RESUMO
We previously reported that asthma prevalence was higher in the United States (US) compared to Mexico (MX) (25.8% vs. 8.4%). This investigation assessed differences in microbial dust composition in relation to demographic and housing characteristics on both sides of the US-MX Border. Forty homes were recruited in the US and MX. Home visits collected floor dust and documented occupants' demographics, asthma prevalence, housing structure, and use characteristics. US households were more likely to have inhabitants who reported asthma when compared with MX households (30% vs. 5%) and had significantly different flooring types. The percentage of households on paved roads, with flushing toilets, with piped water and with air conditioning was higher in the US, while dust load was higher in MX. Significant differences exist between countries in the microbial composition of the floor dust. Dust from Mexican homes was enriched with Alishewanella, Paracoccus, Rheinheimera genera and Intrasporangiaceae family. A predictive metagenomics analysis identified 68 significantly differentially abundant functional pathways between US and MX. This study documented multiple structural, environmental, and demographic differences between homes in the US and MX that may contribute to significantly different microbial composition of dust observed in these two countries.
Assuntos
Poeira , Habitação , Poeira/análise , Arizona , Humanos , México , Asma/epidemiologia , Asma/microbiologia , Bactérias/genética , Bactérias/classificação , Bactérias/isolamento & purificação , Feminino , Características da Família , Masculino , Metagenômica/métodosRESUMO
Asthma is a heterogeneous condition characterized by airway hyperresponsiveness and inflammation that result in variable patterns of reversible airway obstruction with symptoms that vary over time. It occurs in approximately 10% of children. Symptoms typically are intermittent and include wheezing, cough, chest tightness, and dyspnea. In some young children, cough may be the only symptom. Symptoms commonly are caused by infections, exercise, allergens, or irritants. The diagnosis is based on a combination of history and physical examination findings and pulmonary function test results. Young children with symptoms similar to those of asthma with viral infections may or may not develop asthma; various scoring systems can predict the likelihood. For patients with asthma, controller drugs can reduce symptoms and prevent exacerbations. These drugs include inhaled corticosteroids, long-acting beta2-agonists that often are combined with inhaled corticosteroids, long-acting muscarinic antagonists, leukotriene receptor antagonists, and injectable biologics. Drugs are introduced in a stepwise manner, depending on age and severity of symptoms. Acute asthma exacerbations are managed with bronchodilators and oral corticosteroids. Patients with asthma and their families should have an asthma action plan to guide self-management. Physicians should ensure that patients are adhering to drug regimens and using inhalers appropriately. Environmental factors, such as allergens or cigarette smoke, can worsen symptoms and should be addressed.
Assuntos
Antiasmáticos , Asma , Administração por Inalação , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Humanos , Antagonistas Muscarínicos/uso terapêuticoRESUMO
RATIONALE: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric illnesses, specifically depression and anxiety, are more prevalent in patients with asthma and associated with worse asthma control, more emergency department visits, and increased hospitalization rates. OBJECTIVES: We aimed to compare hospital outcomes and charges for children with severe asthma with and without comorbid depression and anxiety, hypothesizing that those with depression and anxiety would have longer hospitalizations and higher charges. METHODS: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's Kids' Inpatient Databases for admissions of patients aged 10-21 years with an ICD-9 code severe asthma (status asthmaticus or any asthma diagnosis with a procedure code for endotracheal intubation). Depression and Anxiety subgroups were created based on ICD-9 codes. Data collected included demographics, hospital outcomes and charges and comparisons made between groups. RESULTS: There were 52,485 admissions for severe asthma: 45,094 (86%) with No Comorbid Psychiatric Illnesses, 1284 (2.4%) with depression, and 1297 (2.5%) with anxiety. Patients with depression or anxiety were older, had longer hospitalizations, and higher hospital charges (p < .001 for all). CONCLUSIONS: Comorbid depression or anxiety is associated with significantly longer hospitalizations and higher charges for children with severe asthma. These findings add to prior reports of worse outcomes for children with asthma and comorbid depression or anxiety and suggest that improved screening for and management of these conditions in children with asthma could improve hospital outcomes and reduce costs.