liver disease. The great advantage and main focus of the project is to create a long-lasting European network of cooperation between medical institutions involved in AATD medical care. The network is a response to the needs of CEE countries and at the same time it will help them to participate in the broader frame of the European network of medical centres specializing in AATD.